Chapter 158 The terminally ill patient may be waiting for an accident. Listen to Zhou Can.
"Those in the ICU are all critically ill. Even if something happens, they won't be sent to the operating room for emergency treatment easily, right?"
Zhou Can felt that there was something mysterious about this matter.
Even if a patient needs to be rescued, it is usually done in the ICU ward.
There are various rescue facilities inside.
Defibrillators, micro-injection pumps, ventilators, multifunctional blood purifiers, a full set of life monitoring equipment, and even extremely expensive ECMO. It can be said that no matter how serious the patient is, if he enters the ICU, he will basically not die as long as his family members do not agree to remove the tube.
He's stopped breathing and needs to be put on a ventilator.
The heart has stopped beating and the breathing has stopped. It’s okay, just put him on ECMO.
Modern medical technology is highly developed and has indeed created many miracles of life for mankind.
Patients stay in the ICU, and the cost of treatment is high, but it is not in vain. Nurses usually serve in pairs, and doctors can take care of up to three beds at most, with the attending physician sitting in charge. Then there are special nurses to do tasks such as wiping feces and urine, turning over, and massaging the back.
With so many people surrounding one patient, if that patient still cannot survive, the hospital has done its best to save him and there is no need for the hospital to take any responsibility.
Once the patient is taken to the operating room for emergency treatment, the nature of the situation changes.
According to Zhou Can's intuition, he chose to take the patient to the operating room when his life was in danger, either to perform some necessary examinations or assist in the operation. Otherwise, the medical staff on duty were seriously negligent and were responsible.
At this point a mistake has been made, and the best remedy is to find ways to rescue the patient.
"I don't know the details. Director Wu happened to be giving a lecture at school and won't be back for a while. The doctors in their group are always self-righteous and very concerned about their reputation. If they hadn't run out of options, they wouldn't easily ask me for help. Let's go over and take a look, and try our best to help if we can."
Director Wen is not too old, not even sixty years old.
Walking with the wind.
In a moment, he rushed over with Zhou Can, Dr. Zou, and Tang Li.
None of the residents were called.
In this case, bringing two attending physicians with you can not only show that you take the matter seriously, but also help the two attending physicians under you gain more experience.
I can help at the critical moment.
As for bringing Zhou Can over, in addition to cultivation, it also means dependence on Zhou Can.
Zhou Can is good at endoscopic surgery and is also very good at pathological diagnosis. He is definitely a main force.
Before the four of them reached the operating room, they were stopped by a fat, middle-aged doctor.
"Director Wen, we've finally got you here. The patient is dying. Please help!" The 45- or 46-year-old male doctor pulled Director Wen forward to help as if he had seen a savior.
Zhou Can knew this male doctor. He was an associate chief physician under Wu Baihe and his name was Kuang Shenfeng.
Although they were not in the same group, after working in neurosurgery for two months, he had basically become familiar with the nurses and doctors in the department.
Different from the humble familiarity of an intern.
Many interns know their senior doctors and nurses in the department, but it is difficult for the senior doctors and nurses to remember the names of the interns. They only have a vague impression of them.
From this point of view, it makes sense to say that interns have no human rights in hospitals and are even worse than the cleaning ladies.
The status of regular trainees is much higher.
But it is still limited.
Zhou Can is an exception.
He has a very high status in neurosurgery. Needless to say, everyone in Director Wen's group treats him as the attending physician.
Doctors in other groups gradually heard of or witnessed Zhou Can's endoscopic surgery skills, and when they met him, many of them would even take the initiative to greet him with a smile.
Not to mention the female nurses, each of them is a smart one.
Even the nurses in the ICU would greet Zhou Can with a smile when they saw him, and they might even chat with him for a few words.
"Where is the patient?"
Director Wen asked directly.
It seems that he was not taken to the operating room.
"Right here. I'm about to take someone to do a CT scan."
Lying on the mobile bed was a thin and haggard male patient, who was probably around 40 or 50 years old.
There is a urinary catheter inserted below, and the trachea is cut open and also has a tube inserted.
On a ventilator.
Even so, one can still feel the patient's rapid breathing and wheezing.
The doctors and nurses pushing the ventilators and beds all had tense expressions.
"The blood pressure is a bit low! The blood oxygen index is also a bit scary... Briefly describe the cause of the disease and the patient's basic condition."
After Director Wen read it, his expression became more serious.
"Oh! It's my fault. When I was on duty, I felt a little uncomfortable in my stomach, so I went to the toilet. Not long after, the nurse called me and said that the patient was breathing rapidly and a little wheezing. He was fine when I left, and I didn't pay much attention to this sudden situation. In addition, this patient often fell into a coma and stayed in bed for many days. He had a tracheotomy and has been living in the ICU ever since."
"He was fine for so many days, so it's unlikely that something serious would happen suddenly. I had a severe stomachache at the time, and I didn't think I would be able to leave the bathroom for a while. So I asked a few questions about the patient. The nurse said that the patient had no cyanosis of the lips and the blood oxygen saturation of his fingertips was not low. Based on the above symptoms, I diagnosed that the patient had a lung infection."
"The patient's lung infection had actually occurred for some time. He originally had a malignant brain tumor, and had undergone tumor resection and chemotherapy, but the results were not satisfactory. His family insisted on treatment, so he had to be kept in the ICU."
Long-term tracheal intubation is very likely to cause inflammation and infection.
The patient already had a lung infection, so he had wheezing and shortness of breath. In addition, his blood oxygen level was not low, so most doctors would think it was not a big problem.
At least compared with other serious conditions in the intensive care unit, shortness of breath is nothing.
"I told the nurse to suction the patient's phlegm first, turn him sideways, and pat his back. If he is still a little breathless, he can be nebulized."
Deputy Chief Physician Kuang Shenfeng gave a brief introduction to the situation at that time.
Although this treatment is a bit sloppy, it is quite satisfactory and I don't think there is anything wrong with it.
"The nurse didn't call me again. I wasn't so anxious anymore. After An Xin went to the toilet, her legs were very numb when she came out. She sat outside for a while before returning to the ICU. After I went in, I checked on the patient and found that he was still a little short of breath, but there was nothing else particularly abnormal."
"Just then, another patient developed ventricular fibrillation, so I rushed over to treat him. Less than an hour later, the patient's monitor suddenly sounded an alarm. I looked and saw that his blood pressure had plummeted. His heart rate and breathing were all abnormal. Only then did I realize that the treatment I had asked the nurse to do before might have been too hasty."
Kuang Shenfeng was still filled with regret when he mentioned the situation at that time.
In Zhou Can's impression, Kuang Shenfeng's surgical skills are very strong, and he is firmly in the top position among the many doctors under Wu Baihe.
The fact that he was awarded the title of associate senior professional speaks for itself.
So, sometimes, accidents really only take a moment to happen.
A moment of negligence by a doctor or nurse may lead to the death of a life.
"Why not just rescue her in the ICU?"
Director Wen believed that Kuang Shenfeng would definitely understand the meaning of these words.
"Because the patient had been bedridden for a long time, I seriously suspected that the patient had pulmonary embolism. This disease is extremely dangerous. Because of my misdiagnosis and negligence, the patient was delayed for more than an hour. I wanted to take him directly to the operating room for rescue. At least our positive attitude towards rescue can make it easier for the family members to accept it. If something goes wrong, the family members may make less fuss."
Kuang Shenfeng was hesitant when he said these words.
Clearly something was left unsaid.
If something went wrong, the family would make a scene, and then the higher-ups would definitely investigate the patient's cause of death. Misdiagnosis, dereliction of duty, and delay in rescue were enough to put Kuang Shenfeng in serious danger.
Having a positive attitude towards rescue will at least make things much better.
"Pulmonary embolism is indeed a very likely possibility. Have you had any tests done?"
"For now, we have only done an electrocardiogram. I sent it to Director Wu, and he also thinks that there is a high possibility of pulmonary embolism. Now we are going to take him to the CT room for angiography. After the cause is determined, we will see whether direct thrombolysis or interventional thrombectomy is needed."
Kuang Shenfeng replied.
It seems that Zhou Can misunderstood and thought that Kuang Shenfeng took the patient directly to the operating room.
It’s a bit shocking to think about it.
After all, I have reached the level of deputy chief physician. No matter how flustered I am when encountering an emergency, I can still distinguish the importance of things. I still have the proper sense of propriety when doing things.
It is a very correct approach to take him for examination first.
"I've also checked the electrocardiogram, and it's basically confirmed to be a pulmonary embolism."
Du Leng was also at the scene participating in the rescue.
The vast majority of members of a medical team are particularly united.
In the face of various sudden illnesses, we must unite as one to save patients' lives in a timely manner.
What he said was quite weighty.
At least from his confident tone, it can be seen that he regards himself as an important figure.
Other doctors and nurses also treated him with great respect.
"Doctor Zhou, what do you think?"
After understanding the situation, Director Wen did not rush to express his opinion. Instead, he turned around and asked Zhou Can behind him.
Everyone's eyes immediately fell on Zhou Can's face.
Some people even secretly compared Zhou Can and Du Leng.
Both of them are outstanding students in this training session and their performances are excellent.
During the two months that Zhou Can was in neurosurgery training, he did not meet Du Leng very often.
Sometimes when the same department is consulting or Wu Baihe and Director Wen perform joint surgery, Zhou Can and Du Leng will appear in the same occasion.
During consultations, Zhou Can generally does not express his opinions easily.
Du Leng seems to be very high-profile.
I often have debates with several directors.
As for performing surgery, Du Leng's surgical skills were average. For level 3 and 4 surgeries, he could only watch from the sidelines.
Zhou Can often handle the key parts of some endoscopic surgeries.
It is for this reason that Zhou Can and Du Leng are jokingly called surgical genius and theoretical genius by the doctors and nurses in the same department.
At this moment, Director Wen asked Zhou Can for his diagnosis in public, and this was after Wu Baihe and Du Leng had already expressed their opinions. This was enough to make everyone realize how important Zhou Can was in Director Wen's mind.
"I remember when I first started training in the emergency department, my teacher once said to me that when a terminally ill patient who has been bedridden for a long time is admitted to the hospital for treatment, what he is waiting for may not be a medical miracle. Instead, he is waiting for a medical accident to happen."
Instead of giving a diagnosis, Zhou Can said such an outrageous statement, which may aggravate the distortion in the doctor-patient relationship.
Many doctors and nurses looked down on him.
It's already this late, and instead of rushing to save the patient, they are here saying that the patient has ulterior motives and deliberately waiting for a medical accident to happen.
You should be struck by lightning if you say such nonsense.
"you mean?"
Kuang Shenfeng's tone was cold.
He has always been arrogant and looks down on the doctors under Director Wen from the bottom of his heart.
Zhou Can's words undoubtedly severely irritated his tense nerves.
The four words "medical accident" are definitely the four words that Kuang Zhufeng hates to hear the most right now.
"He probably doesn't have a pulmonary embolism. If you really performed thrombolysis on him, it would definitely be a medical accident." Zhou Can seemed very calm and didn't care about the contemptuous looks of other doctors at all.
After hearing this, Kuang Zhufeng's face became even colder.
The look he gave Zhou Can was full of contempt and disgust.
"Director Wen, let's take the patient for a CT scan first. Once we find out the nature and grade of the pulmonary embolism, we'll ask you to help with the rescue."
Kuang Shenfeng obviously regarded Zhou Can's diagnosis as nonsense.
It was only because of Director Wen's face that he didn't get angry.
"OK!"
Director Wen naturally would not stop it.
I originally brought people here to help.
The other party's diagnosis and treatment opinions will definitely be the main ones. To put it bluntly, if the patient really cannot be saved or an accident occurs, he will just walk away with the doctors in his group.
We will never take any responsibility.
"Doctor Zhou really believes that this patient does not have pulmonary embolism?"
Director Wen attaches great importance to Zhou Can's opinions.
Because in these two months, Zhou Can had different opinions in many consultations, and his accuracy rate was as high as 100%.
Zhou Can's diagnostic ideas are very different from those of ordinary people.
"It shouldn't be pulmonary embolism. Some of the surface symptoms look similar, but intuitively, it may be related to the lungs. It's not the key cause of the disease." Zhou Can has his own judgment.
He would never blindly follow a doctor's diagnosis just because he was of high rank or had great authority in the medical field.
"Let's wait until the patient's test results come out! During this time, we can take a look at the patient's previous test data and learn about the patient's cause of illness, medical history, etc."
Director Wen called several people into a nearby conference room and held a consultation with the patient's medical records and examination reports.
At this point, we can see that there are still some barriers between the groups.
The four of them sat in a small conference room to discuss the cause of the patient's illness. The doctors in Wu Baihe's group sat on the other side, led by Kuang Shenfeng and Du Leng, and conducted their discussion.
Director Wen and Zhou Can and others were discussing the cause of the patient's illness.
Kuang Shenfeng and Du Leng were discussing how to rescue after the test results of pulmonary embolism came out.
Taking a patient into the operating room for interventional surgery is quite risky.
This matter must be communicated with the family first.
As long as the patient is helped through this crisis, the responsibility caused by Kuang Shenfeng's negligence can be forgiven.
Soon, the results of the angiography examination came out.
CT showed fluid accumulation in the lungs, but after CTA examination, no obvious pulmonary embolism was found.
It’s just that the patient’s blood circulation is very poor.
It is normal for patients who have been bedridden for a long time to have qi stagnation and blood stasis.
This result was beyond everyone's expectations.
At this time, Kuang Shenfeng thought of what Zhou Can had said before.
Among so many doctors involved in the rescue, only Zhou Can diagnosed that the patient did not have pulmonary embolism.
"Doctor Kuang, after the examination, the patient's breathing has become weaker. The systolic blood pressure is already below 110. I'm afraid he won't be able to hold on for much longer. Do you think we should send him back to the ICU first, or what?"
In this case, there is actually little point in sending the patient back to the ICU for emergency treatment.
If the cause of the disease cannot be found, the patient will still die.
No matter how advanced the equipment in the ICU is, it is not a panacea after all.
In many situations, we are actually powerless.
Medical staff who have worked in the ICU understand that patients are using various expensive medical equipment, but the alarms of life monitors continue to sound.
Every alarm that sounds at each bed means that there is a dangerous situation.
If it is not treated in time, let alone a ventilator, even if ECMO is used, even if the most expensive drugs are used, the patient will still die.
When Kuang Shenfeng heard this bad news, it was like hearing a death knell.
There is no longer the arrogance and calmness of the past.
Cold sweat kept coming out of his forehead and his eyes were full of panic.
He took out his cell phone and called Wu Baihe.
Briefly reported the situation here.
"Teacher, what should we do now that we find out that the patient does not have pulmonary embolism? The patient's breathing is already very weak, and his systolic blood pressure has dropped below 110." Kuang Shenfeng first asked Wu Baihe for help, which showed that he did not trust Director Wen deep in his heart.
When it comes to his future and destiny, he only trusts Wu Baihe.
In his heart, Wu Baihe is like a god.
"I heard that Doctor Zhou Can diagnosed that the patient does not have pulmonary embolism, right?" Wu Baihe's ears and eyes were really well-informed and he actually knew the situation at the scene.
"Um!"
Kuang Shenfeng responded with difficulty.
Whether he admits it or not, reality gave him a hard slap in the face.
What Zhou Can said may be unpleasant to the ear, but it is all correct.
"I have already rushed back to the hospital and will be there in about 20 minutes. To be honest, I may not be able to handle such a difficult case. You should listen to Dr. Zhou Can and do whatever he tells you to do. This may be the only chance of survival."
Wu Baihe actually said such words, and Kuang Shenfeng was completely stunned after hearing it.
