Chapter 226 If something goes wrong, please ask the general surgeon to come to the rescue
The patient's condition was very critical, but the attending physician's skills were limited and he was unable to see it.
Zhou Can gritted his teeth and decided to talk about it.
After all, human life is at stake.
"Boss Luo, I have something to report to you!"
Zhou Can had just arrived and kept a low profile.
In the departments where he worked, not only the chief resident, but even the attending physicians were all polite to him. Basically, they were trying to curry favor with Zhou Can.
"You're too polite, Doctor Zhou! Just tell me if you have anything to say!"
Seeing Zhou Can's serious face, Luo Shengsheng couldn't help but respond seriously.
"When I arrived, I happened to see a doctor examining the patient in bed 51."
"Well, I know the patient in this bed. He was admitted to the hospital because of blood in the stool, abdominal distension and pain, and severe malnutrition. We have performed gastroscopy and colonoscopy on him, and even used capsule endoscopy, but we still couldn't find the bleeding point. His case is intermittent bleeding, which is more difficult to detect."
After listening to this, Dr. Luo took the initiative to explain the patient's condition to Zhou Can.
"Uh... When I passed by, the patient looked very dangerous. Judging from his complexion, lips, and some superficial symptoms, he was probably bleeding internally. And it was probably bleeding in the jejunum and ileum, where blood clots are very likely to form. If we don't treat him in time and wait until he goes into shock before trying to save him, we will be in a passive position."
When Zhou Can said this, there was a hint of solemnity in his tone.
This was done intentionally to make Luo Shengsheng aware of the urgency of the situation.
He has been to the gastroenterology department twice, and to be honest, he didn't have a good impression of it.
The doctors in this department are a bit slow and methodical in their work, too formulaic and rigorous, and lack flexibility.
Regarding the patient with gastrointestinal bleeding that Zhou Can met in the Department of Critical Care Medicine last time, he had specially looked for Xia Ping, the attending physician of the Department of Gastroenterology. However, when Xia Ping heard that he was a resident intern, he hung up the phone directly.
The bossy style prevails.
"It's not that serious! The patient has been in the hospital for several days and has been bleeding intermittently. But if it is confirmed that he is bleeding, we can check it again."
After hearing this, Luo Shengsheng's attitude was similar to that of the attending physician.
This is an inertial way of thinking.
The patient had been fine, so how could something suddenly happen to him?
Many doctors have this kind of complacent thinking.
"I suggest you do a gastrointestinal angiography right away! After all, you've already had a colonoscopy. If you do it again in such a short time, the patient may not be able to handle it."
Colonoscopy can cause some stimulation to the anus or colon mucosa, which can easily cause mucosal damage and a small amount of bleeding. There is even a certain probability of complications, intestinal damage, bleeding, or even perforation.
Therefore, under normal circumstances, it is not recommended to perform colonoscopies continuously within a short period of time.
Zhou Can took the opportunity to cleverly suggest a gastrointestinal angiography examination, which would be much more likely for Luo Shengsheng to adopt.
"Yes, Dr. Zhou's suggestion is very good, but the patient's attending physician is Dr. Xia Ping. It would be better to wait until he comes to decide what specific tests to do. When he comes, I will focus on the gastrointestinal angiography suggestion you mentioned."
Luo Shengsheng's words were flawless and he was completely smooth like a seasoned veteran.
"All right then!"
Zhou Can didn't say anything else.
He had fulfilled his duty to remind the patient, but if the senior doctor didn't listen to him, there was nothing he could do.
Time passed little by little, and Zhou Can sat in the office quietly waiting for Dr. Chi to arrive.
It was almost eight o'clock when a middle-aged doctor in his forties walked into the office with steady steps.
"Doctor Xia is truly a role model for our generation! He arrives at the hospital early every day for work and has never been late." Luo Shengsheng greeted him with a big smile on his face. Seeing his flattery, Zhou Can sighed.
Different people have different ways of living.
Luo Shengsheng is so fawning on his superior doctor in order to survive better.
It will be easier to get promoted if you have a good relationship with the senior doctors in the department.
You can get some advantages in every aspect.
Promotion, opportunities for further study, participation in important projects, opportunities for surgical training, etc. Those who can flatter others do have more advantages than honest people.
"Haha, I don't dare to be a role model, but it does take a certain amount of willpower to stick to it for decades. How about it, are there no accidents with the patients in my group?"
If there is only one Doctor Xia in the Department of Gastroenterology, then this middle-aged man who looks elegant should be Doctor Xia Ping, with whom Zhou Can had once dealt with on the phone.
Doctor Xia obviously didn't know Zhou Can. He just glanced at him and didn't say anything.
Instead, she walked to a seat at the desk, put down her handbag, and habitually turned on the computer to check the various records and nursing conditions of this group of patients.
"Just now, Dr. Zhou Can said that the patient in bed 51 might be suffering from internal bleeding and suggested that we perform a gastrointestinal angiography on the patient."
Luo Shengsheng took the opportunity to tell this matter.
"Zhou Can?"
Doctor Xia's gaze fell on Zhou Can's face again and he looked at him carefully.
"This name sounds familiar, and your face looks unfamiliar. Who are you?"
"I'm Zhou Can, a new resident trainee. I hope Doctor Xia will give me more guidance in the future."
Zhou Can greeted with a smile.
As for asking him to be as flattering as Luo Shengsheng, he couldn't do it.
Even when dealing with the chief physician, Zhou Can never bowed down to him, at most he showed normal respect.
There is no right or wrong in this matter, and it does not mean that he is nobler because he is unwilling to bow down.
It's just a different way of living.
He wants to live with more dignity.
I would rather gain extra points in terms of ability through diligent study and hard work rather than by fawning and pleasing my superiors.
He would flatter people occasionally, but his flattery was much more advanced than Luo Shengsheng's.
Most of the flattery he did was of high-level kind.
"Oh... I remember now. Last time, there was a patient with lower gastrointestinal bleeding in the Department of Critical Care Medicine, and you called me. Later I heard that you diagnosed the patient. You are quite capable, young man."
Dr. Xia Ping has a deep memory of this incident.
The patient had been under his treatment for a long time with no effect, and was eventually sent to the intensive care unit. His life was hanging by a thread and he might have to prepare for death at any time.
Unexpectedly, a junior college student named Zhou Can found out the real cause of the disease, which turned out to be infection with a parasite that had never been seen before.
The patient was cured, which was a slap in the face to Dr. Xia Ping.
Therefore, Xia Ping has a deep memory of this incident.
He was afraid that he would be slapped in the face again today.
"How did Dr. Zhou know that the patient in bed 51 was suffering from gastrointestinal bleeding?"
Xia Ping suffered a loss once, and this time he learned his lesson and did not dare to take it lightly again.
"I came here to report in this morning. I happened to pass by and saw a doctor measuring the basic vital signs of the patient in bed 51..."
Zhou Can recounted what had happened.
"Therefore, I suggest that the patient be given a gastrointestinal angiogram immediately and treated promptly to avoid a tragedy."
"You need to make an appointment with the interventional department to do gastrointestinal angiography. Can you determine whether it is jejunal or ileal bleeding just by taking a few glances?" Dr. Xia Ping has taken this matter seriously.
But he still remained skeptical about Zhou Can's diagnosis.
Not to mention Zhou Can, even he, the attending physician with more than 20 years of work experience, could not determine the patient's bleeding site after just a few glances.
Gastrointestinal bleeding, in particular, is very difficult to diagnose.
At this moment, a nurse ran into the office in panic.
"Doctor Xia, Doctor Xia, please go and have a look. The patient in bed 51 is suddenly in a worsening condition and is close to shock! Doctor Zhang is trying his best to treat him. Please come over and report."
The tragedy still happened.
Zhou Can sighed secretly.
These doctors in the Department of Gastroenterology should be sent to the Department of Critical Care Medicine for a few months of training.
Let them feel what it means for a patient to die in front of you in the next second.
Digestive tract diseases are generally chronic diseases, and patients rarely die suddenly. Generally, the disease progresses slowly, leaving doctors with ample time to treat.
Long-term diagnosis and treatment of this type of patients has cultivated a slow-reacting work style among gastroenterologists.
"I'll be right there!"
Xia Ping didn't even have time to think about it and hurried to the ward.
If something goes wrong, he needs to take the main responsibility.
Moreover, this happened despite Zhou Can's repeated reminders, so the responsibility is even greater.
"Damn, something really happened!"
When Luo Shengsheng looked at Zhou Can, his eyes were completely different.
Not to mention him, the other two interns in the office also looked at Zhou Can with god-like worship.
This trainee is simply a prophet.
"Mr. Luo!"
Zhou Can stood up and looked at Luo Shengsheng.
"Ah... I'm here, I'm here! Doctor Zhou, just tell me if you have anything to say." Luo Shengsheng took the initiative to lower his attitude to the extreme.
The word "command" is used.
"I'll go to the ward to check. The patient's condition has progressed to the stage of shock. I'm afraid the doctors don't have much time to save him. When Doctor Chi comes, please help me explain."
Zhou Can has extraordinary skills in both rescue and interventional and endoscopic surgery.
Go and take a look, maybe you can help.
It is the duty of medical staff to rescue patients in emergencies, as well as the minimum professional ethics.
Zhou Can followed him to the ward and saw that the patient was already unconscious, with his family members standing beside him in great grief. The attending doctor was frantically taking necessary rescue measures.
"Immediately send the patient to the interventional department for urgent gastrointestinal angiography."
Doctor Xia Ping's face was as gloomy as water.
As soon as he saw the patient's condition, his heart sank to the bottom due to his decades of medical experience.
I know that something is wrong.
If you are not careful, you will suffer a serious setback today, and your career and future will be seriously affected.
At this moment, Dr. Xia Ping felt a little regretful.
If I had listened to Zhou Can's advice at the first moment instead of asking questions and being indecisive, perhaps this kind of thing would not have happened.
"Now that he's in trouble, you let him do this angiography. Earlier, Dr. Zhou proposed to do an angiography, but you refused. If anything happens to my father, I will sue him to the end even if I lose everything I have, and make you, a mediocre doctor, receive the punishment you deserve!"
The patient's son completely exploded at this moment.
If it were any family member, they would probably be extremely angry.
More than 20 minutes ago, Zhou Can suggested to the attending doctor, Dr. Zhang, that the patient be sent for a gastrointestinal radiography examination.
As a result, Dr. Zhang, the doctor in charge of the patient, scolded Zhou Can instead.
Now that the patient looked like he was dying, the hospital's senior doctor agreed to do the angiography.
From the patient's point of view, isn't this deliberately delaying treatment until the person is about to die?
"Now is not the time to make a fuss. The most important thing is to try to save the patient's life. Once a person falls into shock, it will be very dangerous and he may die at any time."
Dr. Xia Ping calmed the patient's family members while arranging for the patient to be sent for emergency examination.
Zhou Can pushed the flat bed over. The family members still believed him and cooperated by making way.
"Hurry up and bring the patient up!"
Zhou Can looked at Doctor Zhang with some disappointment, as he was being scolded like a dog by the family members but didn't dare to say a word in return.
The attending physician just doesn't deserve to be beaten up by the family members. Even if he suffers this loss, he will learn a lesson.
So as to avoid treating patients in a bureaucratic manner next time.
Without saying a word, Dr. Zhang helped lift the patient onto the cart and urgently sent the patient to the interventional operating room for examination.
Soon, the patient was sent to the interventional room.
This examination requires inserting a catheter into the superior mesenteric artery. The doctor performing the operation is a novice, and it's so frustrating to watch.
"Let me do it!"
Zhou Can stepped forward and took over the job without giving any explanation.
I saw that he was very skilled and easily inserted the catheter into the superior mesenteric artery.
After the contrast agent was injected, the abnormality was discovered within just two or three seconds.
The patient had abnormal staining and contrast extravasation in the left upper abdomen.
The extravasation of contrast agent at this site means that it is the bleeding point.
"It turns out that the bleeding point is in this area. No wonder the colonoscopy couldn't find it. When the patient was examined, the bleeding had just stopped. It was impossible to imagine that the bleeding point would be here."
At this moment, Dr. Xia Ping was full of admiration for Zhou Can.
It's hard to express in words.
This trainee is amazing. Just by looking at the patient with his naked eyes, he was able to identify the bleeding site as the ileum or jejunum based on the patient's symptoms.
The bleeding point has now been identified, and it is the blood vessel branches in the upper jejunum that are bleeding.
"Doctor Peng, where is your master? The patient's condition is so serious that it must be treated urgently. You don't usually operate, so I'm afraid you won't be able to do it. Call your master and ask him to come over!"
Dr. Xia Ping should have a high status in gastroenterology.
At least that can be seen from the attitude of the doctors in the interventional operating room towards him.
"Okay, I'll call right away!"
Without hesitation, the young interventional doctor asked his master for help.
I was on duty at night and it was almost time to hand over my shift, but I didn't expect this to happen.
The patient was already in a state of shock. He had been doing gastrointestinal interventional surgeries for so long, but this was probably the first time he had encountered such a condition. His face turned pale with fear.
"Before his master comes, let me try the operation first! The patient may not be able to wait until then!"
Zhou Can said this to Doctor Xia Ping.
"Okay, thanks to Dr. Zhou!"
At this moment, Xia Ping felt that Zhou Can was simply a savior sent by God.
Just now, when he saw Zhou Can easily insert the angiography catheter into the artery, he knew that Zhou Can must have strong abilities in interventional surgery.
With approval from his superior doctor, Zhou Can no longer hesitated.
The microcatheter is manipulated to the artery supplying the bleeding.
Arrived at the first branch of the superior mesenteric artery, the vascular branch of the upper jejunum.
It seems like a simple operation, but without a certain level of interventional skills, it is impossible to perform it. At least neither Xia Ping nor Dr. Zhang has this ability.
In order to confirm the accuracy of the test results, Zhou Can injected contrast agent again for examination.
It was confirmed that this was the blood vessel causing the bleeding.
Just as Zhou Can was about to discuss the next treatment plan with Xia Ping, the patient's condition deteriorated sharply again.
The patient's eyelids suddenly turned up, his whole body convulsed, and his blood pressure dropped sharply.
It dropped directly to 45/28 mmHg.
This frightened Doctor Xia Ping. Not only him, but also the medical staff around him were all extremely nervous and looked serious. They all rushed to rescue the patient.
Even the doctors and nurses who were performing another operation in the adjacent operating room, who had time to spare, rushed over to help rescue the patient.
Doctor Xia Ping directly adjusted the patient's infusion speed to the maximum.
"Adrenaline, two shots first!"
He urged again and again.
"Two is too few, push at least four at a time!"
Zhou Can's rescue skills are no worse than Dr. Xia Ping's.
Zhou Can learned a lot of first aid knowledge and life support skills from anesthesiologists Dr. Guan and Dr. Feng. He also received three months of training in the Department of Critical Care Medicine, which was enough to make his rescue skills much better than those of ordinary attending doctors.
After all, every profession has its specialties, and many attending physicians are only good at knowledge in their own fields.
"Push four!"
Doctor Xia Ping hesitated for a moment, and finally chose to listen to Zhou Can.
Although this made him somewhat ashamed, when he thought of Zhou Can's many outstanding performances, Xia Ping could only do it willingly.
In fact, when rescuing patients, the one or two most skilled doctors are definitely the backbone of the operating room.
All medical staff obey their orders.
Zhou Can is so young, but the rescue decision he made was obeyed by the attending physician, which inevitably caused other doctors and nurses to take time to look at him.
"Has the red blood cell suspension been adjusted at the blood bank?"
Zhou Can was not polite at all and asked directly.
"It's been adjusted and will be delivered soon."
A nurse rushed to answer.
"Give me the deep vein catheter kit!"
Zhou Can's ability to place a catheter is probably better than that of others. After taking over, he directly placed a deep vein catheter in the patient.
At this time, the blood bank finally delivered the blood.
After a series of fluid infusions, catheterization, blood pressure increase, blood transfusions, and embolization of bleeding vessels, the patient was finally pulled back from the brink of death.
All the medical staff breathed a sigh of relief.
However, this is only an emergency rescue measure and does not really solve the problem.
"Call the general surgery department for help and ask them to send a surgeon to perform an emergency laparotomy on the patient."
Internal medicine doctors are not good at performing surgery.
The patient's condition can only be completely cured by asking a general surgeon to come and help.
Zhou Can's lips moved, but he finally swallowed back what he wanted to say.
He is not of sufficient rank to conduct the operation now.
We can only wait for the general surgeon to come.
It’s really interesting that I just came out of the general surgery department yesterday and today I can see the general surgery doctor again in the gastroenterology department.
I just don’t know which doctor from the general surgery department will be sent to provide support?
