My medical skills add experience

Chapter 255 Blood pressure drop caused by profuse sweating, Dr. Huang Liang's surrender

At this time, Zhou Can had already helped Yu Xin see the patients in bed 65, and he walked straight out of the ward.

For the patients in Director Zheng's group, he wouldn't worry about it!

Sometimes people are overly enthusiastic, and people may not appreciate it, and they will think that he is showing off his skills.

"Doctor Yu, I'm going back to the office to write the medical records and course of the disease. If you need anything, you can come to me at any time. After nine o'clock, you have to wait until I have the operation before I can help you."

Zhou Can said to her.

"okay, thank you!"

Yu Xin was very envious of Zhou Can's special treatment in the Department of Gastroenterology.He can follow Director Shang or Deputy Director Shi to perform operations every day, and Director Shang must call Zhou Can to accompany him whenever he goes to the outpatient clinic.

Not to mention Gui Peisheng, even resident doctors are envious of these treatments.

Take Dr. Huang Liang as an example, he is already considered a leader among residents, but he still only has one day a week for outpatient training.No one took it yet, so I went to the outpatient clinic by myself.

Regardless of the huge outpatient volume of the Gastroenterology Department of Tuya Hospital, but these resident physicians sit in outpatient clinics, and without exception, there are very few people.

Even if the registration fee is only 8 yuan, very few patients register with these residents.

Occasionally, the appointment of the expert, deputy director, and attending account has been completed, and a resident doctor's consultation number is registered in desperation, and the patient and family members even look disgusted.

They would rather scramble for the director number of tens of dollars than the cheapest resident doctor number.

No one patronizes, which means that there are not many opportunities to exercise.

The harvest of sitting in a clinic for a day may not be as good as Zhou Can's diagnosis of a patient with Director Shang.

Because the patients with special needs expert account are basically with complex or serious conditions.Only by treating such patients can we learn the real thing.

Zhou Can returned to the office and took the time to write the medical records and course records.

It is easy to write for one or two patients, but for as many as eleven patients, the workload is too great.There are many things to worry about.

The doctor's order of each bed patient must be verified repeatedly, and the room needs to be checked at least twice a day.

Zhou Can has to worry about all the patients' discharge, surgery, etiological examination, and medication.

If he only took care of these eleven patients, he would be able to bear it.

The key point is that he still has to spare half a day for surgery or to accompany Director Shang to the clinic.There are only 24 hours in a day, and the working time is eight hours.

In fact, he works more than ten hours a day.

Sometimes when encountering complicated endoscopic surgery, or the patient in charge of him has a condition, the off-duty time will be later.

For example, there was a patient who vomited blood the day before yesterday, and he was about to leave work when he was admitted to the hospital.

At that time, the patient vomited two mouthfuls of blood from time to time, and the situation looked really scary.

In this case, Zhou Can, as a bed doctor, really couldn't leave.

If the cause of the patient's illness is not found out, and the patient's condition is not under control, he will be handed over to the doctor on duty.

Out of the doctor's sense of responsibility, when encountering such a patient, he will leave work without handling it well, and he will not feel at ease!
What if the patient dies at night?
While the course record was being written here, Duan Zifu ran over panting.

"Doctor Zhou, Doctor Zhou, please help Yu Xin quickly! The blood pressure of the aunt in bed 65 suddenly started to drop for some reason."

Seeing Duan Zifu's anxious expression, Zhou Can couldn't help but think of the five words 'goddess' licking dog'.

Duan Zifu seems to be interested in Yu Xin, and has been pursuing her.

But she has always maintained aloofness towards Duan Zifu, and has never smiled at Duan Zifu.Her conversation with Duan Zifu also cherishes words like gold.But Duan Zifu didn't care, and kept showing her all kinds of hospitality.

When we meet, you are guaranteed to be the first to greet her with a smile on your face.

Many times, the two work in different wards, and Duan Zifu would take the initiative to run over to find her.

"Sudden drop in blood pressure? What is aunt doing?"

When Zhou Can heard that the patient's blood pressure dropped, his nerves tensed up immediately.

The aunt herself has just been transferred from the intensive care medicine department, and her condition has deteriorated. If she is not handled properly, the patient will die if she says so.

Often a drop in blood pressure is a sign of a sharp deterioration and aggravation of the condition.

Zhou Can ran to the ward, and Yu Xin was nervously measuring the aunt's blood pressure.

"Doctor Zhou, the patient's blood pressure has dropped suddenly, and it has been dropping all the time. Please help me!"

Yu Xin was so anxious that a thin layer of sweat broke out on her forehead.

"The doctor's order for medication hasn't changed, has it?"

The first thing Zhou Can suspected was the problem of medication.

This is also the most likely cause of the patient's blood pressure drop.

"No, there is absolutely no change. I am a patient who has just been transferred from the intensive care unit, how dare I change the doctor's order!" Yu Xin bit her red lip and shook her head in denial.

Zhou Can carefully checked the infusion bottle, on which the name of the drug was written with a black marker, and it was indeed correct.

The possibility of taking the wrong drug or overdosing was ruled out.

He looked at the patient, his forehead was wet with sweat.

Slightly lifted the quilt and saw that the patient was covered with a thick coat.Covered with a hospital quilt.

Is this sweating?

"When was the coat put on?"

Zhou Can asked.

"An hour ago! What's wrong? Is my mother's sudden drop in blood pressure related to Gai's clothes?"

The family members asked puzzledly.

"When I left, I remembered that the patient hadn't sweated at that time. After walking for less than four or ten minutes, the patient was already sweating profusely, indicating that her blood pressure dropped just now, probably because of excessive water loss in a short period of time. Caused."

After careful observation, Zhou Can made a preliminary conclusion.

Patients suffering from myocardial infarction, or hypothyroidism, adrenal insufficiency and other reasons can basically be initially ruled out.

This made Zhou Can even more convinced that it was caused by the patient covering his sweat.

"Oh, I really made a mistake just now, why didn't I think of this aspect?"

After hearing Zhou Can's explanation of the cause of the disease, Yu Xin suddenly realized.

After hydrating the patient, remove the covering clothing to avoid continuing to sweat profusely.

It didn't take long for the aunt's blood pressure to rise back.

Yu Xin let out a long breath of relief.

The sudden situation just now really scared her a lot.

"Okay, it's all just a false alarm."

Zhou Can shrugged and got up to leave.

The intern in charge of bed 67 walked up to him, and said respectfully and nervously to Zhou Can, "Doctor Zhou, can you please help me to see the patient in our bed? The cause of the disease has not been found out yet, the patient had diarrhea not long ago. I took a stomachache once, but the symptoms of abdominal pain are still not relieved."

For patients with abdominal pain, especially those with acute enteritis, the symptoms of abdominal pain will generally be relieved after diarrhea.

The patient's stomach has been hurting for more than [-] hours, and the symptoms have not been relieved. This makes Dr. Huang Liang, who almost had an accident not long ago, very nervous.

He was very afraid that the patient would have a dangerous disease such as intestinal perforation.

Unlike Gui Peisheng, he is already a senior resident doctor, and he is not just managing the bed.

And need to be responsible for the entire treatment process of the patient.

To put it bluntly, it is a treating doctor.

Zhou Can turned his head to look at bed 67, only to see Huang Liang standing there with an embarrassed face, forcing a stiff smile at him.

This man is really interesting.

I couldn't bear to ask Zhou Can for help, but I ordered my interns to come over and ask Zhou Can.

"My level is also very limited. I can only help you as a staff member. The opinions given may not be correct."

Zhou Can is very humble.

Walking to bed 67, I began to conduct a simple face-to-face consultation with the patient.

"Dr. Zhou has diagnosed many difficult cases in a row recently. Director Zheng told us to learn more from you. You are too modest! This patient's condition continues to deteriorate. Although I have diagnosed some, I am worried about misdiagnosis, so I would like to ask Zhou Let the doctor take a look."

Huang Liang bit the bullet and said something.

The words had the meaning of praising Zhou Can, but he refused to lower himself too much.

"I wonder if Dr. Huang can talk about the diagnosis?"

Zhou Can asked him.

"Based on the patient's symptoms, I am more inclined to acute gastrointestinal perforation or acute cholecystitis." Huang Liang gave two diagnostic opinions, which shows that he has no idea at all.

Just like that, he was still pretending to be a wolf with a big tail in front of Zhou Can.

Zhou Can didn't expose him either.

Instead, I took the patient's information and began to check it carefully.

The patient's abdominal ultrasound showed no abnormal shadow, and the abdominal plain film was also normal.

The patient is in his prime, 31 years old. He drank and ate hot pot with some friends last night. After eating, he felt unbearable pain in his upper abdomen.After a few hours of pain, the symptoms did not ease, so I went to Tuya Hospital to go to the emergency department.After emergency anti-inflammatory treatment, no effect.The diagnosis and treatment capacity of the emergency department is limited, and the patient is sent to a specialist for further diagnosis and treatment.

The patient had vomited several times, and the vomitus was the content. The pain did not shift, there was no chest pain, chest tightness, fever and chills, no urgency to urinate, no blood in the stool and hematemesis...

After reading it, Zhou Can made a psychological estimate of the patient's condition. It was an emergency, but not as serious as imagined.

It should be an acute lesion caused by overeating.

Hot pot is generally very spicy, strong taste, and very hot.

Coupled with drinking, the hidden diseases in the body are directly detonated.

The patient's WBC: 22*10 to the ninth power/L, blood sugar 15.3mmol/L.Heart rate 85 beats/min, no family history of diabetes...

The patient's myocardial enzymes were normal.

Blood calcium decreased, blood sugar was high, blood lipids also increased significantly, and blood amylase also increased.

Cholecystitis is indeed a possibility.

However, the possibility of acute gastrointestinal perforation is unlikely.

Zhou Can tried to press the patient's abdomen, as long as the upper abdomen was pressed, the patient screamed in pain.Press other parts, the patient does not respond.

"Bend your knees to your chest and try."

Zhou Can said to the patient lying on the hospital bed.

The patient did as he was told, with a comfortable expression on his face.

"It doesn't seem to hurt that much anymore!"

The patient's pain was relieved, and he could not help but trust the young doctor's medical skills.

"Have you ever had abdominal pain like this before?"

After Zhou Can temporarily relieved the patient's pain, he continued to ask.

"No, it's never been this painful."

The patient shakes his head.

His girlfriend was accompanying him in front of the hospital bed, looking haggard.If it were anyone who accompanied the patient for one night, followed by fear, it would probably be in this state.

"Smoking?"

"Suck!"

"Has he always been this yellow?"

"I don't think so! It used to be quite fair." The patient's girlfriend thought for a while before answering.

"Dr. Huang, according to the patient's symptoms and various auxiliary examination data, mild jaundice, plus abdominal B-ultrasound and plain film showed no abnormalities. My diagnosis is acute pancreatitis. I think his jaundice is very serious. It may be that the common bile duct is compressed by the enlargement of the head of the pancreas, which is why the symptoms of mild jaundice appear. Elevated blood amylase is an important basis for diagnosis."

After seeing the patient, Zhou Can made a preliminary diagnosis based on various examination data and the patient's symptoms.

"Not acute cholecystitis?"

Huang Liang's expression changed after hearing this.

He got two diagnosis results, but unfortunately he didn't get any of them right.

"Probably not."

Zhou Can shook his head lightly.

"When I gave the patient a physical examination just now, in addition to upper abdominal tenderness, it was also accompanied by abdominal muscle tension. In addition, multiple auxiliary examination data can also indirectly prove that acute adenitis is more likely. The pathogenesis is mainly due to the zymogen in the acinus It is activated, triggering a series of chain reactions, which have a great relationship with patients' overeating."

Zhou Can's current pathological diagnosis level is at the low level of indications, and is moving towards the middle level of indications.

He has the diagnosis bonus of the special medical skill of emergency life wisdom.

Coupled with the fact that he has studied under many chief physicians, the diagnostic level is really not comparable to that of a senior resident like Huang Liang.

He can directly point to the source of the lesion through the symptoms and examination data.

Other doctors who are not qualified enough and have insufficient diagnostic experience will appear to be confused.

"But the B-ultrasound did not detect any obvious abnormalities of the pancreas!"

Huang Liang still asked unwillingly.

"Now check the B-ultrasound again, I believe that the pancreas can be found to be significantly enlarged."

Zhou Can's tone was full of confidence.

B-ultrasound data will continue to change according to the progress of the patient's condition.For some diseases, it is necessary to do two more B-ultrasound examinations.

Of course, this kind of repeated examination in a short period of time may make patients and their families confused.

Doctors need to be patient in explaining and communicating.

Let patients understand that doctors are not earning black-hearted examination fees, but to help patients clarify the cause, find the lesion, and relieve the patient's pain.

After hearing this, Huang Liang pondered for 30 seconds, and finally made up his mind.

"You have heard what Dr. Zhou said just now. I am going to apply for another B-ultrasound examination for the patient immediately, and have a re-examination." Huang Liang looked at the family and the patient.

This kind of repeated inspection definitely requires the understanding and consent of the family members and patients.

"Okay, I believe in the level of this Doctor Zhou."

The patient's mind has always been in a state of sobriety, and Zhou Can's various performances are indeed different from Huang Liang and others.He has a calmness and self-confidence that only a chief physician can have.

This is the demeanor of the legendary general.

It can naturally convince people from the bottom of their hearts.

Huang Liang gave the patient an abdominal B-ultrasound examination on the spot. Perhaps the patient with intestinal perforation a few days ago gave him a psychological shadow. After applying for the examination, he did not dare to delay and accompanied the patient to do the examination himself.

Under normal circumstances, there is no need to queue up if there is a doctor taking the examination.

Especially for some emergency patients, the examination department also has the responsibility to give priority to examination of this type of patients.

For example, when patients with chest pain enter the hospital, they can directly go through the green channel of the chest pain center.

Soon, the test results came out.

Sure enough, as Zhou Can diagnosed, the patient had acute pancreatitis.

Through this incident, Huang Liang's attitude towards Zhou Can completely changed.He finally let go of the arrogance that remained in his heart, and was completely convinced by Zhou Can.Sometimes it may not be so easy to distinguish the level of medical level.

But when the level of the two is very different, it is still easy to compare the level of one.

In the two diagnoses, Huang Liang was obviously inferior to Zhou Can.

This point, I believe others don't say it, Huang Liang is also well aware of it.

At this moment, Luo Jingyi, a graduate student under Director Shang, ran over, stood at the door of the office and shouted at Zhou Can.

"Doctor Zhou, Director Shang asked me to ask you, is the patient at hand ready to be handed over? The interventional operation room is about to prepare for surgery."

The Chief Physician took the initiative to invite a Gui Peisheng to do the operation. This kind of treatment made Huang Liang extremely envious.

At the same time, deep in my heart, I am even more convinced of Zhou Can.

"Okay, okay, I'll go with you right away."

Zhou Can has already gained experience now. Before [-]:[-] every day, he has to hand over the patients in his hand to Luo Shengsheng, the chief resident, or other doctors in the group.

Because when Director Shang, Deputy Director Shi, and Dr. Huang Xinggui perform surgery, they usually appear at nine o'clock in the morning.

(End of this chapter)