My medical skills add experience

Chapter 251 You Can Be Shot Even While Lying Down, The Benefits of Internal and External Practice
After checking the patients in these beds, Zhou Can went to the ward where the 71-bed patients were located.The anastomotic opening from the esophagus to the jejunum and the repair of the fistula have been performed on the patient yesterday.

The effect of the operation is not yet visible. It takes about five to nine days until the patient's surgical site is basically healed before trying liquid food.

Such as millet porridge, milk and so on.

"Well, there is no abnormal reaction after the operation, right?"

Zhou Can asked the family members.

"Thanks to the hospital for unblocking and fistula repair for my dad. Everything is going well. We are very much looking forward to the eating test in a week."

The attitude of the family members towards Zhou Can is very friendly.

Tuya Hospital performed this operation for the patients, and they were very satisfied.

But this is only temporary.

Family members will be really satisfied only when the patient can really drink water and eat.

If the patient's problem is still not resolved, it's just another pain.

After checking 71 beds, Zhou Can still has three new patients who need to be managed.

There were seven patients in total, and it took him more than half an hour just to do the ward rounds.

According to the patient's condition, changes in signs, and new symptoms, he also needs to adjust the doctor's order in time.Then it is to write the medical record and the course of the disease.Patients who have not been managed yet are discharged from the hospital.

Otherwise, he would have one more thing to do, which was to discharge the patient.

Fortunately, none of the seven patients in his hands were critically ill.

Around [-]:[-], Director Shang came to work.

Normally, Director Shang would not come so early.

Today, I arrived at the hospital nearly 10 minutes early. There was only one thing, and that was ward rounds.

According to the requirements of the hospital, the chief physician makes rounds at least once a week.

In the matter of ward rounds, the chief physicians are surprisingly consistent, and they should be as lazy as possible if they can.Many powerful chief physicians lead a medical team by themselves and manage many inpatients.

A ward round takes at least one hour.

Don't encounter difficult cases and critical cases, otherwise it will take longer.

Therefore, the most common practice of chief physicians is to give full play to the role of the three-level ward round system.Let the interns and trainees in the group carefully manage the patients first, and report anything to the resident physician in charge of the bed.

Sometimes, there are not enough residents in the group, and fellows will be used instead.

Many trainees are official doctors in county and city hospitals, not only have certificates, but also belong to the excellent doctors of the original unit.It's perfectly fine to use them as a resident.

If you encounter a problem that the resident doctor can't solve, report it to the attending doctor.

Generally, they can be mixed up to the attending level, and their level and experience are not bad, enough to be able to stand up to half of the chief physicians.

The attending physicians can basically solve problems large and small.

If you really can't solve it, report it to the chief physician for handling.

Only with this arrangement can the chief physicians be busy.

Director Shang is the number one bully in the Department of Gastroenterology, and he has a lot of patients to manage.

"Get ready, the directors will check the room immediately."

Huang Xinggui notified the doctors in the group.

The doctor in charge of the bed needs to prepare the patient's examination data, sign records, medical records and other materials, and put them on the bedside of the hospital bed, so that the chief physician can read them during ward rounds.

In addition, the bed doctor must know the patients he manages well. When the chief physician finds out the bed, the bed doctor needs to quickly introduce the basic situation of the patient in concise language.

If you have any problems that you can't solve, you can also take this opportunity to ask the chief physician.

Zhou Can quickly sorted out all the materials of the patients in the seven beds under his care, and put them on the bedside of the hospital bed.I quickly reviewed the conditions of several patients in my heart.

Just getting ready here, Director Shang, several chief physicians of the department, as well as nearly 20 head nurses, deputy chief physicians, and attending physicians, formed an extremely large ward round team and entered the ward.

The director's rounds are generally called big rounds.

The specifications and numbers of doctors and nurses dispatched are often the largest.

The specific day of ward rounds is not fixed, it depends on the arrangements of the chief physicians themselves.

In the first ward, Zhou Can was already waiting beside the third bed.

The patient in bed 3 is a patient with enteritis, who was assigned to a new patient managed by Zhou Can just yesterday.

When Director Shang led people to make rounds to bed 3, he unhurriedly introduced the patient's condition and the examinations done in the hospital.

Patients in internal medicine usually do more biochemical tests.

Enteritis is mostly acute enteritis, if it is chronic, unless the condition is particularly serious, few patients are willing to go to the hospital for treatment.

The patient's enteritis was not particularly serious, but he ate a roadside stall, and then developed persistent abdominal pain and diarrhea, so he rushed to the hospital for treatment.After analgesia, antidiarrheal, and electrolyte supplementation, it has improved.

To be honest, with Tuya's level, this kind of simple enteritis patients are rarely hospitalized.

The cases treated here are basically challenging cases.

Either the condition is serious or the etiology is complicated.

"Director Shang, this is the doctor's order I gave to the patient in the morning, please help me to see if there is anything missing!"

Zhou Canji made some amendments to the doctor's order according to the patient's condition.

As the patient's condition improves, the doctor generally reduces the dose of the drug.If the patient's condition worsens, it is necessary to increase the dose or even increase other medications.

Patients with high fever may need ice packs to cool down.

"I am very relieved of your doctor's order!"

Director Shang highly affirmed Zhou Can's medical level in front of so many doctors, nurses, family members and patients.This also made Zhou Can instantly become the focus of everyone's attention.

In fact, from the first day Zhou Can entered the Department of Gastroenterology, he has already received the attention of many doctors in the department because he saved a serious medical accident that could have killed him.

"I have read the doctor's instructions, and the compatibility, dosage, and administration method are all very accurate."

After Director Shang praised Zhou Can, he still read the doctor's order carefully.

Then give a high score evaluation.

"Director Shang seems to have a lot of trust in this young Gui Peisheng! The young man looks handsome and energetic." A short and fat male doctor seemed to have something to say.

It sounds like insinuations.

This person is one of the chief physicians of the Department of Gastroenterology, named Zheng Hongtao, and he has a team. It is said that the strength and level are no worse than Director Shang.

The two sides have always competed fiercely.

This time when Zhou Can entered the Department of Gastroenterology, Director Shang asked him to leave, which made Zheng Hongtao quite critical.

Zheng Hongtao was not friendly to Zhou Can under the psychological influence of saying that the grapes were sour if he could not eat grapes.

At least when Zhou Can met Zheng Hongtao in the office or elsewhere in the past two days, the other party was lukewarm and the atmosphere was weird.

"Doctor Zhou is prudent and down-to-earth, and his medical skills are also outstanding, so he is trustworthy. Isn't Dr. Huang Liang under Director Zheng also reassuring? You can find excellent young doctors everywhere."

Director Shang responded with a friendly smile.

As the director of the department, I must try to maintain the unity and harmony in the department.

Zheng Hongtao complained quite a bit about him snatching Zhou Can away, but there was nothing he could do about it.Before Zhou Can entered the Department of Gastroenterology, Vice President Ye hinted that Zhou Can entered the regular training of various departments of the Department of Internal Medicine, and everyone should train him as much as possible and help him.

Being able to let Vice President Ye say hello in person at a doctor's meeting of the Department of Internal Medicine shows that Zhou Can is at least one of the key training targets selected by Tuya Hospital.

Later, Director Tan from the Department of Internal Medicine approached Director Shang privately to mention Zhou Can's matter.

Unlike Vice President Ye's hint, Director Tan said it directly.

After all, we are all 'insiders'.

Director Tan greeted directly, saying that Zhou Can's time of entering the Department of Gastroenterology would be flexible.After Zhou Can entered the Department of Gastroenterology, he hoped that Director Shang would take him in person.

The two leaders greeted each other one after another, can Director Shang not follow suit?
If he gave Zhou Can to Zheng Hongtao, and Director Tan asked him about it, how would he answer?

Don't look at Director Tan's kindness, he never speaks harshly, but he has a very high status in internal medicine.Everyone respects him from the bottom of their hearts.

Director Shang specifically emphasized that there are excellent young doctors everywhere, and he just hoped that Zheng Hongtao would stop worrying about this matter.

Unexpectedly, after hearing this, Zheng Hongtao raised the corners of his mouth.

"Heh, Huang Liang is about to be promoted to attending physician. Director Shang compares Dr. Zhou with Dr. Huang Liang. I think Dr. Zhou Can is really outstanding."

Zheng Hongtao praised Zhou Can, but his heart must be full of disdain.

I'm probably thinking, can a Gui Peisheng compare with my doctor Huang Liang?

"Dr. Zhou is much better than me. He gave clear and clear medical orders for patients with enteritis. When I was a regular trainer, I didn't have the guts of him. Even if it's just the simplest medical order for admission, I still have to think about it for a long time. , and then ask the superior doctor to pass the test before daring to open it."

A 34-year-old young man with a flat cut was standing behind Director Zheng Hongtao and took over the conversation.

He kept a high degree of consistency with Zheng Hongtao's tone, boasting on the surface, but secretly mocking Zhou Can's recklessness.

Gui Peisheng's doctor's order was actually carried out without going through the checks of the superior doctor.

Zhou Can can naturally hear the yin and yang of these two people.

He really died unjustly, and he could be shot twice while lying down.

Did not provoke these two people.

It can only be said that the grievances and resentments of adults often come from interest disputes and have nothing to do with other things.

As long as you touch the interests of others, even if you don't provoke anyone, you can still provoke a meal.Even the release of all kinds of cynicism and hostility.

Zhou Can didn't say anything, just doing his own thing well.

I believe that these two people can only silently accept his excellence and rise in a short time.

The rounds continued.

It is also a coincidence.

In the second ward, there were three patients in Huang Liang's charge. 6-bed and 8-bed patients, one for intestinal polypectomy, one for duodenal ulcer.The situation is serious.

The patient in the seventh bed was diagnosed with intestinal infection because of abdominal pain.

After being admitted to the hospital, Dr. Huang Liang prescribed anti-infection drugs to the patient, as well as fasting and fluid rehydration therapy and stayed in the hospital for observation.

The three patients of Huang Liangguan were all intestinal diseases.

Explain that his special field is the gut.

"After my preliminary observation and diagnosis, the patient in bed 7 should have acute gastroenteritis and stress hyperglycemia. This is the patient's examination report, abdominal ultrasound and upright abdominal plain film, biochemical tests and various auxiliary All tests can show that the patient is suffering from acute gastroenteritis."

Dr. Huang Liang is very capable in his work, and like Zhou Can, he has already prepared all the information of the patient.

Zheng Hongtao took the patient's examination materials and flipped through them casually.

"What is the treatment plan Dr. Huang is currently prescribing for the patient?"

"The patient had abdominal pain when he was admitted to the hospital. After the initial treatment, the abdominal pain was still frequent and severe last night. At about [-] o'clock this morning, the patient vomited due to the aggravated abdominal pain. The current treatment for the patient is volume expansion and rehydration. In addition, the patient started to have a fever in the morning , I prescribed oral antipyretics for him during the rounds in the morning, plus ice packs to physically cool him down."

Huang Liang stated some treatment measures implemented for patients.

Generally speaking, these treatment measures are quite satisfactory, and there are no major problems.

But in Zhou Can's view, he is a bit conservative.

Moreover, seeing the patient's face twisted due to the pain, and his body bowed into a shrimp shape, it shows that the treatment measures taken by Dr. Huang Liang did not have much effect.

Although abdominal pain is not as dangerous as chest pain, patients with frequent and severe abdominal pain are very prone to accidents if treatment is delayed.

Zhou Can studied with Director Jia for three months in the regular training of digestive surgery, and he is especially clear about some dangerous symptoms of digestive tract diseases.

The patient's condition now appears to be very dangerous.

However, with so many chief physicians leading the rounds, it was naturally not his turn to express his opinion.

What's more, Dr. Zheng Hongtao and Dr. Huang Liang already had prejudices against Zhou Can. If he dared to say that there was something wrong with Huang Liang's treatment in front of so many people.He would definitely offend Huang Liang to death.

In Zheng Hongtao's view, it would be a show of showing off.

Zhou Can decided to listen to what the chief physicians had to say first.

"I think the measures Dr. Huang has taken are quite safe. Director Shang, what do you think?"

There are several chief physicians in Gastroenterology.

Zheng Hongtao thought that the only person who could rival him was Director Shang.

He didn't ask other directors for their opinions, but only wanted to hear Director Shang's thoughts.

"In terms of treatment, symptomatic treatment has been achieved. However, I see that the patient's pain is so severe, and it's just a matter of rehydration and volume expansion. Is it too conservative?" Director Shang reminded tactfully.

This patient's disease is more inclined to surgery, and these chief physicians in the internal medicine department seem to have not realized the danger at all.

Zhou Can watched anxiously for a while.

"Abdominal ultrasound and abdominal plain film both suggest that the patient's condition is quite optimistic. Which treatment measures should be added in Director Shang's opinion?"

Zheng Hongtao really asked for advice with an open mind this time.

Because according to his cognition, doing these treatments should be enough.As for the follow-up treatment, we can only take one step at a time and decide according to the changes of the condition.

This is also the most common treatment step in internal medicine.

After the patient is admitted, he will be given symptomatic treatment first, given a certain amount of life support, and then make constant adjustments by observing the effect of treatment and changes in the condition.

From this point of view, internal medicine has great similarities with ancient Chinese medicine treatment.

"It's hard to say what additional treatment measures will be added. Just because he is in such pain, we must pay attention to it. Show me the examination data and medical records."

Director Shang didn't dare to jump to conclusions.

Decided to take a closer look at the patient's situation first.

The director's ward rounds are originally to check for various possible safety hazards, or omissions and mistakes in diagnosis and treatment.

"Doctor Zhou is also helping the staff!"

Director Shang waved to Zhou Can who was standing near the door.

There is no way, Zhou Can is just a trainee, and there are so many directors, deputy chief physicians, and attending physicians on site, it is good that he was not pushed out of the door.

"Don't ask the deputy chief physician and chief physician staff under him, but give priority to Dr. Zhou, the regular trainee, for help. It seems that Dr. Zhou's status in Director Shang's mind is even higher than I imagined!"

Zheng Hongtao said with emotion.

Director Shang's deputy director Shi, attending physician Huang Xinggui and the others had a rather ugly expression upon hearing this.

They are very optimistic about Zhou Can's ability, but they just want to say that Zhou Can's ability is superior to theirs, and they will not admit it even if they are killed.

Zhou Can walked up to Director Shang honestly, and at the same time said to Zheng Hongtao, "Director Zheng misunderstood, not because of my high status, but because Director Shang supported me, a novice doctor, and wanted to take this opportunity to increase my knowledge. Usually in the group, Deputy Director Shi, Dr. Huang and others also take good care of me, and I am extremely lucky to have met so many enthusiastic senior doctors."

In a word, Zheng Hongtao's provocation was perfectly resolved.

When Huang Xinggui, Deputy Director Shi and others looked at Zhou Can, they already had smiles on their faces.

Senior doctors like this kind of humble young doctor.

Zhou Can's way of speaking and doing things is very comfortable.

Taking some inspection materials from Director Shang, Zhou Can began to examine them carefully.Especially some of the key inspection data.

For this kind of acute gastroenteritis, the blood picture is a very important reference data.

After reading the patient's blood test report, Zhou Can's face changed drastically.

Director Shang noticed the change in his expression.

"Zhou Can, what's the matter? Is there any major problem with the patient's examination?" Director Shang has seen Zhou Can's abilities in all aspects, and has never seen Zhou Can's expression so serious and dignified.

In charge of Ruo's department, what he worries most is that patients have accidents in the hospital.

So when he saw Zhou Can's expression, his nerves tensed immediately.

"The situation is very bad, I will look at the urine test report again!"

Zhou Can quickly dug out the urine test sheet, and after reading it, his brows were as solemn as a mountain.It seems that the army has already approached the city, and the city will be broken soon.

"Doctor Xiao Zhou, can you stop being so exaggerated? You will cause high tension among family members and patients."

Huang Liang said to Zhou Can with some dissatisfaction.

Not calling him Dr. Zhou, nor Zhou Can, but calling him Little Zhou in front of everyone is a kind of contempt and insult in itself.

Zhou Can didn't pay attention to this person.

Instead, he stared at the parameters in the urine test report.

"Director Shang, this patient's condition is extremely dangerous. I suggest immediately asking a doctor from the general surgery department to participate in the consultation. If it is delayed, the consequences may be very, very serious."

Zhou Can has always been very measured in his words and actions, and he used two extremes in a row, which is enough to see how dangerous the patient's situation is.

(End of this chapter)