My medical skills add experience

Chapter 589 The cause of death is not catheter insertion, relying heavily
The cause of the patient's death was related to the failure of the urinary catheter, which means that the Department of Gastroenterology needs to take responsibility.

"The patient's abdominal distention is like a drum, and the skin all over the body is brown, indicating that the urine and feces are retained in the body for a long time and cannot be discharged. The toxins in turn invade the body, causing severe organ failure and death. The catheter has no urine output, it is true There is a problem."

Director Shi of the Hospital Infection Office also came to a similar conclusion.

They are all professionals, and they generally don't miss the analysis of the cause of death of patients.

The preliminary investigation results of the two people both believe that there is responsibility in the diagnosis and treatment of the Department of Gastroenterology, which makes the attending doctor and Director Shang immediately feel on pins and needles.

Including the nurse who inserted the catheter for the patient, also looked terrified.

"Doctor Zhou, what's your opinion?"

Assistant Qin looked at Zhou Can who hadn't spoken yet.

Director Shang looked at Zhou Can begging for help, hoping that he could help the Department of Gastroenterology reduce the responsibility for the accident.

"The death of the patient had nothing to do with the catheter!"

Zhou Can said in a firm tone.

Director Shang and several medical staff immediately looked at Zhou Can with expressions of gratitude after hearing this.

It's still Xiao Zhou talking about old love!

"Hmph, Dr. Zhou is now participating in the investigation as a member of the quality control department. You must not be partial to the investigation results because of your past friendship."

Director Shi from the Infection Office snorted, dissatisfied with Zhou Can's conclusion.

He definitely knew that Zhou Can had been trained in Gastroenterology, and had a certain friendship with the doctors of Gastroenterology.

As a referee, the most taboo is injustice.

Members of the quality control department must not engage in malpractice for personal gain. They obviously found problems during the investigation, but because they are familiar with the department or doctor under investigation, they open their eyes and tell lies.

"Doctor Zhou must pay attention to his position and must learn to adapt to his new identity."

Yuanzhu Qin reminded him in a low voice.

"I don't mean to be partial to the Department of Gastroenterology. I just draw conclusions based on my own inference. The patient has been unable to pass the stool. After using Kaisailu, the family members help the patient pick up the stool with little effect. Xiaobian yesterday morning at five It started at about [-]:[-] am, and he didn’t urinate until his death occurred at [-]:[-] am today.”

Zhou Can shared the patient's nursing records.

"I have seen urinary catheters. Although the patient's body changed after the death and the catheters were tightly stuck, there should be no problem regardless of the depth or angle of insertion. Even if I do an autopsy, I have more than 99% of them. Grasp ensures that the catheter is properly inserted into the bladder."

In terms of implantation, Director Ju of the Nursing Department and Director Shi of the Hospital Infection Office should be far behind Zhou Can.

Especially after reaching the sixth level of implantation, Zhou Can's evaluation of various implants is more accurate.It can even be seen at a glance whether the placement is in place.

"Then why was the urinary catheter inserted four hours before death, but no urine has been discharged?"

Director Shi asked unconvinced.

"According to common sense, even if the urine output is small, there will be urine drawn out after using the catheter."

The bladder is a very amazing organ.

The human body's urine formation and excretion mechanism is very ingenious.

The blood passes through the glomerular arterioles, and the macromolecular proteins and blood cells in it can pass through normally. After being filtered by the glomeruli, the blood is unimpeded in the renal arterioles and returns to the blood system of the human body.

Most of the water, glucose, inorganic salts, and urea enter the bladder after being filtered by the glomerulus.The renal tubules also have some absorption.

This is what makes urine.

When the doctor checks the patient's urine, as long as albumin and blood cells are found in the urine, it can be concluded that there is something wrong with the patient's kidneys.

This means that there is a problem with glomerular filtration.

Albumin and blood cells are very important nutrients for the body. If they are excreted through urine, the body will become weak.Various symptoms gradually appear, such as weight loss, anemia and so on.

Patients sometimes cannot urinate because the urine output is too small, and the bladder is not full, so the patient has no desire to urinate.

If the urine output is too small, even if the patient wants to urinate, he cannot pass it out.

The internal pressure is not enough, and even a little bit of urine can't be squeezed out.

However, after the catheter is inserted, even if the patient's urine output is small, it can basically be discharged.

Of course, it depends on the doctor's catheterization technique.

Director Shi and Director Ju both thought that after the catheter was inserted, no urine came out for a long time, which was because the catheter was not inserted in the correct position.The patient's abdominal distention is like a drum, but the stool cannot be discharged, and it is generally impossible to be so exaggerated.

Only when urine and stool cannot be excreted from the body will cause abdominal distension like a drum and bulge like a pregnant woman.

The patient's intra-abdominal pressure is too high, which can cause many problems.

This is their diagnostic point of view.

"First of all, everyone should know that if urine is not excreted for a long time, it will be reabsorbed by the body."

Zhou Can analyzed his opinion.

Doctors often advise patients not to hold back their urine, and it is best to urinate at least once an hour or two, regardless of whether they feel the urge to urinate or not.

This is because urine contains a lot of toxins and harmful substances.

If it is not excreted in time and reabsorbed by the body, it will cause great harm to the body.

Occasionally holding back the urine once or twice is fine, but if it happens often, all kinds of serious diseases are easy to find.

And the skin of this kind of people is also prone to lose luster and become dull.

The eye sockets are black, and the whole person will appear similar to a uremia patient.

"You mean that the patient's urine has not been excreted for a long time and has been reabsorbed by the body?" Director Shi was obviously dissatisfied with this conclusion.

"No, what I mean is that the patient may have no urine before the catheter is inserted. Even if there is a small amount, it may be reabsorbed by the body, resulting in anuria."

Zhou Can explained lightly.

"Where did the patient's urine go? The stomach is bulging like that, you can't tell everyone that there is no urine in the stomach?"

There was a hint of sarcasm in Director Shi's tone.

He is a senior physician, and now he is the leader of the Infection Office of the hospital. It is normal to look down on Zhou Can, a young doctor.

Others were also not convinced by Zhou Can's explanation.

Even Shang Zhuxing who was sitting across from him didn't believe it.He felt that Xiao Zhou was sincere and loyal, and he was obviously helping the Department of Gastroenterology to play sloppy eyes and reduce the responsibility for the accident.

"There is indeed no urine in the patient's stomach. Have you noticed a detail? The patient suddenly vomited a lot of blood before he died."

Zhou Can's eyes swept over everyone.

"When I checked the patient just now, I pressed the patient's abdomen, and it was soft. It shows that there is a large amount of fluid in the abdominal cavity, not just feces."

In fact, even if you don't have a bowel movement for a week, it is impossible to turn your stomach into a pregnant woman.

Because feces are mostly solid matter.

Especially for patients with difficult defecation, the feces stay in the body for too long, and the water is absorbed by the body, which will make the feces drier.

For patients with constipation, doctors often recommend drinking more water, which is basically the same reason.

Insufficient moisture in the stool, which is too dry, can cause it to pass through the bowel with difficulty.

"I suspect that the patient should have ruptured a large artery or vein, causing massive bleeding into the abdominal cavity in a short period of time, which caused severe abdominal distension." He concluded this.

"That's impossible! The patient has been anuric since five o'clock yesterday morning. After such a long period of intra-abdominal hemorrhage, he will definitely have various blood loss symptoms. No matter how poor the level of gastroenterology is, this situation cannot be discovered. "

Director Shi questioned.

"This is what I'm curious about. Is there such a possibility? At the beginning of the patient's abdominal cavity, hemorrhage was only slow. However, the amount of hemorrhage was not particularly small. Because the patient had severe retention of stool, There will definitely be a lot of discomfort in the abdomen. So the pain and other symptoms caused by bleeding are ignored."

"Because the internal bleeding is severe, in order to maintain the normal operation of the blood circulation system, the body will mobilize water from other body fluids into the blood. As a result, the patient has no urine for nearly a day. At night, the patient's bleeding not only does not stop Instead, it becomes bigger. This leads to vomiting blood and death."

Zhou Can made a bold guess.

"Even if Dr. Zhou's deduction is correct, but the patient's bleeding is in the abdominal cavity, how can he vomit blood from the mouth?"

The Director of the Nursing Department questioned.

The people in the medical department didn't speak anyway.

They hoped that the gastroenterology department would not have to bear any responsibility.Because they are the coaches of the clinical department, if something goes wrong, they are also responsible for the lack of guidance.

"Patients who vomit blood usually have bleeding in the upper gastrointestinal tract or respiratory tract. This patient's bleeding is in the abdominal cavity. According to common sense, he should not vomit blood from the mouth. There are only two possibilities for this situation. Either the upper gastrointestinal tract There is bleeding, or the bleeding in the abdominal cavity is in the intestinal tract. What is the specific situation, I am afraid that an autopsy will be needed to find out."

Zhou Can is also very curious about where the patient bleeds and dies.

One thing can be determined, the patient's death was related to internal bleeding, not because the urinary catheter was not inserted properly, resulting in the inability to discharge urine, which is why he died.

"The family's opinion is that the deceased is the most important, and they do not agree to do an autopsy. Our hospital also hopes to calm down the matter and let the deceased be buried as soon as possible. Dr. Zhou's investigation concluded that the patient had a large amount of bleeding in the body, which caused the death. I don't know Shi Do the Director and Director Ju agree with this conclusion?"

Old Xiong, the deputy head of the medical department, asked in a timely manner.

Zhou Can knew that Deputy Section Chief Xiong and Director Shang were friends.

Now that there is an accident in the Department of Gastroenterology, Deputy Section Chief Xiong will definitely help wipe his ass with all his strength, and turn the major incident into a minor one.

It is very beneficial to have more friends.

"I agree!"

Director Ju Shiman of the Nursing Department nodded in approval of Zhou Can's conclusion.

Director Shi from the Hospital Infection Office was still somewhat skeptical, "Dr. Zhou is really sure that the patient didn't have a ruptured bladder, or that the urinary catheter wasn't inserted properly?"

"I'm sure. If the bladder really ruptured, the patient would have been in extreme pain before he died. However, according to the response of the family members and the on-duty medical staff, the death of the patient almost happened within a few minutes, and it was too late to be rescued. So I think it's OK. The possibility of bladder rupture was ruled out. As for the improper insertion of the urinary catheter, based on my personal professional level and experience, I can be sure that this problem does not exist.”

Zhou Can said confidently.

Indeed, as he said, a bladder rupture would cause great pain to the patient.

Impossible to have no reaction at all.

Not to mention pampered human beings, even wild antelopes would lose most of their mobility on the spot if their bladders ruptured.

An experienced old antelope will urinate in the middle of the night without waiting until the next morning.

Because lions and wolves often hunt them in the morning.

This is because a beast with hunting experience knows an Achilles' heel of the antelope.Herbivores eat a lot of stems and leaves of fresh plants, which contain a lot of water.After a night of digestion, the bladder will fill with urine.

Many young antelopes have no survival experience and do not know the dangers involved.At night, lethargy, coveting comfort.

In the early hours of the morning, the lion roared suddenly and came to kill it from a distance.

They will run away in a panic.

In order to survive when frightened, he will definitely burst out with the strongest escape speed.If the bladder is full at this time, it is easy to cause the bladder to rupture in a sudden outbreak.Once this happens, the antelope is almost certain to die.

Its escape speed will soon become slow, because the pain in its body is severe!

At this time, it will become a delicious meal for the lion.

Those old antelopes have summed up the experience of saving their lives because they have experienced many times of hunting by beasts in the early morning.So in the middle of the night, I would overcome my sleepiness and run to a distance to pee.In this way, there is no need to worry about the bladder being too full when attacked, which may cause the bladder to rupture when fleeing.

Moreover, a large amount of urine in the body is discharged, and the weight is reduced, which is more conducive to increasing the speed when escaping.

Human beings are far weaker than beasts.

Antelope's bladder rupture is unbearable, if the bladder rupture of this dead patient, he would have been crying so much that the whole ward could have heard it.

Therefore, Zhou Can boldly speculated that the patient's bladder did not rupture.

Of course, autopsy of the patient is the only gold standard if it must be verified.

"Fine, I agree with Dr. Zhou's conclusion! The death of the patient has nothing to do with the urinary catheter operation."

After listening to Zhou Can's explanation, Director Shi finally agreed with his conclusion.

Director Shang and the others on the opposite side all showed joy and breathed a sigh of relief.

Assistant Qin looked at Zhou Can with a highly appreciative look.

The name of a person, the shadow of a tree, this kid in Tuya Hospital, in just a few short years, has made a name for Ruoda with a bachelor's degree.There are really two hits.

The people in the medical department had known Zhou Can's ability for a long time, but they seemed very calm.

Director Ju Shiman of the Nursing Department was also secretly surprised by Zhou Can's medical skills.She probably didn't expect this young doctor to be so good.

Of course, being able to enter the first group of the quality control department is a very remarkable achievement in itself.

Every place in the first group is extremely precious.

You need to go through many tests before you can be selected.

"Doctor Zhou, now you have helped the Department of Gastroenterology to clarify the responsibility, which is very good. It's just that it's not easy for us to explain to the family members. See if you can further deduce the cause of death of the patient without conducting an autopsy. No need It’s too specific, just roughly target an area.”

Yuanzhu Qin obviously became more dependent on Zhou Can.

(End of this chapter)