Chapter 161: Goodwill from Vice President Ye, Corpse Transport Sect
Zhou Can lowered his head in thought.
After working in the hospital for so long, whether it was an internship or eight months of regular training, his understanding of the ICU was actually very limited. I believe that most doctors would think that Tuya's critical care medicine department is a mysterious place.
Vice President Ye personally asked him to undergo three months of regular training in the Department of Critical Care Medicine, which must have a profound meaning.
“Maybe many people don’t know much about the Department of Critical Care Medicine, so let me introduce it to you now.”
The person in charge did not urge Zhou Can.
"Currently, the Department of Critical Care Medicine is the only formal department in Tuya General Hospital. The Department of Respiratory and Critical Care Medicine can only be regarded as a sub-department, which is not much different from the specialized ICUs of neurosurgery, cardiology, and obstetrics. I believe that you may have had the opportunity to see the ICU during your specialist training and internship. But I want to tell you that there is a big difference between the real Department of Critical Care Medicine and the subdivided specialized ICUs."
Everyone was listening carefully.
Tuya Hospital is like a complex big city with numerous and diverse functional departments.
Even if you are a doctor in our hospital, without certain qualifications, you may know little about other departments of our hospital.
"The specialized ICUs you see are, more precisely, intensive care units. They are quite different from real intensive care unit wards. The construction of specialized ICUs is based on the needs of various departments. In terms of technology, management, and equipment, they can only be described as 'immature'. They mainly monitor the patient's ECG and blood oxygen levels, and observe changes in the patient's condition at any time. Rescue measures are very limited."
This is a rather obscure statement.
What I mean is to tell everyone here that specialized ICU wards are amateur level, and only the critical care medicine department is professional.
Zhou Can couldn't help but think of the goals that Qiao Yu had mentioned.
She said that after working for a while, she would work hard to pass the assessment of the critical care medicine department and go in to gain experience for a period of time.
It seems that she already had a deep understanding of Tuya's critical care medicine department.
Zhou Can was secretly wondering at that time, there is an ICU ward in the emergency department, and he hadn't heard that it was particularly difficult to work there!
Now that she thinks about it, she should have wanted to enter this real critical care medicine department.
"In principle, each trainee has only one application opportunity to enter the critical care medicine department for regular training, and the regular training lasts for one month. If you become an elite in the specialty in the future, you may have the opportunity to apply for further training here. Or you may be selected to work directly in the critical care medicine department. However, the probability of this is very small. Therefore, cherish this one-month regular training time! Learn as much as possible about critical care medicine nursing, rescue knowledge, and technology."
Hearing what he said, ordinary interns only have one month of training in the Department of Critical Care Medicine, but Zhou Can has two months longer than them. This is special treatment.
If you don't take advantage of an opportunity, you are a coward.
Zhou Can already had a plan in mind.
Isn't it just a little more stressful and tiring? Three months is three months. By then, I will have learned how to rescue and care for critically ill patients, which will be of unimaginable benefit to my future medical practice.
He vaguely felt that competition among various departments in the hospital was everywhere.
The specialist department does not want to see the emergency department become stronger and hopes that the emergency department will always be just a transfer station for medical treatment.
There is also competition between critical care medicine departments and specialized ICU wards.
Each department is striving to demonstrate its own unique value.
Otherwise, it will soon be replaced and eliminated.
Cruel workplace rules are almost everywhere, forcing everyone, every department, and every company to work hard to improve their competitiveness.
This is actually a manifestation of social progress.
"Zhou Can, how are you thinking about it?"
After the person in charge introduced the difference between the critical care medicine department and the specialized ICU ward, his eyes fell on Zhou Can's face again.
Isn't it obvious that the introduction just now was a disguised form of ideological work for Zhou Can?
"I am willing to train in the Department of Critical Care Medicine for three months . I would like to thank Vice President Ye and all the leaders for their training."
After Zhou Can understood the situation clearly, he agreed decisively.
The training time in the Department of Critical Care Medicine was extended by two months, which also meant that his training time in other departments had to be shortened.
If it is replaced by an ordinary trainee, there will hardly be much impact.
But he is different. Not only does he have to do residency training in multiple surgical departments, he also has to do residency training in internal medicine.
At present, he has used up 8 months of his 36-month regular training time, plus the three months in the critical care medicine department, nearly one-third of the time is gone.
"Okay, very good! Many years later, you will find that the choice you made today was a very wise one."
When the person in charge saw Zhou Can agreed, he smiled happily as if he was relieved.
Zhou Can thought about it for a moment and understood the mystery.
If he failed to accomplish the tasks that Vice President Ye personally assigned him, he, as the person in charge, would definitely lose points in the eyes of Vice President Ye.
"Let me introduce to you the sources of patients in the Department of Critical Care Medicine. They can be roughly divided into four categories: the first category is patients with acute reversible diseases. Such as various types of shock, patients after major surgery, severe trauma, severe infection, acute poisoning, and patients after cardiopulmonary resuscitation. There is a prerequisite for this type of patients to be admitted to the ICU, which is to clearly be able to effectively reduce the mortality rate and the therapeutic effect is certain."
This type of patients should account for the majority.
During his training in neurosurgery, Zhou Can discovered that many patients who had just undergone major surgery would be specifically instructed by the surgeon to be sent to the ICU for monitoring.
As for patients with acute poisoning, severe infection, etc., neurosurgeons rarely see them.
"The second type is high-risk patients. These patients have underlying diseases that may be dangerous and are about to undergo high-risk invasive surgery. For example, they have severe pancreatitis, severe asthma, organ failure, severe obstetric diseases, etc. The admission of these patients can effectively prevent and treat their complications, reduce medical expenses, and shorten hospital stays."
There are many patients who, if they are not admitted to the ICU while waiting for surgery, may never meet the criteria for going on the operating table.
At this time, it is a good choice to decisively choose to be admitted to the ICU, save life first, and then undergo elective surgery.
Many people think that staying in the ICU ward is a waste of money, but in fact it is just the opposite.
Sometimes it may even save medical expenses.
Just imagine, when various complications break out, the rescue costs will be very staggering.
And it will greatly prolong the time of discharge from hospital.
"The third type is patients with acute exacerbations of some chronic diseases. The intensive care unit can help them get through the acute phase and try to help them return to their original chronic disease state. For example, patients with exacerbations of chronic respiratory diseases belong to this category."
This type of patient is very common.
The saying "money can buy life" often refers to this type of patients.
If they are admitted to the ICU, they can really escape the punishment of the devil.
After they get through it, they can live well again.
"The fourth type is patients whose diseases have become irreversibly malignant. For example, patients with massive bleeding and ineffective bleeding control, or patients with malignant tumors in the terminal state. There are also elderly patients waiting for natural death. The greater significance of admitting such patients is to show respect for life and reverence for life."
The last type of patients are mostly from wealthy families who have too much money and nowhere to spend it.
Generally speaking, as long as the family members do not allow the tube to be removed, these patients can stay in the ICU for a considerable period of time.
Basically, as long as they are not brain dead, they can stay there.
It is worth mentioning that after the fourth type of patients are admitted to the ICU, very few can get out alive.
They already knew this would be the outcome before they entered IC U.
It's purely to make life last longer, that's all.
Of course, we must also realize that the relatives of such patients are willing to pay the expensive medical bills because they cannot give up their family ties.
For example, children who don’t want to see their parents who raised them pass away are willing to give everything they have, even if it’s just to let their parents stay in this world for just one more second.
"The sources of patients in the Department of Critical Care Medicine are roughly these four categories. I have given you such a detailed introduction so that you can have a clear idea of what to do after you start working. I want to make it clear what the treatment direction and purpose are for each type of patient."
The person in charge said loudly.
There are four types of patients, and each type has a different focus on treatment.
In preparation for surgery, we must find ways to reduce complications and provide patients with better nutritional support as much as possible.
In order to prolong life, we must find ways to ensure that the patient does not die.
After listening to this, Zhou Can had a preliminary sense of the tense atmosphere in the Department of Critical Care Medicine.
"When the critical care department admits a patient, in addition to the four criteria given above, there is another very important indicator, which is the mortality score. For example, the acute physiology and chronic health scoring system is used to predict the mortality rate based on the scores of the patient's various physiological indicators. A score of 15-35 means that the mortality rate is higher than 15% and lower than 85%, and the patient is most suitable for admission to the ICU."
This scoring standard is currently basically the gold standard for admission to each ICU.
The mortality rate is less than 15%, and patients are generally admitted to specialized ICUs or general wards.
The mortality rate is higher than 85%. Unless the family really has a mine, the doctor will recommend that the patient spend the last moments of his life in the emergency room out of conscience.
Of course, this standard cannot be dogmatic.
The predicted mortality rate of some patients is higher than 85%, but the attending physician believes that they can be saved by being admitted to the intensive care unit. As long as they can get through the most difficult period, there is a possibility of improvement, so they must be admitted.
Reducing the mortality rate of patients in our hospital is the fundamental purpose of establishing the Department of Critical Care Medicine.
"Next, let's talk about the grouping. The clinical medical team is divided into three groups, working in three shifts, eight hours a day. The nursing team has five groups, working 12 hours a day. The critical care department is a high-intensity job, so you must be mentally prepared."
The ratio of doctors to nurses is about one to three.
There are three nurses to one doctor.
Each patient in each bed receives one-on-one service.
One doctor is in charge of a maximum of three beds.
It's like a battlefield, we charge forward wherever there is a need.
"Okay, that's the basic introduction. If you don't understand something, you can find an opportunity to ask the senior doctors. But I must tell you that when working in the intensive care unit, it's best to talk less and do more. Your senior doctors need to concentrate on handling every emergency. If you ask questions at the wrong time and interrupt their train of thought, you will be scolded at best, or sent to me so that I can teach you the rules."
The person in charge first explained the rules to the 32 trainees.
It is completely different from ordinary departments.
In the specialist ward, doctors are more relaxed. Not only do they ask questions, but they also chat with each other.
"Now we will start assigning you senior doctors to teach you. Currently, we can only arrange for residents to teach you. Those who perform well will have the opportunity to get a chance to become an attending physician."
Flipping the cards is the emperor's choice of which concubine to sleep with at night.
What this means is probably that if you are appreciated by the attending physician, he may personally take you under his wing.
By following the attending physician, you will definitely learn more advanced knowledge.
"Zhou Can, your instructor is the attending physician Hu Yiba."
The first person to announce was actually Zhou Can.
Everyone could see that this trainee named Zhou Can was given special treatment in every aspect and his treatment was completely different from theirs.
The few interns who came from the Department of Neurosurgery with Zhou Can were fine, as they knew that Zhou Can's strength and talent were far superior to those of ordinary interns, so it was not surprising that he could receive such treatment.
People who don't understand him are already cursing him in their hearts.
Damn, who is this person who has connections and comes here to attack people?
Under normal circumstances, how could a trainee get special care from the vice president? For many trainees, they have never even seen whether the vice president is fat or thin, male or female.
"Jin Mingxi, with Yuan Kun as the instructor. Chen Hao, with Luo Sanzhang as the instructor..."
Different from the regular training in other departments, the treatment enjoyed here seems to be one-on-one guidance.
Everyone felt much more balanced.
It is also very good to have one-on-one guidance from a resident doctor .
Only one level lower than Zhou Can.
Soon, all the teaching teachers were arranged. Except for Zhou Can, who was taught by an attending physician, all the others were taught by resident doctors.
"Have you seen this duty roster? You can find your supervising physician on it. If your supervising physician is not working now, you can first familiarize yourself with the rules in the office, or you can go home and sleep directly, and adjust your working hours to coincide with your supervising physician."
Without someone to lead you, you probably won’t be able to even enter the door of the intensive care unit.
Zhou Can looked at the shift schedule of the attending physician Hu Yibao, which was from 8 a.m. to 4 p.m.
The scheduling here is very similar to that of the emergency department.
It's also a 24-hour shift.
"Are you all ready? Students who are scheduled for the morning shift, I will take you to the ICU. Remember, after entering, wash your hands first, and then change into isolation clothes. It is under sterile management, and in principle, you cannot enter and exit at will. If you need to go to the toilet or drink water, take care of it now. Students who are scheduled for the evening shift or night shift can go home and rest, and come back later."
Many people who were on the early shift rushed to the toilet or drink water.
Zhou Can secretly counted and found that there were nine people on the morning shift, including himself.
When he came back from the toilet, some of the interns had already left.
The person in charge of these trainee students was still waiting for them patiently.
"Is everyone here? Follow me!"
At the order given by the person in charge, everyone followed him out of the doctor's office.
"It's divided into multiple wards. If the senior doctor asks you to go over and support the rescue of a bed, you must do it immediately. Even if you are asked to wipe the patient's feces, urine, and phlegm, you must do it without hesitation. When you get here, the first thing you need to do is to put away your pampered nature. Also, you will see death almost every day in there, so you must learn to control your emotions. You are not allowed to cry in there, no matter how uncomfortable you are, you have to hold it in."
These words should be said to the two female doctors.
When male doctors see a patient die, they usually just retch and feel sad, but rarely shed tears.
Girls are very emotional. When they encounter sad things, they can cry in front of you at any time.
The person in charge took them to the corridor outside. On the wall covered with dark gold tiles were five large black characters "Critical Care Medicine Department".
There is a sign below that says "Nutrition Infusion Demonstration Ward".
The spacious automatic metal door was closed, and a conspicuous warning sign was hung on the wall next to the door.
"If we can't answer your doorbell in time, please understand that we are busy with rescue. Please go through the side door of the companion waiting area!"
I've heard that the intensive care unit has several entrances and exits.
Medical staff usually go in and out through this main door. Family members need to apply for visits and usually enter through the side door.
There is no one on duty there 24 hours a day.
If family members have something to give to the patient, or have prepared a nutritious meal and want the nurse to feed it to the patient, they can give it to the nurse on duty here.
However, it must be reminded that it is understandable that family members want patients to eat better and recover faster.
In fact, many of the foods given to patients are not necessarily fed to them by nurses.
I accepted it only to avoid medical disputes.
Sometimes patients actually cannot eat.
For example, patients who are about to undergo surgery, patients with tracheotomy, or other patients who need to fast are not allowed to eat.
There is really no need to ask where the food that was received went.
If you ask, the answer is that it was either poured out or fed to the patient.
Let me clarify that family members are not required to stay with the patient in the ICU, as everything will be taken care of by doctors, nurses, and professional caregivers.
In addition to the main gate and the side door for people to enter, there is another well-known door called the corpse transport door.
Dead patients are not transported out through the main entrance.
One is that it has a bad influence, and the other is that it can easily spread germs.
There is a special back door to transport the bodies out.
