My medical skills add experience

Chapter 92 A scheming woman, a troublesome patient

"Oh~!"

A sigh came from not far away.

Zhou Can turned his head to look, and saw that Jin Mingxi had turned into a bitter face.

The two exchanged a look, which Zhou Can understood in seconds.

Qiao Yu always acts as Zhou Can's assistant, and today is certainly no exception.Then the remaining preparatory nurse in the operating room must be assigned to Jin Mingxi.

The probability of Tian Tian appearing is very high.

I don't know that Tian Tian is able to please her superiors because she has a clever mouth.Or is there any background relationship.

She has at least four to five morning shifts a week.

She's fine.

Zhou Can and Jin Mingxi suffered disaster.

Whoever puts her on the table will be unlucky.

I was really afraid that something would happen, and not long after, Tian Tian walked into the operating room with small steps.Jin Mingxi sighed again, the expression on his face was as if he had eaten Coptis chinensis.

After Qiao Yu changed into the blue nurse's surgical gown, she walked into the operating room first.

"Hello, Doctor Xu!"

"Ok!"

Dr. Xu hummed with a serious face, which was regarded as a response.

"Qiao Yu, you look very beautiful today!"

Dr. Lu's eyes seemed to be attracted by a magnet, moving with Qiao Yu.

Even though Qiao Yu rejected him thousands of times, he always treated Qiao Yu like first love.

"Thank you for the compliment!"

Qiao Yu replied lukewarmly, and walked quickly towards Zhou Can.

"Hi, here I come!"

She smiled sweetly and waved to Zhou Can.

"Finally it's your turn for the morning shift?"

Zhou Can was also very happy to see her.

It was a pleasure to work with her.

"No! Didn't you send a message yesterday? I asked Shuangshuang to transfer a shift, and the price was to treat her to kebabs." She explained in a low voice.

The Shuangshuang she was talking about was Li Shuangshuang.

Usually, Li Shuangshuang usually works as an assistant for Jin Mingxi.

If Qiao Yu hadn't switched classes with her, Tian Tian would definitely be assigned to Zhou Can again today.

Today was the first time he asked the teacher for a more difficult surgical case.

If you mess up, it will be more difficult to gain Dr. Xu's trust in the future.

The time span is also extremely long.

Therefore, Qiao Yu came to be his assistant today, he was so lucky.

"Hey, you were supposed to invite this mutton skewer."

She said slightly coquettishly.

Probably because he was worried about Zhou Can's misunderstanding, so he went to Li Shuangshuang's class.

"Haha, no problem, no problem! As long as you will be my surgical nurse every day in the future, let alone a meal, it's okay to ask me every day."

Zhou Can didn't care about this little money at all.

It's worth it to cooperate with the best partner for a meal of mutton skewers and avoid Tian Tian, ​​​​a pig teammate.

"You are so beautiful! I also work as a surgical nurse for you every day! I checked the duty list in the morning, and I still don't have a morning shift next week."

Qiao Yu said slightly aggrieved.

"Your head nurse is really..." Zhou Can quickly stopped before finishing his sentence.

Because he found Tian Tian coming over.

The female nurse looked at her with a smile, and she said everything well, but in fact, in Zhou Can's eyes, she was a scheming bitch.

Those who make light promises will have few beliefs.Those who face reputation must be blamed.

People who often speak nicely in person should be especially careful.This kind of person likes to speak ill of others behind their backs.

The status of the head nurse is not low.

It is almost equivalent to the head of the department, except that she is in charge of nurses.

If this Tian Tian heard Zhou Can say that the head nurse was bad, and ran to the head nurse to chew her tongue, Zhou Can would have made a big enemy for no reason.

"Doctor Zhou seems to be talking about our head nurse just now! Is it because our head nurse arranges too few day shifts for Qiao Yu?"

Tian Tian asked with a smile.

See, she's a scheming whore.

She clearly knew that Zhou Can liked to have surgery with Qiao Yu, but every time she worked as Zhou Can's assistant, she never mentioned this.Instead, try to sell herself.

"Ah, I mean, your head nurse is amiable, wise and powerful, and has arranged so many nurses properly. If I were to arrange them, one would be the first and the second would be the oldest."

Zhou Can talks nonsense when he sees people, and talks nonsense when he sees ghosts.

When I first came into contact with Tian Tian two days ago, I didn't pay much attention to what I said.

Later, I found out that she was very scheming, and she was always very careful when speaking in front of her.

"Hehe, that's right! Our head nurse is really good, she is my idol! Dr. Zhou just doesn't like to do management work. You put all your thoughts on the operation, so the operation can be done. You did so well. I heard many nurses and doctors praise you in private!"

Tian Tian's clever mouth made everyone happy.

In fact, she is a good match with Dr. Lu.

Both of them are very good at speaking.It's a pity that Dr. Lu doesn't like her.

Otherwise, the two are really a match made in heaven, a match made in heaven.

"Haha, is that so?" Zhou Can laughed.

"Of course it's true! They all said that Dr. Zhou is young and promising, he will definitely become a famous doctor in the future!" Tian Tian boasted without hesitation.

There are many witty words.

If it was another rookie who had just entered the workplace, she might be so filled with her ecstasy soup that she couldn't even tell the north from the south.

Zhou Can was smiling, but deep in his eyes was the look of watching a clown perform.

"Okay, get ready to work!"

Dr. Xu swept over here with stern eyes.

As someone who has experienced it, he doesn't want his apprentice to be killed by Tian Tian's nonsense.

Dr. Xu will resolutely stop any behavior that may endanger Zhou Can's progress.

Tian Tian is not afraid of others, but Dr. Xu.

She shrank her neck in fright, and walked to Jin Mingxi's side honestly, causing Jin Mingxi to suffer.

The first surgical patient was brought in.

It was a patient who had a wound stitched up.

"Jin Mingxi, you will be responsible for this patient."

"it is good!"

Jin Mingxi said in a simple way, after taking over the patient, after some inspection and simple questioning, he directly began to give local anesthesia, debridement, and suture for the patient.

The second patient who came in was an old man in his 60s.

Pushed in with a wheelchair.

People can no longer walk.

The old man clutched his chest tightly, moaning in pain from time to time, accompanied by signs of vomiting.

This situation looks a little scary.

Emergency surgery arrangements are generally to rescue critically ill patients first, and then rescue patients who may be life-threatening.The last thing is to treat patients in general condition.

Most of the people who come here for medical treatment are emergencies.

Falls, cuts, injuries, animal bites...these are the most common patients in emergency department operating rooms.

The types of patients received in the emergency room are more complicated.

Those who drink pesticides, those who eat poisonous mushrooms, those who suddenly vomit blood...any kind of patients may receive it.

If an operation is needed in the emergency room, it will be checked and discussed with the family members before it will be sent to the emergency operating room.If it exceeds the capacity of the emergency operating room, it can only be sent to a specialist.

"What's up with him?"

Dr. Xu asked the nurse who brought the patient in.

"Acute cholecystitis, I checked abdominal plain film CT, the situation is not very good."

The nurse handed the examination report to Dr. Xu for review.

"You only did a urine test, didn't you do a blood test?" Dr. Xu asked with a frown.

"It's done, but the time is a bit tight, and the laboratory has not yet produced the results. Because the patient's condition is a bit critical, I thought of sending it in for you to see first."

The level of doctors in the emergency department is definitely not as good as that of Dr. Xu.

Most of the medical staff in the emergency department know that Dr. Xu used to be a director-level physician, so when they encounter some serious surgical patients, they will finally rely on Dr. Xu's diagnosis results.

"This ultrasound image suggests that there are intracystic stones!"

Doctor Xu frowned even more.

For acute cholecystitis, traditional laparotomy is only a secondary operation.If you do minimally invasive laparoscopic surgery, it belongs to the third level.

If the patient wants to perform this operation in the emergency department, he can only do traditional laparotomy.

Because the patient is too old and his physical condition does not look very ideal, there must be a certain risk of laparotomy.

This kind of operation is often done electively rather than immediately.

"Did you just receive it today?"

"Well, I heard it was delivered at five o'clock in the morning."

"Have you fasted yet?"

"After being sent here, the doctor on the night shift in the emergency department suspected cholecystitis or gallstones, and asked the patient to fast."

The work of a nurse is actually quite hard.

Even the simple task of getting a surgical patient into the operating room still requires memorizing a lot of basic patient information.So that the surgeon can answer fluently when he asks.

Their role is more like a bridge between the surgeon and the attending doctor.

"This patient also has a fever and is so old, the risk of surgery is very high!"

After reading all the examination reports, Dr. Xu frowned, his face revealing a thoughtful look.

"Xiao Zhou, come here for a consultation!"

Dr. Xu called Zhou Can over.

Dr. Lu stood beside him and carved a castle.

Even if Dr. Xu couldn't make up his mind, he should call for a joint consultation with his senior resident doctor.

Calling a Gui Peisheng for consultation is simply a kind of contempt for him.

"Can I see it?"

Doctor Lu couldn't stand still.

With Qiao Yu present, he didn't want to watch Zhou Can show off by himself.

"of course can."

Dr. Xu gave the information to Dr. Lu.

The patient said weakly, "Doctor... doctor, cough... hurry up and operate on me..." Acute cholecystitis will bring great pain to the patient.

Before the old man entered the operating room, he thought in his heart that it would be fine as long as he entered the operating room.

The doctor can relieve his pain with three strokes, five strokes, and two strokes.

Unexpectedly, after being pushed in, the doctors were not in a hurry to operate on him, but to study his condition together.

"Don't worry, the surgeons have to make sure the operation is safe before they can operate on you! The anesthetist is on his way."

Abdominal surgery, which already requires the use of professional anesthesiologists.

It's not something that can be done with a single round of anesthesia.

In fact, even if it is only an epidural anesthesia, a professional anesthesiologist is required to be present.

There are specializations in the surgery industry. Doctors may know anesthesia knowledge, but they cannot be as proficient as they are.

A top-notch surgical team needs at least one chief surgeon, two to three auxiliary doctors, one anesthesiologist, and one instrument nurse.If the requirements are more demanding, nurses on tour are also indispensable, and the more professional the better.

In surgery, everyone's division of labor is different.

The importance of the anesthesiologist is not less than that of the chief surgeon.

Dr. Lu took the examination materials and checked them one by one.

After a while, he held back a sentence with a serious face.

"This gallbladder must be surgically removed!"

Saying is basically equivalent to not saying.

The patients have already been pushed into the operating room, and they must be ready for surgery.

Don't cut off the gallbladder, but still keep it for the Chinese New Year?
"Tell me your specific point of view!"

Dr. Xu seemed to be concerned about the patient's condition and wanted to hear more professional opinions from doctors.

He really listened to Dr. Lu's surgical advice with an open mind.

"The calculus is so serious, and acute inflammation has occurred, surgical resection is the only way to cure it." Dr. Lu gave his own diagnosis point of view.

"Well, it makes sense."

Dr. Xu just nodded slightly, without much expression on his face.

"Xiao Zhou, your diagnostic ability has always been excellent, and you also help the staff!"

"Ok!"

After Zhou Can read all the information carefully, he checked the actual condition of the patient.

"I don't think surgery is right now!"

Zhou Can has learned various surgical knowledge from Dr. Xu these days, and has made great progress.

Vision, predictive ability, and risk control have all been greatly improved.

The patient became anxious as soon as he heard it.

"Doctors, please hurry up and help me with the operation! I can't stand the pain. If I don't do the operation, I... vomit, wow..."

Whoa!

The patient vomited, but fortunately the experienced nurse Liu Xia was quick to catch the patient.

Fasting for [-] hours before the operation is actually to prevent the patient from vomiting under anesthesia, which will lead to suffocation and death.

In the situation just now, if the patient is under anesthesia, the patient is very dangerous.

"Do you think the patient is not suitable for surgery now because there is no pre-operative fasting?"

Doctor Xu asked.

The contents of the patient's vomit were not small, and it was very worrying to watch.

"This is actually something that the anesthetist should consider. I think there are two views that it is not suitable for surgery. First, from the examination report, the patient should have gallstones that damaged the inner bile mucosa, which eventually led to bile stasis in the gallbladder, causing Bacterial infection. He will feel acute pain, nausea and vomiting, probably because the bile cannot be discharged and the internal pressure is too strong."

Zhou Can presented his own diagnostic point of view in an unhurried manner.

It is much more detailed than Dr. Lu's hasty words.

A doctor's diagnosis has a lot to do with a person's style of doing things.Lazy people try to save as much trouble as they can when diagnosing, including the surgical plan given, more is to consider how to deal with it quickly and simply, rather than thinking too much about the prognosis of the patient and the many potential risks during the operation.

It's not that they are unprofessional, they just don't want to think about it.

There are such doctors, and they account for at least [-]% of the doctor team.

Many are dawdling.

But they're generally hard to come by.Because there are superior doctors watching and checking them.

Moreover, superior doctors and department leaders know their behavior style, and it is impossible for such a person to make decisions about some important diagnosis and treatment activities.

Basically just assign them to do some less risky work.

"Secondly, the patient is weak and old, and the risk of surgery is high. Coupled with the analysis of the inspection report, I suspect that there is suppuration around the gallbladder. It is necessary to drain the pus first, control the inflammation, and then elective surgery."

Zhou Can absolutely couldn't express these views on surgery before.

Therefore, the fastest growth of doctors is practice.

He spent more than half a month in the operating room every day, and he got a lot of opportunities to practice surgery every day, plus Dr. Xu's careful guidance.Compared with the past, knowledge and various practical knowledge of surgery have improved too much.

Just like when he ridiculed Du Leng for talking on paper.

What can be learned from reading books is only theory, the flexible application of knowledge in practice, and the combination with various practical experiences.

Only when you are on the scene, can you learn real surgical knowledge in the operating room.

"You have also seen the patient's current situation. The risk of death from acute cholecystitis is not low. Tell me about your treatment plan. The safety of the patient must be guaranteed."

The mortality rate of acute cholecystitis exceeds 10%, which is really not low.

Moreover, this disease is often a complication caused by the patient's major surgery, or the patient is weak and caused by various underlying diseases.

After the onset, the patient's physical condition could not tolerate cholecystectomy at all.

In this case, the only treatment is symptomatic.

Stabilize the patient's condition first, and wait until the indications for surgery are met before performing surgery.

"My diagnosis and treatment opinion is to do ultrasonic puncture first, lead part of the bile out of the body, and reduce the internal pressure of the gallbladder. At the same time, do an interventional contrast imaging positioning puncture on the patient to draw out the pus around the gallbladder. After the patient meets the indications for surgery, then Operate."

Zhou Can gave two treatment opinions.

"Operate me quickly. If I don't operate today, I won't go out, and I will die inside..." The patient's face was distorted in pain.

Generally speaking, when patients have severe pain and are not feeling well, they tend to have a particularly bad temper.

The patient doesn't understand medicine, and when he hears the doctors discuss not to operate on him, he doesn't agree with anything.

"Please come over for a consultation with the gallbladder surgeon and physician!"

Dr. Xu is actually quite helpless in the face of threats from patients.

Dora's consultation with doctors from two authoritative departments can reduce the pressure they need to bear and spread the risk.At the same time, it can also convince patients and family members.

(End of this chapter)