My medical skills add experience

Chapter 509 The dangers of rapid infusion, the hidden rules cannot be broken

This kind of existence, for any department, the more the better.

Doctors are also human beings who need to eat and make money.

When treating patients who have no medical insurance or only have agricultural insurance, doctors try to save costs for patients as much as possible.Even if you encounter patients who have purchased employee medical insurance, you need to control the amount.

Only this kind of god-like veteran cadres don't need to have any worries, and they can do whatever they want to get the best treatment effect.

When Zhou Can came to the intensive care unit, he found a thin old man with a slightly cyanotic face lying on the hospital bed.

The cost of this kind of ward is very high, and there are only two beds at most, with a separate bathroom.

It is managed by specialized nurses and doctors to provide patients with the best quality service as much as possible.

Ordinary people generally cannot afford to live there.

"Excuse me, is this Mr. Bai Dongyang?"

"Yes, he is my lover!"

Accompanied by the hospital bed was an old lady with outstanding temperament, her hair was all white, but her spirit was quite good.

Many veteran cadres and their husbands and wives are senior intellectuals.

"How's it going? Still feeling short of breath?"

"That's right, it's still difficult to breathe, and the chest is tight."

Zhou Can nodded after hearing this, and said to the patient in a gentle voice, "Let me listen to the chest and lung sounds. Does it feel uncomfortable to lie on your side all the time?"

The patient had just had a left pneumonectomy, so no matter which side he lay on his side, the wound in his body would be affected.

"Lying flat is uncomfortable..."

The patient speaks as if he needs to use the strength to feed.

Just try to squeeze out.

The voice is also quite weak, and the Qi in the middle is obviously insufficient.

At present, he has not been put on a ventilator, and he has only been treated with concentrated oxygen inhalation through one nostril.

It must be said that it is extremely irresponsible to put patients on ventilators at every turn.In particular, invasive ventilators are often only used when life-saving is needed.

For patients who can breathe spontaneously, but have some difficulty breathing, but are not life-threatening, sometimes even oxygen is not needed.

Doctors will decide on measures to improve the patient's breathing based on actual needs in the clinic.

Before auscultating the patient's chest and lung sounds, Zhou Can made a detail, first heating the probe of the stethoscope before using it on the patient.

This is to reduce irritation to the patient.

The feeling of the cold metal probe being attached to the weak patient's chest must be unpleasant.

He listened carefully to the patient's chest and lung sounds.

There are distinct crackles and blistering sounds in the lungs.

The left lung has been completely removed, and now only the right lung is left to work.

The appearance of this bad noise indicates that there is also a big problem with the right lung.No wonder the patient has dyspnea and chest tightness.

This person's situation is already quite dangerous, and he may not be able to get up at any time.

Zhou Can looked at the patient's body record after admission, and the blood pressure was 162/100mmhg, which is considered high blood pressure.A systolic blood pressure over 140 is considered high blood pressure.

However, sometimes there will be some false high blood pressure.

For example, the patient is in agitation, or sucks some irritating food.In this case, blood pressure tends to return to normal after a period of time.

An ECG showed that the patient had sinus tachycardia.

Now combined with high blood pressure, and unable to lie flat.

The word "pulmonary edema" jumped out of Zhou Can's mind.

It is not difficult to find out the cause of the patient.

After receiving the diagnosis, Deputy Director He of Tuya and another doctor jointly consulted the patient, and they both determined that it was pulmonary edema.

But the specific cause of the disease, the pathology is clear, this is the real difficulty.

If the cause of the disease cannot be identified, there can be no treatment.

If it is only treated as postoperative complications, it would be too rough and superficial.It is also impossible to solve the problem.

After Zhou Can checked the actual physical condition of the patient, he did not leave.

Instead, take the patient's examination data and postoperative medication for a careful review.

Check one by one.

The surgery was done successfully.

The pre-operative examination was also done in great detail.

Because people's medical insurance reimbursement ratio is close to 100%, it is naturally how to do it safely.

None of the inspections that should be done fell through.

This also provides favorable conditions for Zhou Can to find out the cause of the patient.

He can do the left pneumonectomy himself, and he has done many such operations.

When diagnosing the cause, he can accurately give corresponding judgments for every step of the patient's diagnosis and treatment.

Multiple preoperative examination results showed that only the left lung had malignant tumors, and the right lung was normal.There are no other hidden diseases.

The operation process is also very careful.

At least according to the surgical record, the operation was very successful.

It can also be seen that the surgical strength of the Provincial People's Hospital is very strong.

Since there was no problem in the preoperative screening and the operation went smoothly, there is only one possibility, the cause of the patient's disease was postoperative.

The possibility of postoperative complications is high.

It is possible that some parts were not done properly during the operation, or some negligence caused right lung edema.

However, judging from some cases transferred from the Provincial People's Hospital that Zhou Can has received, the operation process of the Provincial People's Hospital is standardized, and every step is very strict, and the responsibility is assigned to the individual.

This patient is a veteran cadre again, so he is considered a special patient.

He will only be treated with more care.

The possibility of postoperative right pulmonary edema caused by surgical negligence or removal of the left lung is extremely low.

Then there is only one possibility, there is a problem with the post-operative care.

This happened more than once.

Some are caused by the paralysis of medical staff, and some are caused by the professional level of medical staff, or some unexpected wrong nursing methods.

"Did he develop dyspnea after waking up from the anesthesia?"

"No! When my wife returned to the ward after the operation, she was in good condition. Later, the nurse came in with the medicine and gave my wife an infusion. After the infusion was over three hours later, my wife felt uncomfortable. The nurse who came over to withdraw the needle responded, and she told us that it is normal to have a little adverse reaction after the infusion. The infusion is to improve my wife’s anti-infection ability, supplement the body’s necessary nutrients, and speed up recovery. I also Nothing more to say."

The patient's wife should always be by her husband's side.

Otherwise, I wouldn't know so clearly.

Husbands and wives come less frequently and accompany each other when they are old.

It can be seen that the relationship between the two old people should be very good.

After learning about this important situation from the family members, Zhou Can immediately checked the patient's postoperative infusion.

There is nothing wrong with the drugs and saline used.

The infusion volume is up to 1200ml.

This is really the special care of the God of Wealth!
Seeing that people's medical insurance reimbursement rate is [-]%, is that why you desperately infuse patients?

At least in Zhou Can's view, the dosage must have exceeded the standard.

However, he did not understand the actual situation at the time, so it was not easy to judge whether the doctor was over-medicating.

"How long did the whole infusion process last?"

he asked.

Just now the patient mentioned an important detail, the postoperative infusion took about three hours to complete.

"Uh... At that time, I didn't check the start time of the infusion. I only knew that it was close to four o'clock in the afternoon when the infusion was finished. My wife came out of the operating room and returned to the ward at close to one o'clock in the afternoon. The whole infusion process should be smooth. More than three hours."

The family gave the answer.

The Provincial People's Hospital is quite cunning. The post-operative care records only include the medicine and dosage, and what kind of care was done. The time of infusion was not given.

"Doctor, is there a problem with the infusion of my wife at the Provincial People's Hospital?"

The family members seem to have smelled it.

Ask Zhou Can directly.

"Because I wasn't there at the time, I can't comment. Your husband should have severe pulmonary edema. I'll give him a doctor's order to treat him as soon as possible. Is it convenient for him to urinate now?"

Naturally, Zhou Can would not evaluate whether the operation of another hospital was wrong in front of the patients.

It is impossible for him to do such a thing that is easy to provoke disputes.

"It's also convenient. You can use a urinal to continue."

They were all old couples, and she didn't feel any embarrassment when it came to taking care of her husband's urination.

"Does he have any drug allergies?"

"should not."

"That's fine. He may need to be given some diuretics for a few days, and the amount of urination will exceed the normal level. If your husband wants to drink water, there is no need to deliberately stop it, just eat and drink normally."

Zhou Can explained some precautions and directly gave the patient a doctor's order.

It is necessary to ask Deputy Director He to check it first before it can be implemented clinically.

Basically, Zhou Can's current doctor's order, whether it's Deputy Director He, Director Xueyan, etc., is checked briefly and passed directly.

[Pharmacological syndrome differentiation experience value +1, bonus experience value +10.]

The improvement of pharmacological syndrome differentiation is really a long way.It's only level five at the moment, and there's still a long way to go to advance to level six.

He has basically found out the cause of the postoperative right lung edema in the patient.

Based on his work experience in the Department of Critical Care Medicine, he believed that the patient's pulmonary edema was probably caused by rapid postoperative infusion.It may be that the nurse in charge of infusing the patient at the Provincial People's Hospital is not very professional, or some unexpected circumstances occurred at that time, and the infusion of the liquid was accelerated.

For example, the family member turned up the infusion switch privately.

This is the most common case.

Some family members and patients think that the infusion speed is too slow, so they will secretly increase the infusion switch to speed up the infusion speed.

From their point of view, it has to be infused into the body anyway, and it doesn't matter if it's finished earlier or later.

Sometimes when encountering such patients and their families, nurses are also very helpless.

I can even tell the family members gently that I can't do this again next time.

Don't even dare to say serious words.

Because you speak more seriously to your family members, some family members who have a bad temper can immediately quarrel with you, or even get violent.

In addition to family members who have adjusted the infusion speed privately, sometimes patients have certain physical conditions that require emergency infusion treatment. After comprehensive consideration, the medical staff will also speed up the infusion speed.

Compared with some possible side effects, life-saving must be the first priority.

For example, if a patient has internal bleeding, hemostatic drugs need to be used to control the patient's bleeding and help them stop bleeding.

If the infusion is done slowly for 24 hours, the patient's blood has already run out.

Or anticoagulation and thrombus, it is also necessary for the drug to take effect quickly.

This is why Zhou Can does not make any negative comments on the nursing care of the Provincial People's Hospital.

If you're not there, you never know what the situation was like for the doctors and nurses.

The medicine he prescribed to the patient was to give intramuscular injection of 10 mg of coffee immediately, mainly for sedation.This is done not only to relieve the suffering of patients, but also to control blood pressure.

No matter how excited the patient is, blood pressure may rise.

Furosemide 20mg, Cedilan 0.4mg intravenously.

This is a doctor's order that will be implemented now, and there is also a long-term doctor's order. In the next five days, the patient needs to be given drugs such as diuretics and digitalis.

The purpose is to quickly reduce the symptoms of pulmonary edema.

The lung governs water, and when it becomes edematous, the first thing to consider is not water deprivation.But a diuretic.

If the patient has kidney failure at the same time, that situation is very dangerous.

When there is a problem with a certain organ of the body, it can actually be like a certain ancient kingdom being attacked and asking for help from its neighbors.You can also turn to other organs of the body for help.

It's just that this help requires doctors to use drugs or other methods to achieve it.

Giving this patient diuretics is equivalent to a problem with the lungs, asking for help from the kidneys and other organs to speed up the discharge of excess water in the body.To relieve symptoms of pulmonary edema.

After finding out the cause and pathology of this patient, Zhou Can earned 101 pathological diagnosis experience points.

Among them, 100 points are rewarded by the system.

For diagnosing such difficult cases, basically, at least 100 pathological diagnosis experience points can be rewarded.

Sometimes luck is good, he has won the huge reward of 1000.

Pathological diagnosis is also skyrocketing all the way, throwing out pharmacological syndrome differentiation by several blocks.It is about to be promoted to level six now.

Because of the live broadcast of yesterday's surgery, Zhou Can directly pushed Tuya's cardiothoracic surgery to the throne.Following that, there will be a steady stream of difficult cases, and opportunities for him to earn large experience rewards will also continue to flow.

There is a premise that nothing can happen.

If a major medical accident occurs, all reputations are likely to be ruined.

After dealing with this veteran cadre, Zhou Can is going back to the office to study another difficult case.

Don't underestimate his contribution.

Every time such a difficult patient is handled well, the reputation of cardiothoracic surgery will increase a lot.Adding up over time, this is pretty impressive.

"Doctor Zhou, please come here!"

Director Bu waved at Zhou Can.

Zhou Can quickly walked into the conversation room dedicated to communicating with patients and family members.Two bodyguards stood in the corridor, they looked quite professional, watching every person approaching the conversation room vigilantly.

These two have long remembered Zhou Can.

After all, their boss came here from Shanghai to see Zhou Can for medical treatment.

Indoors, the patient Chen Zhongzhi sat there with a calm expression.

"Director Bu talked and communicated with me just now. I also understand the regulations and policies of your medical industry. But I hope that Dr. Zhou can help me with my operation. As for how to do superficial articles, you can do whatever you want."

Chen Zhongzhi's status is noble, and his life is also very important.

He was unwilling to undergo aortic replacement surgery in a large hospital in Modu because the risk was too high.Not willing to take such a big risk.

"I'm just a resident!"

Zhou Can usually performs level [-] surgery, even if he is performing the surgery on a patient, he is performing the surgery as a participant on the surface.

Although some foundation of trust has been established with this patient, it is impossible for him to admit some hidden secrets face to face.

There are some unspoken rules that can only be felt, not explained in words.

For example, to give gifts to some important leaders, if you carry a big suitcase or bring a bundle of banknotes, they will not let you in.

Because who knows if you secretly filmed?Is there anyone else secretly filming?

The risk is too great.

It has long been no secret that Zhou Can can preside over level [-] surgeries in the Cardiothoracic Surgery Department of Tuya Hospital.But it will never be passed on, nor can it be passed on.

(End of this chapter)