Chapter 167 A special medical skill, a turnaround for the patient in bed 6
"Just meet me at the office around 3:30 tomorrow afternoon."
It looks like Director Liu will be working the night shift tomorrow.
"You have WeChat, right? Join the group later. If there are any temporary shift changes or other matters, we will notify you in the group."
Doctors in almost every department are divided into several medical teams.
For example, there is a group for orthopedics and bone trauma. The doctors in this group basically study diseases in the field of bone trauma. Then there is a group for bone and joint surgery, a group for microsurgery, a group for hand surgery, a group for ankle surgery, and a group for spinal surgery.
Zhou Can had just entered the intensive care unit and wasn’t familiar with the grouping of this department.
The Department of Critical Care Medicine is generally divided into three groups.
It mainly includes three areas: respiratory, multiple organ dysfunction, cardiovascular and cerebrovascular, and neurological.
To put it simply, it is the three major systems of internal and external circulation and nerves.
As long as these three systems are fine, a person's life is guaranteed.
External circulation mainly refers to breathing, including the entire respiratory system, blood oxygen exchange and synthesis, etc.
Internal circulation mainly refers to blood transportation, the supply of blood and oxygen in the body, and the supply and excretion of nutrients.
Needless to say, the nerves are the entire nervous system with the brain stem as its center.
After analyzing the three major systems that support a person's life, the work of the anesthesiologist does not seem so mysterious.
If you want to make a patient lose their sense of pain, just cut off the nerve signals.
General anesthesia and spinal anesthesia are the most commonly used methods by anesthesiologists. As for local anesthesia, they rarely need it.
Considering the cost of surgery, the surgeon in charge usually does this operation together.
"Doctor Hu, after get off work, remember to add Doctor Zhou to our group."
After Director Liu finished explaining, he left without waiting for Zhou Can to say anything else.
As soon as Director Liu left, Dr. Hu was obviously much more relaxed.
"From now on, it's your young people's world! The waves of the Yangtze River are like waves ahead, and each generation is stronger than the last." Doctor Hu's expression was very complicated.
Looking at Zhou Can's great achievements, it would be a lie to say that I didn't feel jealous.
Now, Zhou Can has won the appreciation of Director Liu and can be said to have grown stronger.
Dr. Hu could only accept the reality.
Try to maintain a good relationship with Zhou Can as a colleague and no longer treat him as an ordinary trainee.
At this time, the alarm of bed 6 sounded.
The alarm sound of each machine is actually different.
Zhou Can had been working here for a day. As soon as he heard the sound, he knew there was something wrong with the blood pressure.
I ran over to take a look, and saw that my blood pressure was indeed dropping sharply.
I'm afraid that bed number 6 will have to send someone away again. When will this curse be broken?
Dr. Hu is accustomed to all kinds of big scenes, so he is not panicked.
After checking, he said decisively, "It's ventricular fibrillation. It must be ventricular fibrillation. Defibrillate immediately."
Ventricular fibrillation is the rapid and weak contraction or uncoordinated rapid beating of the ventricular muscle.
This will result in the heart not pumping blood, and all heart sounds and pulses will disappear.
Blood perfusion to organs such as the heart and brain and surrounding tissues stops.
The human heart is like a water pump. It pumps blood out through continuous beating and transports blood to major organs and tissues throughout the body through arteries.
When ventricular fibrillation occurs, it is equivalent to a problem with the water pump, and the blood cannot be pumped out effectively.
Irreversible damage will occur to the brain if the brain is deprived of blood for three minutes. Brain cells begin to die.
Ventricular fibrillation is very dangerous.
At this time, the most common rescue method is defibrillation with a defibrillator.
"Xiao Zhou, I taught you how to defibrillate yesterday. Do you know how to do it?"
"meeting!"
Zhou Can took the prepared defibrillator and said nothing.
Administer an electric shock to the patient's chest.
The patient's body bounced back violently after receiving the electric shock.
This is a normal reaction.
[First aid, experience value +1. ]
Zhou Can was a little confused.
I have never acquired this medical skill! How come a medical skill of emergency and life-saving suddenly appeared?
He was in a hurry to save the patient and couldn't go into it in detail.
The first time the patient was defibrillated, the effect was not very good.
“Come again!”
Doctor Hu stood by and gave orders calmly.
Zhou Can performed electric defibrillation on the patient again.
[First aid, experience value +1. ]
The patient's heart rate and blood pressure gradually returned to normal, and his life was temporarily saved.
He and Dr. Hu both breathed a sigh of relief.
It was really scary to see the patient's blood pressure dropping straight down just now.
Some patients living in the ICU ward have to go through the gates of death many times a day.
Doctors and nurses worked together to pull them back each time, and then continued various life support and treatments until they exhausted all means to help them successfully escape danger and be transferred out of the ICU.
Or eventually send people away.
There are also some special circumstances that will require the patient to be transferred out.
For example, family members do not agree to treatment. Or patients with malignant tumors or other terminal illnesses know that they cannot be cured.
In principle, such patients would be transferred away.
Some private hospitals or small hospitals may take the operating costs of the ICU into consideration. If there are not enough patients, keeping the patients for a few more days is a common practice.
For a regular doctor like Tuya, when performing emergency treatment on ICU patients, he needs to get the family members’ signature and consent if the material costs exceed 200 yuan.
Moreover, the operating costs of the ICU are very high and basically it is a loss-making operation.
Let's take two examples of charges to explain that one day's treatment cost in the ICU is at least two to three thousand, and up to tens of thousands. Why do people still say that it would be a loss?
The cost of performing thoracentesis or abdominal puncture on a patient is about 90 yuan.
At least two medical staff are required to perform a thoracentesis.
A senior attending physician and a nurse assisting him.
If the puncture goes smoothly, it will take at least half an hour. This is only possible if the attending physician has strong operating skills, skilled techniques, and the nurse cooperates well. The patient's condition should be relatively normal.
Otherwise, various difficulties will occur during puncture. At this time, B-ultrasound positioning must be used to complete the puncture.
Two or three people worked for at least half an hour, and used B-ultrasound, which is not cheap but not particularly expensive. And consumables. The final charge was 90 yuan.
Do you think the hospital is losing money?
To give another example, I believe many people are familiar with chest compression.
This is the cardiopulmonary resuscitation method that is often mentioned.
Chest compressions seem simple, but they are actually very tiring. If you are rescuing an adult, the depth of each compression is about 5 cm, and you need to perform more than 100 compressions per minute.
It is best to reach about 120 times.
This kind of high-intensity compression can be done by one or two people taking turns for a short time, but if it lasts for a long time, don't even think about it.
But the family members were unwilling to give up, and the medical staff had to continue the rescue even if they had to shed tears, grit their teeth, and work themselves to death.
Generally, the rescue process will last for several hours.
Four or five hours is common.
Family members generally hope for a miracle of life, so that doctors can save their loved ones. Therefore, family members will not give up hope unless they try to save their loved ones for several hours.
Even if you press it for four hours.
Such long-term compressions usually require four or five medical staff. Nurses have limited strength, so doctors usually do the compressions.
Four or five doctors work hard for four or five hours, how much is the final charge?
100 yuan.
Moreover, the hospital has a strict rule that patients can only be admitted once.
Some patients' hearts can stop beating several times a day. He is just teasing you doctors, asking you to press and resuscitate desperately.
The final charge was still 100 yuan.
Did the hospital make a loss or a profit?
It’s not even enough for half a day’s salary for a doctor.
Many family members and patients said that the hospital's ICU was really fucking rip-off, charging them ten or twenty thousand yuan a day, which was a robbery.
But they don’t even look at what expensive instruments, consumables and drugs were used that day.
Many consumables are imported.
Why not use domestic products? It's hard to describe the quality of domestic products.
Not to mention medicinal herbs.
In a large public hospital like Tuya, please stop saying that the cost of ICU treatment is expensive. As long as you can save lives, it is definitely worth it.
In case of loss of both life and property, the medical staff really did their best.
…
Zhou Can waited until the condition of the patient in bed 6 stabilized a little, then immediately checked out the new medical skills that had suddenly emerged.
As a result, you won’t know until you see it, and you will be delighted when you see it.
I don’t know when these two new medical skills emerged.
It is very likely that I acquired it while falling asleep last night.
Because he returned to the apartment yesterday, he practiced the knife skills and checked his personal medical skills. He did not have these two medical skills.
[First aid wisdom, current experience value: primary 2/1000. Special medical skills, can double wisdom when rescuing patients, keep a calm mind, and improve diagnostic thinking by 50%. ]
This was the first special medical skill he acquired.
Very interesting, this medical skill is only useful when it comes to rescuing patients.
His diagnostic thinking improved by 50%, which greatly helped him in diagnosing the cause of the patient's disease and finding the lesion.
No wonder when I was giving this car accident patient defibrillator his mind was obviously clearer than usual.
Maybe it was this medical skill that worked.
The diagnostic idea is equivalent to the problem-solving idea. The clearer it is, the easier it is to answer the question.
The accuracy rate will also be higher.
Let’s look at another new medical skill.
[Pharmacological dialectics, current experience value: Level 3 1/1000, lower level of resident doctor.]
This medical skill can deepen the understanding and application of pharmacology, and can use medication dialectically to ensure correct medication and achieve the best treatment effect.
This medical skill is directly at the level of a resident doctor, which may be related to Zhou Can's solid basic knowledge of pharmacology.
His pharmacological foundation is far better than that of ordinary trainees.
Now that he has mastered the skills of pharmacological dialectical medicine, Zhou Can can quickly improve his medical skills after obtaining his practicing physician license and the right to prescribe.
Pathological diagnosis is to identify the cause and clarify the pathological mechanism.
Up to now, Zhou Can has the three major means to defeat the disease: diagnosis, medication, and surgery.
As long as he gradually improves these medical skills, he believes that more and more diseases will be able to be cured.
These two new medical skills must have been acquired from treating the patient in bed 7 last night.
Pharmacological dialectics is because he prescribed medicine for the patient, and Dr. Shi probably adopted it.
As for his emergency medical skills, it is equivalent to giving him a compliment for his active behavior in rescuing the patient.
Or when he was rescuing patients, he often seemed possessed and extremely obsessed.
In this state, diagnostic thinking and wisdom are far beyond normal states.
It means to perform beyond one's normal level.
No matter what, Zhou Can felt like he had gained two new medical skills, and he was filled with joy.
"Xiao Zhou, Xiao Zhou!"
Doctor Hu saw Zhou Can standing there in a daze and called out to him repeatedly.
"Ah...you called me?"
After Zhou Can came to his senses, he felt a little embarrassed.
"You can't be absent-minded when working here. You must always be highly vigilant. Otherwise, a small mistake may lead to delayed rescue of patients and cause extremely serious consequences."
Dr. Hu warned him in a more serious tone.
"Got it! I'll definitely pay attention next time."
Zhou Can couldn't help but think of Zhu Shenfeng in a trance. Just because of diarrhea and a moment of negligence, a serious medical accident almost occurred.
"You keep an eye on it here, I'll go over there and help them."
Five or six doctors and nurses were gathered around a bed not far away, trying their best to rescue the critically ill patient.
Even from a distance one could feel the severity of the battle.
Dr. Hu took the initiative to help, which greatly changed Zhou Can's impression of him.
At least in terms of departmental unity and normal rescue process, Dr. Hu is a qualified and good doctor.
He was unwilling to take the risk of giving medication to patients because he had his own concerns and worries.
Not every doctor is willing to risk his or her future and hard-earned job.
Any mistake could result in losing your job or even being sued.
Sentencing generally occurs rarely.
Even if a doctor is clearly at fault, as long as he has no subjective malice, the most he can do is be suspended from work, have his prescription rights and surgery privileges suspended. In more serious cases, his medical license will be revoked. The most serious is a lifetime ban from the industry.
This means that you are not allowed to practice medicine again for the rest of your life.
Zhou Can picked up the patient's file for bed 6 and checked it. The examination report showed that the patient had severe intracranial hemorrhage, and the leg fracture was nothing compared to the brain injury.
"The bleeding point is close to the brain stem, and it is a large area of bleeding, accompanied by subarachnoid hemorrhage. There is a skull fracture. The patient is in a deep coma."
No wonder no doctor dared to operate on this patient.
The risk is too great.
The only way is to stay in the ICU for a few days to see if the bleeding can stop automatically?
Once the patient has overcome this difficulty and his condition has stabilized, we will formulate the next treatment plan.
"If the surgery can stop the bleeding and remove the blood clots in the brain, the patient's life should be saved at least."
After reading the examination report, Zhou Can quickly thought about the patient's treatment plan in his mind.
The plans he came up with might not actually be implemented.
But it can help him accumulate treatment experience and broaden his thinking.
The patient's chest CT scan showed no serious injuries. The ventricular fibrillation that occurred just now was probably caused by a problem with the brain.
The most common phenomenon caused by intracranial hemorrhage is intracranial hypertension.
Or a hematoma may occur, compressing important brain tissue.
A more serious case is when the bleeding occurs on important brain tissue. This situation is usually accompanied by damage to important brain tissue.
"If the patient's condition can be stabilized, maybe we can try a cranial endoscopic surgery. It mainly involves stopping bleeding, sucking out blood, and reducing intracranial pressure."
After careful research, Zhou Can found that the only treatment option he could think of was surgery.
Traditional craniotomy would probably take a long time, and would require a much higher level of patient tolerance. For minimally invasive endoscopic surgery, the surgery criteria should be met by tomorrow at the latest.
Zhou Can found that he gained a lot from the two months of training in neurosurgery.
By diagnosing this patient at this moment, he can formulate some reliable surgical plans with considerable confidence.
Having performed so many level 3 and 4 major neurosurgery operations, his knowledge, experience, and predictions of the entire perioperative period are incomparable.
"Brother, if you can hear me, just grit your teeth and get through today. When your condition stabilizes, I will recommend surgery to the senior physician." Zhou Can said to the patient.
I thought the unconscious patient definitely couldn't hear.
As a result, Zhou Can found tears flowing from the corners of the patient's eyes.
Then he found that the patient's heart rate increased significantly, and his brain waves also had some high-peak waves. It seemed that the patient really heard what he said, and it caused the patient to be emotionally excited.
He could hear me talking, think normally, and have emotional fluctuations. It seemed that the patient's brain was clear and the degree of coma had been alleviated.
Zhou Can was overjoyed after making these discoveries.
This patient, who seemed to be in extremely critical condition, could be saved. As long as he survived this crisis and underwent surgery to stop the bleeding in his brain and remove the hematoma, he would be able to survive.
While examining the patient in bed 6, Zhou Can recorded various conditions such as central venous blood pressure and urine volume.
Patients in the ICU are given urinary catheters not only to prevent them from urinating on themselves or going to the toilet frequently, but also to accurately observe the amount and color of urine.
If hematuria, proteinuria, etc. occur, they can be discovered at the first time.
If a patient has no urine flow for more than two days, the situation is not optimistic even if other signs are stable.
Basically, if a patient has no urine for a long time, it means that the internal circulation is failing.
This kind of organ failure is usually irreversible.
It is impossible to save the patient by dialysis or other support.
So, for ordinary people, eating, drinking, defecating and urinating, which are insignificant every day, are the most necessary things for critically ill patients.
Some key data are usually recorded every fifteen minutes.
By the time Zhou Can finished recording, the patient in Bed 7 had already started to make loud sputum sounds, which scared him so much that he hurried over to help Bed 7 suction out the sputum.
The nurse is turning the patient in bed 8 over and checking whether he has defecated on himself.
The nurses working in the ICU are all warriors.
Because suctioning out the patient's phlegm, wiping his feces, scrubbing the perineum and lips, and crushing the medicine and carefully feeding it to the patient are just the simplest daily tasks.
The stench from some septic patients is enough to make many young nurses unable to eat for a whole day.
However, if you work here for a long time, you will gradually adapt and become mentally very strong.
After suctioning the sputum of the patient in bed 7, Zhou Can checked the patient's blood pressure, breathing, urine volume and other data, and found that the patient had improved significantly. This was the most gratifying thing for him.
