My medical skills add experience

Chapter 294 The doctor's helplessness, Dr. Pang survived a catastrophe
"Well, very good! In addition to controlling blood sugar, what other treatment measures do you think this patient should take?" Zhang Bihua was very satisfied with Zhou Can's answer.

Then test him.

"Although the patient's condition is currently improving, there is still the possibility of rebound. We should continue to replenish fluids, correct dehydration, and continue to supplement small doses of insulin intravenously to try to correct the patient's electrolyte imbalance. If the patient's pituitary disease persists and refuses to undergo chemotherapy, surgery may be a The only way."

After thinking for a long time, Zhou Can felt that if the patient's pituitary lesions were not treated effectively, and only diabetes was treated, it would definitely not get better.

Diabetes insipidus and amenorrhea are all caused by pituitary lesions.

If these two problems are left alone, the patient's treatment will be anticlimactic.

Because actively controlling the patient's diabetic hyperosmolar coma and ketoacidosis can only save the patient's life.

"At that time, I will find a way to persuade the family members." Director Zhang Bihua has a high probability of not being able to persuade the family members, and this matter may have to be considered in the worst direction.

……

When he was about to get off work, Zhou Can got the news that the patient's thalamus-pituitary axis function test had results, ACTH18.1pg/ml, which was significantly lower than the normal value of 46pg/ml.

Hemoglobin F16.12ug/ml, this is within the normal range.

E2 167.59pmol/L, T1.0nmol/L...

After viewing a series of evaluation results of the patient, it can be confirmed that the central amenorrhea is caused by pituitary lesions.

Now I hope Director Zhang Bihua can persuade the family members to accept radiation therapy.

When I got off work in the evening, the family members still did not agree to receive radiation therapy, and their attitude was firm.

In this regard, Zhou Can was also helpless.

Obviously the cause was found out, but the family members refused to treat it, and the doctor was a little distressed.

Xinxiang Maternity and Children's Hospital also seemed to want to publicize this case as a typical case, and specially sent people to do ideological work for family members and patients.

The pregnant woman in the rescue room finally passed the most dangerous first six hours safely.

After get off work, Director Zhang rushed to the emergency room to check the condition of the pregnant woman.

After checking, she was very satisfied with the work of the crisis management team.

"It's not easy to rescue this pregnant woman from the clutches of death. Thank you for your hard work."

Director Zhang affirmed their work.

"Director Zhang, I want to stay on duty at night."

The medical staff of Xinxiang Women's and Children's Hospital were a little derelict, and it was difficult to reassure Zhou Can.

He voluntarily stays in the duty room of the hospital at night, so that he can be rescued in time if there is any emergency.

Director Zhang was stunned for a moment, and then he glanced at several medical staff of Xinxiang Women's and Children's Hospital as if realizing something.Whether it was the doctors or nurses in the emergency room, they were laughing and sloppy at work, which made her frown.

But she just came here temporarily for a few days, which is equivalent to a guest.

It's not easy to manage other people's housework.

The pregnant woman was rescued with great difficulty and was handed over to the medical staff of Xinxiang Maternity and Children's Hospital. There were indeed many unstable factors.

It's just that Zhou Cannai is a general and stays on night shift at night. Even though he only needs to take care of one patient, it is still very exhausting.If he doesn't rest well at night, his work status tomorrow will definitely be greatly affected.

"Although Dr. Zhou is the deputy team leader of our crisis management team, he actually assumes the work of the team leader. If he is only allowed to work the night shift alone, it will definitely affect his work the next day. I would like to stay with Dr. Zhou Take turns."

Ji You took the initiative to stand up at this time.

Doctors and nurses work together, which is the most efficient solution.

"Okay! If there are two people on the night shift, the situation will be much better. I'll talk to Section Chief Tang and get a special duty room for you. It is estimated that other doctors in our hospital will also be able to use it in the future."

Director Zhang obviously knew that the medical staff of Xinxiang Women's and Children's Hospital were unreliable.

It's easy to talk to such an 'old Jianghu'.

After communicating with Section Chief Tang, a small room was temporarily vacated for them not far from the emergency room.This is a small room for bedding and sheets.After a little cleaning, put a simple folding bed, a small wooden table, and a chair.

A simple temporary duty room was set up.

"Doctor Zhou, the conditions are a little rough, please be more forgiving and let it go."

Section Chief Tang smiled and apologized to Zhou Can.

"It would be great to have a place to lie down and sleep at night. We are the ones who have caused trouble for your hospital."

Although Zhou Can is a rich second generation, he has no arrogance and extravagance.

They don't pay much attention to food, clothing and housing.

He can eat a high-end meal for [-] yuan, or a boxed meal for [-] yuan.As long as the living environment is not noisy and there is a bed, it is enough.

"Thank you, Dr. Zhou, for your understanding! If you need anything, you can ask me anytime." Director Tang took out a business card as if by magic. "This is my business card. If you need anything, you can directly call my mobile phone number."

Anyone can see that Section Chief Tang's attitude towards Zhou Can is very unusual.

Not only polite, but also extremely enthusiastic.

Director Zhang and the others saw it, but didn't think much about it.Because Zhou Can did perform very well, it is quite normal that Zhou Can has a high hidden status in the mind of Section Chief Tang.

Whether it is rescuing the sick child or the pregnant woman, Zhou Can is the main force and the most important hero.

The senior officials of Xinxiang Maternity and Children's Hospital didn't say anything, but they must look up to Zhou Can in their hearts.

……

After dinner, Zhou Can went back to the hotel to take a shower, and brought a medical book by the way.

On duty at night, you must stay next to the bed of the pregnant woman.

You don't need to stare at those monitoring instruments all the time, you only need to look at them occasionally.Because the monitoring instrument will send out an alarm as long as it detects a major change in the patient's vital signs.

In addition, changing the intravenous infusion, adjusting the parameters of the ventilator, etc., all need to be operated by Zhou Can himself.

As a result, before he could walk out of the hospital, his cell phone rang.

It turned out that the number was an unfamiliar phone number.

"Hello, who is it?"

Zhou Can connected.

"Doctor Zhou, Doctor Zhou, I'm Doctor Pang! The patient's blood oxygen level suddenly dropped, please come over quickly."

There was a hint of nervousness and panic in Dr. Pang's voice.

After all, he is an attending physician and has experience working in the intensive care unit, so he was so scared by the sudden drop in blood oxygen?
Zhou Can quickly turned around and rushed to the emergency room, but he was thinking secretly.

Dr. Pang's professional level is not bad. There are only two possibilities for scaring her like this.Either she neglected her duties and had an accident, or she took measures after the patient's blood oxygen dropped, but to no avail.

Rushing into the emergency room, Zhou Can saw that Dr. Pang and nurse Chen Qingling were rescuing patients.

Three doctors and nurses from Xinxiang Maternity and Children's Hospital stood by and watched.

"Isn't it fine when I went to eat? Why did the patient's blood oxygen drop so badly?"

Zhou Can calmly observed the patient's vital signs, and the blood pressure did not drop significantly.

The situation is not as bad as imagined.

The patient's breathing was short and heavy, and his face was cyanotic.

Diffuse infiltrates were detected in her lungs after the fat embolism, and her lung function is definitely not as good as normal.

But after being put on a ventilator, the situation has stabilized.

Sudden deterioration, what's going on?

In order to save the pregnant woman, Zhou Can has led someone to guard her for a whole day.

Never want to fall short.

"I went to the bathroom at that time, and when I came back, I found that the patient's blood oxygen index was dropping." Chen Qingling replied.

Patient care in the intensive care unit is often one-to-one with nurses and one-to-three with doctors.

What does that mean?

That is, a bed has at least one nurse to provide one-on-one care to patients.A doctor can manage up to three beds at the same time.

In fact, it is most appropriate for this pregnant woman to be sent to the intensive care unit. It is only because of the consideration of the patient's family's economic conditions and the fact that the pregnant woman has not passed the dangerous period that Zhou Can is so dedicated to providing high-quality four-to-one services.

The crisis management team consisted of five medical staff, and Deputy Director Shi just put up a sign.

Only Zhou Can, Dr. Pang, and two nurses actually worked.

Since Zhou Can and Ji You will be on night shift tonight, Dr. Pang and Chen Qingling will be on duty for the time being.

People have three urgencies, Chen Qingling went to the toilet during the duty, no one can say anything about her.

At that time, Dr. Pang was present alone.

Zhou Can looked at Dr. Pang.

"I, I have been staying at the bedside. The patient's blood oxygen index has dropped. I immediately took a series of emergency measures after I found out."

Her eyes dodge a little.

Obviously not telling the truth.

This Dr. Pang was just dissatisfied with Zhou Can as the deputy team leader. Now that he is still so slack in work, Zhou Can suddenly became a little angry.

"You called me as soon as you noticed that the blood oxygen index had dropped. Can the patient's blood oxygen saturation drop below 70%?" Zhou Can's voice was full of anger.

A nurse from Xinxiang Women's and Children's Hospital next to her whispered, "I see she seems to be on the phone all the time!"

Dr. Pang saw that he couldn't make sophistry, so he had to tell the truth.

"I was standing by the hospital bed just now. My family called. My mother has been lying in bed. I was a little worried, so I chatted a few more words. At that time, I may have focused on chatting with my mother. In addition, the pregnant woman was not in any danger for a day, so I really relaxed my vigilance. When the nurse Chen Qingling came back from the toilet, she found that the patient's blood oxygen saturation had dropped to 85%, and the instrument was alarming, so she hurriedly called me."

Dr. Pang also knew that it was wrong, so his attitude was not bad.

Now is not the time to pursue responsibility, find out the problem quickly, and rescue the patients is the most important thing.

"How long has it been since you found the patient's blood oxygen alarm and you called me?"

"Probably less than five minutes later. Dr. Pang didn't get better after taking some emergency measures, but the blood oxygen dropped even faster. She called you immediately."

Chen Qingling said from the side.

"In just a few minutes, blood oxygen dropped so badly, what first aid measures did you take?"

Zhou Can asked Dr. Pang while looking for the reason.

"I increased the oxygen concentration and increased the oxygen flow..."

Dr. Pang explained his rescue measures.

Zhou Can originally suspected that there was something wrong with Dr. Pang's rescue measures. After listening to it, he carefully checked the parameters of the ventilator, and suddenly realized.

Quickly try to reduce the atomization and adjust several parameters of the ventilator.

Then check again whether there is a problem with the patient's intubation.

The blood oxygen saturation, which had dropped rapidly, slowly stabilized, and then rose up little by little.

About 20 minutes later, the patient's blood oxygen saturation rose above 95%, and the alarm was lifted.

The pregnant woman's originally cyanotic face also returned to normal.

It's just that the fingertips are still a little cyanotic.

Dr. Pang breathed a long sigh of relief as if he had survived a life-and-death catastrophe, and his originally gloomy and tense face finally turned bloody.A hint of joy for the rest of her life appeared on her face, and the fear in her eyes disappeared.

If something happened to the pregnant woman just now, Dr. Pang would probably need to bear some responsibility.

With Tuya Hospital's strict approach to medical safety, her future was basically ruined.If he can continue to stay in Tuya Hospital and stay in the attending physician's position until he retires, then he will burn a high incense.

"Doctor Zhou, why did you adjust the parameters of the ventilator so that the patient's blood oxygen saturation can stabilize and then go back up?"

Dr. Pang, an attending physician, used an honorific title for Zhou Can, a Gui Peisheng, for the first time.

It is not only out of gratitude, but also admiration for Zhou Can's ability from the bottom of his heart.

"From the very beginning, it is not correct for you to be eager to increase the oxygen concentration and oxygen flow. Haste makes waste, have you heard that? When Dr. Pang rescues this kind of patient in the future, it is best to combine the patient's condition. Then, you Seeing that increasing the oxygen concentration and oxygen flow is not effective, blindly administering nebulized inhalation to patients, this is even worse for patients.”

"The specific principle is that her respiratory tract is already flooded, and if you make another wave of artificial heavy rain, won't it block her respiratory tract?"

Zhou Can did not hide his secrets, but patiently explained the principles to Dr. Pang.

She may understand these truths, or she may not understand them.

At that time, because she was only on the phone, the blood oxygen of the patient dropped to 85%, and she realized that she must be very flustered out of instinct.

When people are in a hurry or panic, they tend to lose their sense of proportion, and the decisions they make are very error-prone.

Emergency treatment is not only applicable to patients, but also applicable to doctors.

After listening to Zhou Can's explanation, Dr. Pang carefully comprehended and deduced the pathological and physiological mechanisms. It took seven or eight minutes before he suddenly understood.

"So that's how it is... Oh, it's all my fault for being in a hurry! I almost made a big mistake."

After she understood the pathological mechanism, she repeatedly patted her forehead.

"Thank you, Doctor Zhou, for your advice, thank you!"

She thanked Zhou Can this time, it was a surrender and gratitude from the heart.

On the contrary, it made Zhou Can a little uncomfortable to deal with her.Originally, he was thinking of reporting this matter to Director Zhang and giving her a severe lesson.Seeing that she is not young anymore, she is middle-aged, and there is an old mother who is bedridden at home.

It would seem a little cruel to really wipe out her job.

"I don't need to thank you. The most important thing in medical work is safety. Being able to rescue the patient this time does not mean that he will be so lucky in the next accident. I sincerely hope that Dr. Pang can cherish his job as a doctor. Life is entrusted to us, what kind of trust is this? Don't you think so?"

Zhou Can didn't say harsh words, just beat her a few words.

(End of this chapter)