My medical skills add experience

Chapter 517 Crazy Zhou Can, the Disaster Caused by Venipuncture
"Sir, the patient you want to visit is in that bed!"

After seeing Zhou Can enter the ward, the nurse looked around, thinking that Zhou Can was looking for a patient to visit.

Because patients who enter here have to cut their hair and nails clean.

All of them turned into bald heads, and some patients were even covered with bandages, like mummies, which was really hard to tell.

"Oh well!"

In fact, Zhou Can had already guessed that the bed farther away was probably Deputy Director Lu.Because there are multiple doctors and nurses around the bed.Various rescue measures are being used.

Director Xiang Fei, who has the reputation of 'King of Hades', is playing the role of commander-in-chief.

He himself is also participating in rescue work with high technical difficulty.

"You can only stand by and watch, and don't interfere with the rescue of the doctors and nurses."

The nurse was worried that Zhou Can would get into trouble, so he took the vaccination in advance.

"clear."

Zhou Can walked over there.

Because he was wearing a disposable sterile protective suit, the doctors and nurses could tell at a glance that he was a family member visiting the ward.

Everyone has their own work to be busy, so naturally no one pays attention to him.

Only the nurse who accompanied him followed.When family members visit, they must also be accompanied one-on-one by medical staff.In case some family members owe money and accidentally mobilize other patients' ventilators, hemoperfusion machines, hemodialysis machines, monitoring instruments, etc., some behaviors are enough to cause fatal harm to those patients whose lives are already fragile.

This is one of the reasons why medical staff do not like to let family members enter the ICU to visit.

A stranger comes in, which means there are many unknown risks.

Everyone's work is already busy enough, and we have to allocate energy and time to receive visiting family members, which is equivalent to adding a burden to our work.Naturally no one wants to.

When Zhou Can was about to approach the 13th bed, the nurse hurriedly stopped him and told him not to go any further.

On the hospital bed, Deputy Director Lu's hair had been shaved, and there was an obvious traumatic hematoma on the back of his head.The whole person's face looked very gray and lifeless.

In addition, his right hand fell to his side at an unnatural angle. With Zhou Can's experience in diagnosis and treatment, it was obvious at a glance that the hand bone must have been fractured.

The hematomas on his legs were also severe, and there should be some fractures in both legs.

From the fracture and the hematoma on the back of the head, we can basically infer the posture of Deputy Director Lu when he landed.

It should be that his legs landed first, and then his body became unbalanced, and the huge impact caused his body to fall to the ground.The right hand instinctively wanted to support it, causing a fracture.When he fell to the ground, the back of his head hit the hard ground.

But the ground should be a flat concrete floor or the like.

If the ground is rocky, or there are edges and corners where the head hits, it is easy to directly form wounds and bleed.

Only when the place of impact is flat ground can such a large area of ​​hematoma be formed.

Congestion is accumulation in the skin.

After learning about the process of Deputy Director Lu's fall and injury, Zhou Can felt that the hope of rescuing him was much greater.

According to anatomy, the back of the human head is closer to the important brain tissue.

Even in fighting and fighting, it is generally forbidden to hit the back of the head and the male perineum.This is the vital part.

If the back of the head is hit hard, people will easily faint or even die directly.

Deputy Director Lu's injury was probably at the occiput.

The parietal bone was also affected.

It is estimated that the impact of falling to the ground was very large.

It's really hard to say whether the legs touch the ground first.Only the parties themselves know.

The cerebellum, brain, and even the pineal gland may have been severely impacted and damaged. As for where in the brain is hemorrhage?What kind of bleeding?This is simply impossible to know with the naked eye.

Diffuse bleeding is more likely.

Of course, there is also the possibility of intracranial artery rupture, single or multiple sources of hemorrhage.

Zhou Can looked at the screen and dial of the monitoring instrument, and the alarm sounded one after another. Deputy Director Lu's blood oxygen, heart rate, blood pressure, respiration, and brain waves were all abnormal.

The situation is far more serious than imagined.

Central venous pressure monitoring has been done and he is on a ventilator.

Deputy Director Lu seems to have a lot of problems, but as long as the real cause of the coma is found, most of the problems may be solved.If you only start with a certain problem in blood pressure, or breathing, or blood oxygen, you will only fall into a situation where you will be blinded and dazzled.

This is the most common mistake made by doctors at and below the attending level.

Because of the limited application ability of clinical knowledge, it is very easy to confine one's thinking to a very narrow range because one cannot have an overview of the overall situation when making a diagnosis.

Director Xiang Fei is the leader of the Department of Critical Care Medicine at the Provincial People's Hospital, and he is an absolute bully.

His diagnostic thinking must be far beyond the attending level.

The clinical experience is even more abundant.

At present, his idea of ​​directing everyone to rescue is mainly symptomatic treatment, trying to increase the patient's blood oxygen saturation, stabilize the patient's heart rate, increase blood pressure, assist breathing, and so on.

This is also the most commonly used rescue idea in clinical practice of western medicine.

Which sign is not good, I will help you correct which one.

In the emergency rescue of critically ill patients, this is also the most effective rescue method.

If time is enough, there are more advanced rescue methods.

That is to strip away the cocoon, find the real cause of the patient, and then treat it.

For example, Deputy Director Lu has found intracranial hemorrhage, so he must find a way to stop the bleeding, reduce intracranial pressure, and so on.You just help patients raise blood pressure, or increase the assistance of the ventilator, which is a bit like trying to get a fish out of a tree.

Zhou Can stood not far away and looked at it, as if it was five or six meters away.His diagnostic thinking has directly focused on Deputy Director Lu's coma.

With his rescue experience and unique reverse diagnosis thinking, he instinctively felt that the cause of the coma was the key to solving all problems.

The pathogenesis of coma mainly has three aspects.

The first is the disturbance of the normal state of consciousness caused by pathophysiology.The second is the microstructural and neurotransmitter changes in the normal state of consciousness.The third, the main neural structure of the normal state of consciousness.

The cause of deputy director Lu's coma is most likely the main neural structure of the conscious state.

For example, the brain suffers traumatic damage, the brainstem is severely affected by intracranial hemorrhage, and so on.

Even problems with the blood supply to vital tissues in the brain can cause coma.

The main neural structure is divided into three parts, the cerebral cortex, the thalamic diffuse projection system, and the ascending reticular activation system of the brainstem.

Among them, the cerebral cortex was damaged in the impact, which was the first suspected diagnostic direction.

The cerebral cortex is bounded by fissures and sulci, and is divided into more than a dozen gyri or five lobes.

They are connected in the middle by white matter nerve fibers, and the corpus callosum connects the two cerebral hemispheres.

If it is a diffuse lesion, it is very easy to cause varying degrees of disturbance of consciousness.

Therefore, Zhou Can thinks that the first thing to check is the cerebral cortex.

It's a pity that he is only staying here as a visiting relative and friend, and it is impossible for him to view the patient's examination report and auxiliary examination results.

You can only see the data on the bright side.

Such as blood oxygen index, heart rate, blood pressure, central venous pressure and so on.

Ordinary family members can't understand those instrument screens and dials even here.Zhou Can is a professional, so it can be seen at a glance.

"Sir, your visiting time is over, please go out! According to the regulations, the time for family members to come in and visit cannot be too long. Because it is under aseptic management, if you stay too long, it is easy to increase bacterial contamination in the ward risk. Please understand.”

The nurse was very polite to him.

Through her contact with Zhou Can, she must be able to feel that Zhou Can is not an ordinary person.

"Director Xiang, when did the patient undergo central venous blood pressure monitoring?"

Seeing that Zhou Can was about to leave, at this moment, he made a quick and comprehensive diagnosis from Deputy Director Lu's fluctuations in his physical signs and the most intuitive visual inspection results, and came to an astonishing conclusion.

Deputy Director Lu's coma may be caused by many reasons.

Emergency rescue is needed now, which is likely to be related to some minor negligence or mistakes of the doctor in the operation.

The nurse did not expect Zhou Can to be so bold that he directly asked the highest-ranking Director Xiang here.

Her face turned pale with fright.

She didn't know why Zhou Can knew Director Xiang, and the questions he asked were quite professional.

At this moment, what she wants to do most is to invite this 'father' out as soon as possible.

"Sir, please get out immediately, don't interfere with the doctors and nurses' rescue of patients here."

There was a hint of anger in the nurse's voice.

It is estimated that he dare not speak out.

I told this family member well beforehand, why are you so ignorant?

Isn't this causing trouble for her?
Director Xiang Fei, who was directing the rescue work, was a little annoyed at the moment.Because he found that the usual rescue methods seemed to fail in this patient.He secretly guessed that the patient's injury might be too serious.

It is very difficult to rescue the injured from high falls.

All kinds of internal bleeding and damage to internal organs, there is no way to find out in a short time.

Not to mention a series of complications caused by internal bleeding and internal organ damage.

The rescue was in trouble. At this time, the visiting family actually asked him questions openly, which interrupted his ongoing thinking.A surge of anger rose in his heart.

But after all, he is a battle-tested veteran.

Having been engaged in clinical work for many years, reason told him that he should not easily conflict with his family members.

He just raised his head and glanced at Zhou Can, and then replied in a cold tone, "If you have any questions, you can ask the nurse directly. The visiting hours are over, please get out!"

Obviously, he didn't take Zhou Can seriously.

In clinical diagnosis and treatment, he often encounters some "Baidu Xia" and "Kopdi", who question the doctor's operation with some medical knowledge he read on the Internet and medical books.

For this type of family members, no medical staff does not have a headache.

In many cases, when encountering such family members, everyone can basically push the patient away.If you really can't afford it, you will probably start defensive medical treatment in order to protect yourself.

Of course, when dealing with such family members, the attitude of medical staff will probably become more and more cold.

"Director Xiang, it's not that I'm looking for trouble. I'm just providing a diagnosis idea. Will the patient's signs decline due to venous thrombosis? Especially central venous thrombosis, we can focus on investigation."

Zhou Can could only bite the bullet and offer advice again.

People who don't understand think he is crazy.

You, a visiting family member, are here to instruct Director Xiang Fei how to rescue him?

"Please go out! If you have any questions, you can talk to our nurses."

The young male doctor under Director Xiang Fei, who was quite tall, walked over directly and invited Zhou Can out.

His eyes were full of unfriendliness.

If it weren't for the intensive care unit, I would have called the security guard directly.

The young female doctor under Director Xiang also looked at Zhou Can with the same look of looking at neuropathy.I guess I was sneering in my heart, where did a 'big god' come out?Actually taught the director how to rescue the patient.

These days, the world is really big and there are all kinds of birds.

"and many more!"

Xiang Fei called out to stop Zhou Can.

His apprentice obeyed his master's order very much.Immediately stopped driving Zhou Can away.

But the look in Zhou Can's eyes was still very unfriendly.

"Why do you think the patient's central vein was clotted?"

Director Xiang Fei seemed to wake up after being reminded by Zhou Can.No wonder all kinds of rescue have no effect. If central venous thrombosis does form, it will indeed be extremely harmful.

"I'm not sure, and I just suspect. As for the most common cause of central venous thrombosis, it is possible that the air was not exhausted during the puncture, or the air was accidentally brought in. I just gave an assumption and did not question the doctor. means to operate."

After Zhou Can finished speaking, he quickly explained another sentence.

He didn't want to arouse everyone's hostility when he questioned the puncture doctor's improper operation.

After staying in the hospital system for a long time, Zhou Can knows that when a doctor-patient conflict occurs, everyone will join together and become comrades-in-arms on the same front.

Just like corruption or other problems in the officialdom, it is also easy to form a group to resist the scrutiny of the superiors.

To put it bluntly, this is a kind of self-preservation behavior of people.

The establishment of venous access is very common in clinical rescue.Mainly used for circulatory support, central venous pressure monitoring, hemodialysis and so on.

"Are you a doctor too?"

Director Xiang Fei looked at Zhou Can for the first time.

"Yes!"

Zhou Can did not deny it.

"Who is this patient to you?"

"He's my colleague."

Hearing that Zhou Can and the patient were just colleagues, Director Xiang Fei's eyes softened a lot, and his vigilance also eased.

"Tell me why you suspect venous thrombosis."

The tone of Director Xiang Fei's conversation with Zhou Can has obviously changed.

Those who are familiar with Director Xiang can tell that he has a little more respect when talking with Zhou Can.

"When rescuing critically ill patients, it is often necessary to open at least two peripheral venous accesses. If conditions permit, it is better to directly establish a central venous line. Whether it is a large amount of drug administration in a short period of time, or the monitoring of central venous pressure, it can Useful. You can take a look, whether it is the monitoring of central venous pressure or drug administration, it seems that there is an abnormality now. Combined with the changes in various signs and data of the patient, it can basically be concluded that there is a great possibility of thrombosis in the venous access .As for the cause of thrombus formation, there is no need to delve into it.”

After Zhou Can analyzed the reason, he deliberately released some kindness.

Doctors know the pain of doctors best.

There are some negligence and mistakes in the operation, which is a very common phenomenon.

It's when everyone makes mistakes.

If Zhou Can wants to investigate which doctor's improper operation caused the thrombosis in the central vein, he will stand on the hostile side of these medical staff.

Deputy Director Lu's rescue couldn't make a quick breakthrough.

(End of this chapter)