Chapter 163 Death Process: The most powerful person in the critical care department is the anesthesiologist
“Do you know what to do after a patient dies?”
Dr. Hu asked Zhou Can.
“I haven’t dealt with it!”
Zhou Can shook his head.
"When a patient dies, the patient's death should be announced to the family in a timely manner. All long-term medical orders for the patient should be immediately stopped, the computer should be transferred to zero bed fee, the discharge or death registration should be completed, and the department director should be informed in a timely manner."
Dr. Hu taught him some general treatment procedures.
Patients unfortunately die in the critical care department almost every day. This is something that every doctor in the critical care department must learn.
At this time, the family members had changed into protective clothing and came in under the guidance of the nurse.
"My husband... wuwu..."
A woman in her mid-thirties began to sing and cry before she even reached the bed.
Women in many places have the custom of "singing and crying".
It can be understood as crying for others to hear, or proving to others that she is very sad.
In addition to this woman, there was another elderly woman who looked similar to the patient. She lay in front of the bed, stroking the patient's cheek with tears in her eyes.
"My child, how can you be so stupid and cruel? If you leave, how can I live?"
The old woman's voice was so sad that it made people feel very uncomfortable.
It is absolutely a tragedy in the world for the elderly to send off the young.
The mother-in-law and daughter-in-law were crying around the bed. The patient's wife, in particular, cried very hard, and although her tears were not seen, her singing voice was full.
Although it is not known what happened to the family, it eventually led to the man committing suicide by drinking pesticide.
But the man's family is definitely responsible.
If we could have given timely guidance, it wouldn't have come to this.
"Please control your emotions, family members, and hurry up to say goodbye to the patient! He is no longer able to live."
Seeing that the two family members were crying, Dr. Hu had no choice but to persuade them.
The man on the hospital bed was breathing very weakly. He tried hard to open his eyes a little and looked at his relatives and wife in front of the bed.
Tears rolled down the patient's eyes.
"Juan..."
He was calling his wife by her nickname.
"Yes, I'm here!" The woman quickly held his hand.
I don't know if it's an illusion. Zhou Can always feels that this woman is not as sad as he imagined about her husband's death.
No matter what, this is someone else's family affair and he will definitely not say anything.
I won't interfere in anything.
"Take care of... take care of my mother..." The man squeezed out these words with all his strength. When he looked at the woman, his eyes were full of pleading.
"I will, you can go without worry!" The woman nodded and agreed, crying.
The man's mother was crying beside him, her snot and tears mixed together.
Seeing that his wife agreed, the man's desire to survive completely disappeared.
The breathing just stopped.
Immediately afterwards, blood pressure disappeared, brain waves slowly disappeared, and heartbeat stopped.
The monitoring equipment sounded multiple alarms.
The patient has closed his eyes forever.
It must be said here that after the patient dies, the heart rate of some brain-dead patients will not return to zero immediately.
However, in medicine, the determination of death never requires the heartbeat to return to zero.
Brain death, dilated pupils, and respiratory arrest can be fully defined as medical death.
The heart may need to wait for a period of time after the patient dies before it stops beating completely. This time may be from half an hour to several hours.
Zhou Can stood in front of the bed and watched the patient die with his own eyes, and he was not as frightened as he was at first.
Maybe I have already accepted this mentally.
Be mentally prepared enough.
So he remained relatively calm about the patient's death.
The patient's mother fainted beside the bed from crying. She was truly heartbroken and in agony.
The patient's wife also cried bitterly.
Doctor Hu and the nurse handled the case step by step according to the procedures.
Dr. Hu removed the patient's ventilator and declared him clinically dead.
Then let the family members settle the hospitalization expenses.
This is very important.
Under normal circumstances, the family will not be allowed to take the body out of the hospital unless the fees are settled.
Tuya has a special morgue, also known as a morgue.
The body can remain there for up to twenty-four hours.
Some family members may abandon the body.
This situation rarely happens, but we still encounter some very strange family members.
At this time, the hospital will report it according to regulations, and a special department will handle it.
During the period when the family has not settled the hospitalization fees, the nurses will usually take the body to the morgue first.
The vast majority of family members believe that the dead are the most important and do not abandon the bodies.
Soon, the attendant who was responsible for pulling out the corpse came over. The two nurses had already removed all the instruments and tubes from the patient, and prepared and disposed of the corpse.
The body was taken away directly.
The family members had already been asked to leave the ICU.
After Dr. Hu finished filling out the death record, he temporarily called a doctor to help look after the other two beds under his responsibility.
Then he took Zhou Can to the duty room and taught Zhou Can how to use the computer to stop the patient's long-term medical orders and change the bed fee to zero.
This is a matter of detail and must be done in a timely manner.
Otherwise, it is very easy to cause medical disputes.
The patient died after receiving treatment in the hospital, and his family was already in a bad mood.
If, when processing discharge procedures, it is discovered that the patient has died but is still taking medication and still being charged for the bed, there will most likely be an argument.
At that time, the hospital will be particularly passive.
After learning the process of handling patient deaths, Zhou Can followed Dr. Hu back to the ward to continue his work.
The empty bed No. 6 will be cleaned and will soon welcome the next critically ill patient.
The cost of hospitalization in the ICU is very high, but the beds there are extremely limited.
As soon as a bed becomes vacant, the patients waiting outside to enter the ICU will be immediately present.
For a famous hospital like Tuya, there is never a shortage of patients.
On the contrary, what is lacking is beds.
…
It can be seen that the death of the patient in bed No. 6, for which Dr. Hu was in charge, had an impact on his emotions after all.
He looked a little depressed.
When Zhou Can returned to the ward to treat other patients, he also felt a little depressed.
Handle with extreme caution.
I was afraid that the patient would die suddenly.
Dr. Hu took advantage of this rare period of time to teach him how to use various medical equipment in the ICU.
There was basically no need to teach how to use the external defibrillator, Zhou Can had already learned how to use it.
The rest are infusion pumps, microinjection pumps, expectorants, invasive ventilators, non-invasive ventilators, blood filters, fiber bronchoscopes, etc. He was taught one by one, and the various uses were explained to him clearly.
In the ICU ward, the most complicated operation should be the extracorporeal membrane oxygenation (ECMO).
A doctor can't do it at all.
It requires multiple experienced doctors and nurses to work together.
Moreover, the cost of starting up this thing is extremely high, so it will not be easily used on patients.
It is only used for patients whose heart and breathing have stopped. Usually, after breathing and heartbeat stop, extracorporeal breathing and blood circulation pathways must be established for the patient in a very short time .
Otherwise, it won’t make much sense.
Doctor Hu taught Zhou Can how to skillfully use various instruments in the ICU ward, but he did not teach him all at once.
But it's intermittent.
Because in this process, various situations arise from time to time and require emergency handling.
A new patient was soon added to bed number 6.
He was a patient who had been in a car accident, suffered a cerebral hemorrhage, and fell into a deep coma.
The patient had three ventricular fibrillations right after he was brought in, and the situation was extremely dangerous. Dr. Hu appeared very calm and composed, and first operated the defibrillator himself to give the patient electric shocks.
He also taught Zhou Can various defibrillation techniques and key points.
"Doctor Hu, why are all the patients in the three beds we are in charge of extremely critical conditions?" Zhou Can asked with some confusion.
He had been observing secretly for so long.
I found that some of the patients lying on the beds had almost nothing to do.
Some patients have a nasogastric tube inserted, through which food is fed.
Then there was a urine bag hanging from his body, so he didn't have to worry about urinating. He was intubated with a trachea, so he didn't have to worry about breathing either.
The defecation will be handled by the nursing staff.
The nurse just needs to go over and check on him occasionally.
The three beds under the charge of Dr. Hu are all filled with critically ill patients, each one more serious than the other, and none of them are easy.
Zhou Can was terrified even when turning the patient over.
"The greater your ability, the heavier the burden on your shoulders. Haven't you heard of this?"
Doctor Hu retorted.
"Although the three patients in my care are all in serious condition, they are not the most critical. Did you see the patient in bed 17? That's really scary."
The patients cared for by attending physicians are naturally much more difficult than those cared for by residents.
This is roughly what Dr. Hu meant.
Zhou Can looked towards bed 17 and saw two doctors and two nurses busying around the patient.
They all had an expression as if they were facing a formidable enemy.
In the following time, Zhou Can glanced at bed 17 from time to time.
The two doctors and two nurses never had a break.
I don’t know what kind of patient it is, but his condition is so serious.
"Xiao Zhou, after the patient is on the ventilator, you must remember to suction the patient's sputum in time. Don't be lazy. Especially the patient in bed 8 has a lot of sputum. If you don't suction his sputum in time, it will easily block his respiratory tract and sometimes even cause choking. When handling, be sure to wear a mask. Novice doctors and nurses are often sprayed with sputum by patients."
After Dr. Hu taught Zhou Can some basic instrument operations, he began to teach him how to care for patients.
Most of the patients' sputum is purulent, and it's disgusting to think about having it sprayed all over your face.
What's more, many of the patients staying here suffer from sepsis and various infections.
Zhou Can's hair stood on end when he heard this.
When suctioning the sputum of the patient in bed 8, I am always very careful, for fear of being sprayed with sputum by the patient.
Fortunately, this has not happened yet.
After the condition of the car accident patient with cerebral hemorrhage stabilized a little, Zhou Can ran to bed No. 7 again and picked up the patient's information to study.
For this patient with diffuse intestinal bleeding, is it impossible to find out the cause of bleeding?
He loved to ponder these difficult cases that were hard to diagnose.
If the cause of the bleeding can be found, a treatment may be found, and the patient may then be able to improve and return to a normal ward.
Of course, it is definitely not as simple as imagined.
The patients admitted here have already been cleared by the attending physicians and chief physicians of the specialist department.
The fact that even they couldn't find the cause of the disease was enough to show how difficult it was.
"Xiao Zhou, you keep studying the data of the patient in bed 7. Is there something you don't understand?"
Dr. Hu took the initiative to come over.
"What do you think is the real cause of this patient's gastrointestinal bleeding?"
"How would we know? Several chief gastroenterologists have already consulted with the patient. At present, they can only confirm that the patient is bleeding in the colon, and they can rule out tumors and polyps. The attending doctor took the risk of performing a colonoscopy on the patient, used hemostatic enzymes, and even sprayed adrenaline on the bleeding point. But the effect is not obvious. It's like whack-a-mole. Once the bleeding stops, a new bleeding source will emerge."
"The final conclusion was diffuse bleeding in the large intestine. The reason we were willing to admit him to the ICU was because he had chronic gastrointestinal bleeding, and there was no intestinal perforation."
Doctor Hu explained the patient's condition to him in detail.
From these conversations, we can see that Dr. Hu is definitely a qualified ICU doctor.
He had a thorough understanding of the patient's condition.
All possible treatment measures have been taken.
"So, the patient should have extensive bleeding in the inner wall of the large intestine, with multiple lesions. Logically speaking, if there are bleeding in multiple places in the large intestine, wouldn't the patient's wounds become ulcerated and infected?"
Zhou Can asked curiously.
The bacterial flora in the large intestine is very diverse.
This is where human feces is formed.
"Strangely enough, the patient had been suffering from black stools for more than half a year before he was admitted to the hospital. Logically, he should have been infected and had intestinal perforation. But he did not have this condition."
Dr. Hu was also very puzzled about this.
There were indeed many things about this patient that were not normal.
There are many strange and varied diseases in the world, with many causes and symptoms that are beyond the understanding of doctors.
Just like there are countless unsolved mysteries in the world today, which cannot be explained by current human science.
At this time, the machine alarm sounded again in bed 8.
Zhou Can quickly put down the information in his hand and walked over to deal with it.
I saw that the patient's blood oxygen saturation dropped to 75%, which was already scary.
And it is still falling rapidly and continuously.
The machine kept sounding the alarm.
The patient's face and lips are cyanotic, which is the most direct manifestation of hypoxia.
There must be something wrong with my breathing.
Zhou Can quickly checked the patient's ventilator and found it was installed correctly.
The condensation water was just poured out not long ago.
Then he leaned over and listened, but there was no obvious phlegm sound.
There was no sign of the pulse oximeter clamp being loose.
He couldn't figure out the cause, so he turned around and prepared to call Dr. Hu for help.
As a result, Dr. Hu was standing behind him.
"When you encounter this situation, don't panic. You can try adjusting your breathing parameters first."
Dr. Hu appeared extremely calm.
After adjusting the respiratory parameters, the patient's blood oxygen index finally stopped falling and began to recover continuously at a very fast speed.
Zhou Can breathed a sigh of relief and saw with his own eyes that the patient's cyanosis of the lips disappeared little by little.
The problem has been solved.
"Have you learned it?"
Dr. Hu asked him.
"It turns out that breathing parameters cannot be fixed! It seems that I still have a lot to learn. I hope you can give me more guidance in the future."
Zhou Can had no experience working in the ICU, and he felt that he learned more in that day than he had learned in a whole year.
Before I knew it, it was time to get off work.
It was agreed that we would get off work at four o'clock, but the doctor who was taking over the shift didn't come in until five o'clock.
The doctor who came to take over was a middle-aged doctor in his forties, thin, expressionless, and with eyes that lacked the vitality of a normal person. He seemed to be numb to everything in the world.
Dr. Shi is a man of few words and never smiles when he speaks.
After completing the handover and coming out of the ICU, Zhou Can couldn't help but ask, "Dr. Shi who took over was so cold and serious!"
"You'll get used to it. Dr. Shi is actually a very nice person, and he's very warm-hearted when things get tough. He used to be an anesthesiologist, but later switched to become an attending physician in the critical care department. If nothing unexpected happens, he'll be promoted to associate senior professional title this year."
Doctor Hu explained to Zhou Can.
Most anesthesiologists are self-admiring and don't like to talk too much with others.
It’s not that they are aloof.
It's related to their profession. When working, they must always keep a close eye on the patient's vital signs, and if there is any sign of trouble, they must take immediate action or give the surgeon some correct advice.
This means that they are destined to have no smiles and always maintain a serious expression while working.
Over time, this is the kind of personality I developed.
Not only is the work of anesthesiologists hard, but they also have limited room for advancement and their development prospects are not very ideal.
At least that’s the case in China right now.
In developed countries, such as Japan and Germany, anesthesiologists are very popular and have a high status. Anesthesiologists in the United States earn $190,000, which is the highest income among doctors.
China is similar to France, where doctors have a very high status.
In fact, the status of specialists in the United States is also very high.
However, most doctors in the United States are family doctors, which is equivalent to community doctors in our country. Of course, their income is much higher. There are only two types of doctors with real status in the United States. One is a doctor of medicine or professor who does research, and the other is a leader in a certain discipline working in a medical center. Those who have achieved success are called super doctors.
The status is equivalent to that of a first-level director in our country, or even higher.
"Do you know what type of doctors are the best in the intensive care unit? They are doctors who have transformed from anesthesiologists." Director Hu revealed another shocking fact to him.
