Chapter 164 Prepare for a rainy day and find out the cause of the illness of bed 7 patient
The origin of ICU construction abroad is not very clear. The earliest ICU construction in China was led by anesthesiologists.
Speaking of this, I have to first introduce the emergency department.
In the past, there was no emergency department in domestic hospitals. It was a department that came into being later to rescue emergency patients. Later, a series of regulations and discipline definitions were carried out, and finally it was consistent with its name . All emergency patients can register for the emergency department.
And the emergency department cannot refuse to treat patients.
Also, the specialist clinic is closed at night.
There are doctors on duty in the emergency room 24 hours a day, and you must be seen by a doctor at any time when you go to the hospital for emergency treatment.
With these two gold standards, the emergency department later added some privileges.
For example, when a patient who was in a car accident was sent here, there was no family member. It was impossible to contact the family member or the patient's immediate family members for a while. The patient was in critical condition, and according to the hospital's rules, the family member had to sign and pay before the patient could be treated.
In this situation, the emergency department has an additional privilege: during working hours, if there is no family member’s signature, they can go directly to the medical department, and then the director of the emergency department will sign on their behalf.
No one pays, but if surgery or rescue is not arranged immediately, the patient will die immediately.
Easy!
Deal with the outstanding debts first.
Even today, the emergency department still ranks first among the departments with the most bad debts in hospitals.
In addition to these privileges, emergency examinations will generally be marked as expedited.
Many of them can be done without queuing and can be done first.
If you want to be admitted to a specialist department, you have to wait until a bed becomes available before you can be admitted.
There are not so many requirements for emergency treatment. If the condition really doesn’t exist, you can just lie down in the observation room.
Anyway, you doctors can't just watch your patients die in the hospital, right?
With so many conveniences and privileges, patients love the services of the emergency department.
As a result, the emergency department became the busiest department in the entire hospital.
The department heads, experts, doctors, and nurses of various specialized departments naturally refused to agree when they saw that all the patients had gone to the emergency department.
As a result, the emergency department, which was inherently deficient, became a transit station for medical consultations.
We only deal with emergency and critically ill patients, and only provide preliminary treatment. Once the patient's condition stabilizes, they will be directed to the appropriate specialist department to continue treatment.
This way, the specialist departments can feel at ease.
It is equivalent to having an extra helper who can conduct initial screening and treatment of patients.
When sent to a specialist for treatment, the medical staff will just follow the steps and proceed slowly.
The specialist found that life was much more comfortable than when there was no emergency department.
Key revenues have not decreased.
Because the emergency department only provides initial treatment for patients, it earns almost no 10% of the bulk of the medical expenses, such as medication, surgery, and hospitalization.
But the emergency department does more work than any other specialty.
They also have to endure all kinds of abuse and even beatings from patients and their families.
Emergency department work is exhausting, dangerous, and low paying.
So there is a saying in the medical community that advises people to go to the emergency department to be careful of being struck by lightning.
Over time, few doctors are willing to stay in the emergency department for a long time. Especially those capable doctors, after gaining experience, jump to the powerful departments, where they enjoy a good life and a high status.
Failure to retain elite doctors will inevitably lead to poor rescue capabilities in the emergency department.
What should I do?
Later, critical care medicine emerged.
When the emergency department receives some critically ill patients and cannot handle them, the medical staff of the intensive care unit will step in to save the patients' lives.
When it comes to life support and vital monitoring, doctors in the anesthesiology department are undoubtedly the top dogs.
This was also the early critical care medicine department in China, and the core doctors were basically anesthesiologists.
Later, the nutritional support of internal medicine was integrated into the critical care medicine department, and combined with the various life support services of anesthesiologists. This is perfect.
Gradually, some critically ill patients admitted to the ICU were no longer carried in alive and carried out dead.
The number of patients who survived and were transferred to general wards gradually increased.
Today, the Department of Critical Care Medicine has absorbed the examination of the medical technology department, the nutritional support of the internal medicine department, the life monitoring and life support of the anesthesia department, and the surgical support, such as invasive ventilators , tracheotomy tubes, hanging urine bags, etc.
It can be said that the current critical care medicine department represents the comprehensive strength of a hospital.
Elite medical staff are drawn from various departments to provide patients with the best medical resources, life support, and various treatments.
However, no matter how things develop, anesthesiologists have the first-mover advantage and their position in critical care medicine is still crucial.
"It turns out that Dr. Shi used to be an anesthesiologist, so it's understandable that he's taciturn. Do you think that compared to the anesthesiology department, the development of the critical care medicine department is better?"
Zhou Can was very curious, which department was better?
Anesthesiology and critical care medicine, these two departments seem relatively mysterious to most doctors.
We know very little about their income and development prospects.
"To each his own! Dr. Shi's transition to the Department of Critical Care Medicine should be considered a very successful transition. Although he was promoted to the chief physician level in the Department of Anesthesiology before, his title remains unchanged after he switched to the Department of Critical Care Medicine. However, he is likely to be awarded the title of associate senior professional this year, which he may not be able to achieve if he still works in anesthesia."
Being evaluated for associate senior professional title is a hurdle for many attending physicians.
At least one project at the provincial level or above and three papers published in core journals are enough to block many people.
As for the written examination for associate senior professional titles, it is only the easiest first hurdle.
Dr. Shi should be around 39 to 40 years old.
Some doctors with good talent, good foundation and good luck may be awarded associate senior professional titles at the age of 38. But there are only a very small number of them.
Many people are grateful if they can be awarded the title of associate senior professional before the age of 45.
Why add the word "good luck"?
Because when choosing a research topic, if you can hold on to the big legs of a big guy, you can participate in a good project, or you can be assigned a more ordinary project to host.
These good things require luck and character to get.
Dr. Shi was able to be promoted to associate senior professor at the age of 40, especially in a large hospital like Tuya where competition is extremely fierce. This is definitely a very successful transformation.
Zhou Can went to great lengths to inquire about this matter in order to prepare for future professional title evaluation.
Family members know their own business.
His low education level is a major flaw. The higher he climbs, the more obvious this flaw becomes.
Although with his current development momentum, he will most likely be able to solve the academic qualification problem in the workplace, but one must always prepare for the worst.
It would be a good idea to ask more questions now so as to prepare for a rainy day.
"Xiao Zhou, go to the ICU to take over at 8 o'clock tomorrow morning. Remember to arrive about half an hour early."
Doctor Hu gave Zhou Can some instructions before they parted.
Today is only the first day at work. Zhou Can mainly learn how to operate various equipment and familiarize himself with the environment.
Tomorrow, I should slowly add some tasks to him.
After get off work, even while eating dinner in the hospital cafeteria, Zhou Can was still thinking about the patient in bed 7. What was the cause of lower gastrointestinal bleeding?
The patient's various examination reports kept replaying in his mind.
Intestinal bleeding is very likely to cause perforation if not treated in time. However, the patient waited for half a year without treatment and his intestines did not perforate.
This shouldn't be a miracle.
There must be some unknown reason.
The patient has already undergone endoscopic hemostatic treatment. If there are obvious abnormalities in the intestines, the doctor will definitely be able to discover them in time.
The patient underwent routine stool examination and occult blood examination.
No obvious cause was found in the examination report.
The anatomical diagram of the human digestive tract emerged in Zhou Can's mind.
The human intestine consists of the small intestine and the large intestine.
The small intestine starts from the pylorus of the stomach and ends at the cecum of the large intestine.
The length of the entire large intestine is about 1.5 meters for an adult. It is not too long, because the end can be probed from the intestinal gate, so the pathological conditions in the large intestine are easier to detect.
Zhou Can thought to himself that intestinal tumors, polyps, intestinal ulcers, and various types of enteritis can now basically be ruled out.
Vascular malformations and varicose veins can also be ruled out.
This disease is really difficult to deal with.
It’s not really my fault that the gastroenterologists weren’t able to find out what’s wrong.
The patient's illness is too complicated.
It’s complicated, but also simple.
Because its bleeding has been basically confirmed, it is diffuse bleeding in the large intestine segment.
The large intestine mainly includes the cecum, appendix, colon, rectum, and anal canal.
The appendix can be ruled out first.
If there is something wrong with it, the patient will be in excruciating pain and the recovery will not last more than half a year.
And it will rot in the abdominal cavity.
The anal canal can basically be ruled out.
Then there are only three parts left: the cecum, colon, and rectum.
It would be difficult to gain anything if we start from these three parts.
His current level of pathological diagnosis is at the mid-level of a resident doctor. No matter how arrogant he is, he can't be more arrogant than the chief physician.
The reason why he can achieve success time and time again is because of his alternative diagnostic thinking.
Looking at the problem from a different angle can help you see some blind spots that other doctors cannot see.
This is one of his advantages.
“Could it be that there is a malignant tumor in the large intestine, and then it has infiltrated?”
His mind was full of ideas and he thought of a possibility.
The patient underwent a routine blood test and leukemia was ruled out.
Generally speaking, the first step in screening for unexplained bleeding is leukemia and bleeding disorders.
If a patient has a malignant tumor, it should be able to be detected when undergoing angiography.
Zhou Can tried again to recall the angiography report, and finally, he preliminarily ruled out the possibility of malignant tumor infiltration.
That leaves only the last inference.
He boldly speculated whether the cause of the disease might be in the small intestine?
The small intestine of an adult is about 7 meters long, and the shortest is 5 meters long. It is the main nutrient absorption organ of the human body.
The patient is so thin, of course, because of long-term bleeding.
But it's also possible that the bleeding is just a smokescreen.
It is for this reason that doctors are led by this when making diagnoses. In other words, doctors' diagnoses fall into this almost iron rule-like misunderstanding.
When Zhou Can first learned about the patient's condition, he heard that the patient had bloody stools for more than half a year and then came to the hospital for treatment.
I also instinctively think that the patient's weight loss is caused by delaying treatment for too long.
If anyone has bloody stools for more than half a year, it is impossible to maintain weight loss.
"Yes, we should check the small intestine."
The more Zhou Can thought about it, the more it made sense, and his thoughts became clearer.
Alternative diagnostic thinking allowed him to break the inherent rules and avoid diagnostic misunderstandings.
There is a problem with the small intestine segment. What is the most likely possibility?
First, one condition must be met.
When the dirty fluid discharged from the small intestine enters the large intestine, it will cause large intestine bleeding.
This can also well explain why the bleeding site in the large intestine is not fixed.
Zhou Can decided to find the patient's attending physician to ask about the situation.
The doctor who saw this patient was named Xia Ping, an attending physician in gastroenterology.
After finishing my meal in the hospital cafeteria, it was already half past six.
The gastroenterology clinic must have closed long ago.
But there will definitely be doctors on duty in the inpatient department.
Zhou Can has a very good relationship with Director Tan and Director Yin Hua of the Internal Medicine Department. They are all the top bosses in the Internal Medicine Department.
At this time, go to the inpatient department of the Department of Internal Medicine to ask Dr. Xia Ping about the situation. There should be no problem.
He is a man of action, he does what he thinks and never lets his dreams go unfulfilled.
I walked quickly all the way to the inpatient department of the Department of Gastroenterology.
"Hello, I'm Zhou Can, a resident doctor in the Department of Critical Care Medicine. I'd like to speak to Dr. Xia Ping from the Department of Gastroenterology."
Zhou Can could only ask the girl at the nurse station.
"I'm sorry, Doctor Xia has already gone off work. If the matter is not particularly urgent, you can come to see him tomorrow."
The nurse's attitude was pretty good.
The reason why she is called nurse sister is because she is at least over thirty years old.
Much older than Zhou Can.
Only when you meet a fresh and young nurse in her twenties can you call her a nurse girl.
"It's not particularly urgent, but it concerns the safety of a patient in the intensive care unit. I want to ask Dr. Xia about the patient's condition right now. You can give me Dr. Xia's phone number."
Zhou Can was really worried that the patient in bed 7 wouldn't last long.
Because when I had a bowel movement today, my intestines were pulled out.
Moreover, the patient's physical condition is already extremely weak. Finding the cause of the patient's bleeding one day earlier will be much more meaningful.
"We don't have the doctor's phone number here! You can go to the doctor's duty room and ask the doctor on duty."
Nurses deal with large numbers of family members every day.
Each one is very slippery.
If you want to ask something from them, forget it unless they are doctors in the department with whom you have a good relationship.
Zhou Can understood what was going on and without wasting any more time, he went straight into the doctor's office.
Boom boom boom!
The office door was open and the light was on, and there was only one doctor sitting with his back to the door.
Knocking on the door is a sign of politeness.
"Come in!"
The doctor looked back.
"It's you! Why are you here in our gastroenterology department instead of working in the emergency department?"
This male doctor was none other than Dr. Chi, who had gone to the emergency department for emergency treatment last time.
He should have a deep impression of Zhou Can.
Otherwise it would be impossible to recognize it at first glance.
"Hello, Doctor Chi!"
Zhou Can tried his best to respect the other party.
Last time, this Dr. Chi went to the emergency department and acted arrogantly, and ended up in disgrace.
Zhou Can naturally would not mention the embarrassing things in the past again.
"What's up?"
Doctor Chi looked a little unnatural, probably remembering what happened last time. It was definitely awkward.
"I want to talk to Dr. Xia Ping about a patient. Can you tell me his phone number?"
Zhou Can lowered his posture and asked.
"It's Doctor Xia's phone number. OK, I'll look for it. Wait a minute!"
Dr. Chi did not make things difficult. He actually put down what he was doing and looked for Zhou Can's phone number.
"Here, this is Dr. Xia's cell phone number, you can just call it. But it's after get off work now, so I'm not sure if I can get in touch with him."
"thank you!"
Zhou Can called the number on the duty roster.
Fortunately, the call was connected.
He did not shy away from asking about the patient directly in the office.
"Hello, Doctor Xia. I'm Zhou Can, a resident in the Department of Critical Care Medicine. I'd like to ask you about the condition of a patient with gastrointestinal bleeding named Guo Ziyang in bed 7. Is it convenient now?"
Zhou Can asked.
"Convenient, convenient, you say!"
The voice on the other end of the phone was steady and full of charm.
