Chapter 171: Human race is flawed, capable people should work harder
After checking each bed, Director Liu would take the initiative to explain to Zhou Can the patient's symptoms and what targeted treatments were given to them. Whether it was medication, respiratory support, blood filtration, or physical cooling, decompression and other treatment methods, they were all centered around the theme of saving lives.
Compared with Dr. Hu, Director Liu basically taught him various treatment theories in a simple and profound way, as well as their application in practice.
Dr. Hu taught him how to use various instruments and adjust the parameters.
There are also the most basic critical care knowledge and routine operations such as pumping medicine, observing urine volume, body temperature, and respiration.
It can be understood that the rescue knowledge and skills taught by Director Liu are advanced versions.
"The female patient in bed 11 is 17 years old and still very young. Her current symptoms are repeated low-grade fever, difficulty breathing, lung infection, cough and sputum. The doctor who received her conducted an investigation on the cause of the disease and initially determined that it was caused by a minor cold."
Zhou Can looked at the dying girl on the hospital bed, who was completely in a coma.
A persistent low-grade fever can make people feel tired, weak, and sleepy.
A minor cold sent her directly to the ICU. I don’t know whether to say that she was unlucky or it was her fate.
The humble flu actually kills many people every year.
Even though the girl was so sick and looked so haggard, she still looked very beautiful.
She is tall and has very fair skin, the kind with a rosy tint.
The hair is not black, but a little yellowish.
I don't know if it's been dyed.
Her high nose bridge is also impressive.
This girl has the beauty of a mixed-race person.
Zhou Can looked at the ventilator parameters.
The tidal volume was set at 9 ml/kg and the respiratory rate was 16 times/min.
Look at the inspiratory flow rate, 80ml/minute.
This inspiratory flow rate is significantly higher.
Dr. Hu told him that the flow rate should be increased when the patient has a fever, is irritable, or has convulsions, and should be reduced when the patient is sleeping peacefully.
“Does she have COPD?”
Zhou Can asked curiously.
"Yes! It is this disease, and it is probably a congenital disease."
Director Liu nodded slightly.
What causes obstructive pulmonary disease?
Zhou Can frowned slightly and picked up the patient's examination report to check. Chronic airway inflammation, lack of antichymotrypsin in the blood.
No wonder Director Liu said she had a congenital disease.
Chronic obstructive pulmonary disease is abbreviated as COPD. It is a chronic inflammatory disease of the airways.
Due to the presence of chronic airway inflammation, patients may experience some pathophysiological changes.
The most common is airflow limitation.
Then the patient will develop clinical symptoms such as coughing, sputum, and difficulty breathing.
There are many causes of COPD, and the lack of antichymotrypsin in the blood is a very rare congenital disease.
It is said that this has something to do with race.
Asians rarely suffer from this disease, but when the genes of Caucasians mutate, the baby will be born with a lack of antichymotrypsin.
No wonder this girl looks like a mixed-race.
Her father or mother was most likely white.
Antichymotrypsin is mainly found in α1 globulin.
It can inhibit the activity of many enzymes, such as trypsin, chymotrypsin, plasmin, thrombin, collagenase, leukocyte protease, and elastase.
Its deficiency can lead to the development of emphysema.
There is currently no drug that can cure this disease.
"You are an expert in the respiratory system. Is there no cure for chymotrypsin deficiency?"
"At present, there are too many diseases that cannot be cured by humans. Doctors seem helpless when facing many diseases." Director Liu shook his head helplessly.
All we can do for this patient right now is to do our best to help her get through this difficult time in her life.
After checking the patient's temperature, number of suctions, urine output and other records, Director Liu reminded the doctor in charge, "She obviously has too much sputum, and her lungs may be very damp. The tidal volume must not be set too high."
"OK!"
The doctor in charge of the operation was a senior resident, about 30 years old, tall and not very talkative.
Judging from the bed card records he made, he must be a very serious person.
Director Liu took Zhou Can to continue examining other patients.
…
The eight hours of work passed very quickly.
Zhou Can followed Director Liu to inspect the patients in his group, and when patients in other groups were in danger, Director Liu took him to help. Sometimes, other doctors would also anxiously ask him for help.
After the shift change, in the doctor's duty room, Director Liu checked the medical orders and found no problems.
He looked up at Zhou Can behind him.
"Xiao Zhou, after studying with me for a day, what have you learned?"
"I gained a lot. I learned how to use a variety of medications and treatment methods for critically ill patients. I also gained a deeper understanding of the flexible use of instruments."
Zhou Can did learn a lot of knowledge and methods about treating critically ill patients.
"That's a bit vague, let me sum it up in general terms."
Liu Ren tested him deliberately to see if he was studying hard.
Zhou Can thought about it, and then concluded, "When both the heartbeat and breathing are in trouble, restore the heartbeat first. Because the oxygen in the blood can support it for a while..."
"Who asked you to say this? Just summarize what you learned today. There's no need to be so specific."
Director Liu stopped him before he could finish.
It seemed that he was determined to make things difficult for Zhou Can.
"Uh... When treating patients, first ensure the operation of the internal and external circulations. Among them, breathing and heartbeat are the most important. After ensuring these two, then deal with problems such as body temperature, blood pressure, low blood oxygen, etc. When problems with the nervous system lead to respiratory and cardiac arrest, we must decisively establish an extracorporeal dual circulation."
Zhou Can made a conclusive summary.
In most cases, only brain death will lead to neurological failure and respiratory and cardiac arrest.
At this time, there is actually not much point in saving the patient's life.
However, there are many examples of vegetative patients being successfully awakened.
What we are fighting for is the hope that a miracle of life will happen.
"Well, you said much better this time. It seems that your busy day was not in vain."
Director Liu nodded with satisfaction.
He was very satisfied with Zhou Can's learning ability, understanding and work attitude.
As the chief physician, he spent a lot of time personally guiding Zhou Can. If Zhou Can was careless in his studies or pretended to be serious, he actually did not learn anything.
Then Director Liu will stop teaching him.
"Remember, our critical care doctors' ideas for treating patients should be fundamentally different from those of specialists. Specialists think first of curing diseases, while our critical care doctors think of saving lives first. Go back and think about it carefully, and then summarize what you have learned today. You will still be on the night shift tomorrow."
After Director Liu finished speaking, he left in a hurry.
Zhou Can was also about to leave, but Dr. Shi stopped him.
"Doctor Zhou, I'm going to write a paper about the patient in bed 7, and I'll include your name in it. If you're willing, you can study it with me."
Dr. Shi always speaks so directly.
"Thank you! As long as you don't think I'm a burden, you can call me anytime for research."
When it comes to such a good thing, Zhou Can naturally accepts it.
Dr. Shi is very kind.
It is okay not to write Zhou Can's name when writing the paper.
"Doctor Shi, Doctor Shi, the patient in bed 6 has woken up!" the nurse ran over excitedly to announce.
"Are you awake? I'll go check on you right away."
Doctor Shi walked quickly to the intensive care unit, and Zhou Can followed him in.
The patient in bed 6 was able to wake up thanks to the surgery he performed on the patient.
After entering, I found that the patient had opened his eyes and seemed to be conscious.
Because the patient's eyes are not dull.
"Great! It seems that there is still a lot of room for improvement in the treatment of patients in the intensive care unit!"
Dr. Shi was deeply touched.
Just yesterday, the patient was still in emergency state from time to time.
After the operation, the patient woke up from his critical illness and coma in just one day and one night. His vital signs became stable and all aspects of his condition improved rapidly.
Sometimes, treating patients is like fighting a war.
Once the 'command post' of the disease is found and defeated, the enemy will be defeated.
The patient's condition will improve rapidly in a very short period of time.
Being transferred out of the intensive care unit in two or three days is not a dream.
"Dr. Zhou's warrior spirit may lead to an upgrade and reform of the treatment model in the critical care department. In the past, we were too conservative in treating patients. Perhaps learning to take the initiative is the correct treatment concept."
Doctor Shi said to Zhou Can.
The treatment of patients in the critical care department is indeed conservative. Many medical staff only care about saving the patient's life and don't care about anything else.
More aggressive, bolder treatments mean high risks, and few doctors are willing to take that risk.
"Doctor Shi, the patient in bed 22 needs central venous pressure established, but the vein is difficult to puncture. Could you please go over and help?"
A nurse came over quickly.
"OK!"
Dr. Shi is an anesthesiologist by training and is very familiar with the operations of establishing various life monitoring systems.
Monitoring central venous pressure is an invasive monitoring method.
A central venous catheter needs to be placed in the internal jugular vein or subclavian vein and left at the junction of the right atrium and the superior and inferior vena cava for testing. The process of inserting the catheter is not so easy.
Especially when encountering patients with thin blood vessels and unclear veins, the operation is even more difficult.
The resident who was trying to set up central venous pressure monitoring was already sweating profusely.
"Let me try!"
Dr. Shi took the initiative to step forward and take over.
But his brows soon frowned and his expression became extremely focused.
The instrument next to it made an annoying alarm sound, which kept ringing.
The patient's blood oxygen saturation was alarmingly low.
No wonder the resident was anxious to establish central venous pressure monitoring for the patient.
"Damn it, this patient's veins are so thin and slippery."
After Dr. Shi failed twice, he was probably a little embarrassed and cursed himself.
Zhou Can originally came along to learn and stood by and watched.
Doctors generally don’t pay much attention to the practice of injections. It’s just an injection, who doesn’t know how to do it?
Especially since many medicines can be directly injected intramuscularly, it can be done more easily.
"I have practiced injection techniques. Can I try it?"
Zhou Can looked anxious.
This operation was a piece of cake for him, but it was extremely difficult for the resident doctor, and even Dr. Shi.
The patient's small blood vessels are indeed a reason.
After all, it’s the doctor’s lack of skills.
"Be careful not to puncture an artery or a nerve."
Dr. Shi was somewhat worried, but out of trust, he still let Zhou Can give it a try.
Zhou Can took the needle and stabbed him casually.
Dr. Shi and the resident doctor's hearts jumped to their throats.
Is there such a way to give acupuncture?
So scary.
This is the neck!
But when they saw dark red blood flowing out of the catheter connected to the needle, they immediately showed surprise.
The pretty nurse next to him looked at Zhou Can with great admiration.
This new doctor, Dr. Zhou, is so handsome.
His injection skills are better than the head nurse's.
Zhou Can is currently a level 4 injection technician, a mid-level attending physician, and is infinitely close to the excellent level of attending physicians. The average head nurse is really no match for him.
"alright!"
Zhou Can calmly stepped aside.
"Thank you, thank you!"
The resident thanked him repeatedly.
Once central venous pressure monitoring is established, mixed venous oxygen saturation can be measured.
This parameter value, called SOv2, allows doctors to clearly understand the amount of blood pumped by the heart.
SCVO2 is currently close to 40, no wonder the alarm keeps going off.
When blood oxygen saturation drops to this threshold, the mortality rate is very high.
"The cardiac output is too low, give him a cardiotonic immediately!"
Doctor Shi gave instructions from the side.
After the patient was given a cardiotonic, his blood oxygen saturation improved significantly and began to rise.
Everyone breathed a sigh of relief.
A crisis has been resolved.
"I never knew Dr. Zhou was so good at injecting! From now on, when we encounter patients with thin and slippery blood vessels in the intensive care unit who need indwelling, we'll look for you."
It's not easy to get Dr. Shi, a quiet man, to say such a long story.
The main reason was that he was so shocked by the injection skills Zhou Can demonstrated.
Thinking back on it now, I still feel scared and unbelievable.
With just a casual stab, he managed to pierce the vein with incredible precision. This effortless and amazing operation showed Zhou Can's high level of skill.
"Sure, no problem! As long as the other doctors aren't afraid of me getting in trouble!"
Zhou Can's words made everyone laugh.
It was already time for him to get off work, so he left without staying long.
However, news about his abilities and deeds has begun to spread quietly in the Department of Critical Care Medicine.
Just three days after entering the intensive care unit, he had already saved the lives of two critically ill patients, and performed many other impressive small operations.
People with abilities are always liked and admired by their colleagues.
In the next few days, as the patients in beds 6 and 7 were transferred out of the intensive care unit one after another, Zhou Can became even more famous.
When he was on duty, more and more people came to him for help.
At the beginning, the other doctors were somewhat embarrassed. After all, they were asking a resident to help, which was a bit embarrassing.
Later, Zhou Can helped three high-risk and critically ill patients to recover quickly and they were soon transferred out of the intensive care unit.
This is serious.
The other doctors would not care about face or not, and would talk to Zhou Can and ask him to help take a look, unless the patient was a terminal illness such as cancer.
Zhou Can was also very happy about it. Not only could he build good relationships with other doctors, he could also earn diagnostic experience points. Why not?
Sometimes, if you are lucky, you can also earn some other medical experience points.
In particular, the increase in his experience in pharmacological differentiation made him very happy.
As he gradually became familiar with his colleagues in the intensive care unit, Zhou Can often took the initiative to take on tasks such as urinary catheterization, tracheal intubation, and puncture.
His implantation experience finally soared to the skyrocketing level in the Department of Critical Care Medicine.
Some people jokingly call him the urination master, but he doesn't care.
Urinary catheterization is difficult to perform, and medical staff are somewhat reluctant to do it. However, Zhou Can enjoys doing it.
Because inserting a catheter means you gain 1 point of insertion experience.
His implantation technique is now at level four. If he wants to upgrade to level five, he needs to earn 10,000 experience points.
You must be diligent to realize this wish as soon as possible.
As he learned more and more skills in critical care medicine, the burden on his shoulders also continued to increase.
At first, only Director Liu gave him extra support.
Later, deputy chief physicians and chief physicians from other groups also took a fancy to him. As long as Zhou Can was not too busy, he would be summoned in various ways.
