Chapter 234: Saving Small Money and Spending Big Money, the Principle of Fluid Replenishment
"But chicken soup is boiled and will remain boiling for a long time. It is impossible for bacteria to survive in chicken soup at 100 degrees Celsius."
Yu Xin put forward her own views.
Salmonella survives and reproduces in the body of chickens without causing much impact on the chickens.
But once they enter the human body, they are enough to pose a fatal threat to humans.
Generally speaking, exposure to temperatures above 60 degrees for 15 minutes is enough to kill them.
"Normally, boiling chicken soup would not contain live salmonella, but there are exceptions. If salmonella is hidden deep inside the chicken, the chef may cut the meat into large pieces and not cook it thoroughly. In addition, small restaurants are busier at 4 or 5 p.m., when many dishes need to be cooked and processed before the dinner rush."
"Do you think that chicken soup can be cooked for a long time in this situation? There are viable salmonella in the chicken, so the family members must boil the chicken soup to a palatable temperature before giving it to the patient. Under normal circumstances, 40 to 50 degrees is a palatable temperature, neither cold nor hot. During this period of time, salmonella has a chance to escape from the chicken and survive in the soup."
Zhou Can has more social practice experience than Yu Xin.
Thinking about problems is also more comprehensive.
After listening to his analysis, Yu Xin felt that it made some sense.
"At that time... I did warm the chicken soup before giving it to my husband. But I also drank some, so why am I fine?" Questions raised by family members often occur in daily life.
Some people are fine after eating the same food.
Some people will have diarrhea after eating it.
"This is because our stomach acid has a strong killing power and can kill most of the bacteria eaten into the stomach. This varies from person to person. Also, the incubation period of salmonella varies. Your husband just had surgery, and he fasted for at least twelve hours before the surgery, so his stomach motility is much slower than that of a normal person. His resistance is also weaker, making him more vulnerable to viruses and bacteria."
Zhou Can gave a reasonable medical explanation.
After hesitating for two seconds, he looked at the family member and said seriously, "I suggest you do a blood test first to see the results. Because salmonella is difficult to be completely killed by stomach acid, they can resist the body's macrophages and other immune mechanisms. Your physique may be better, but you also drank chicken soup with bacteria, which is a huge hidden danger."
Doctors can only make suggestions; the decision on whether the patient and family members cooperate is not up to the doctors.
"Well... let's test my husband first! He's so sick now, please find a way to save him quickly."
The family members' eyes flickered, and they were obviously not prepared to follow Zhou Can's advice.
Zhou Can stopped persuading him and looked at Yu Xin, telling her that she would be the one to handle the application for the inspection.
Because he was the patient she was responsible for.
She still had some doubts about Zhou Can's diagnosis.
However, it is not difficult to request a routine blood test for the patient and then take a stool sample to check for Oxemophilus influenzae.
If the examination is not expensive, has diagnostic value for the patient's disease, and does not cause any major harm to the patient's body, there is generally no need to think too much about it.
You can apply directly.
…
Zhou Can didn't bother with the matter anymore and went back to the office to discuss the surgical plan for the patient in bed 71 with Director Shang.
As long as Director Shang approves it, Zhou Can will be responsible for following up the surgery.
Since he had nothing to do, he started studying the cases in the group.
Internal medicine patients have certain similarities with surgical patients, and many of them require surgery to treat their problems.
This was different from what he had thought before, that most problems could be solved with medication.
No wonder after the development of endoscopic surgery, surgeons said that life was getting harder and harder. It was certain that the competitive pressure was increasing.
It was almost ten o'clock, and Director Shang had not returned to the office, nor was he seen.
Instead, it was Dr. Yu Xin who ran into the office excitedly and took the initiative to find Zhou Can.
"Doctor Zhou, Doctor Zhou, the results are out, it's really an acute Salmonella infection." The coldness on her face had long disappeared, replaced by excitement and excitement.
For any doctor, finding out the cause of a patient's illness is a very exciting thing.
Especially this kind of sudden unexpected event.
[Pathological diagnosis experience value +1. ]
[You have successfully diagnosed a hidden case of high difficulty, and are rewarded with +10 pathology diagnosis experience points. ]
The experience points reward is not always 100.
Sometimes, if the operation is difficult, or the disease diagnosis is not extremely difficult, only 10 experience points will be awarded.
"Poisonous chicken soup is harmful!"
Zhou Can was not surprised by the test results.
After hearing the result, he seemed very calm.
As for the 10 points of pathology experience points he gained from diagnosis, he no longer felt much about it since he was used to receiving high rewards of 100 points.
"Um... do you have experience in treating this disease? Otherwise, please teach me."
She bit her lip and spoke hesitantly.
There is no doubt that Zhou Can's successful diagnosis of the patient's cause of illness has already earned him a very high medical status in her mind.
She is now completely in the attitude of asking the teacher for advice.
"The treatment of salmonella infection is nothing more than symptomatic treatment and treatment of the pathogen. If it is an ordinary patient, you can prescribe a doctor's order and treat it yourself. This patient has just undergone a major operation. I see that his physical condition is not very good in all aspects. To be safe, you'd better report it to the senior doctor immediately. Anyway, the cause of the disease has been found out, so you won't lose points even if you report it to Director Shang."
Zhou Can has studied under many chief physicians, and his vision, pattern, knowledge and experience are far beyond those of ordinary trainees like Yu Xin.
Even many residents cannot compare with Zhou Can.
This is like a martial arts sect. How can the disciples taught by the deacon compare with the disciples taught directly by the sect master?
The gap is very big.
Zhou Can has a more accurate grasp of which situations can be handled by himself and which situations should be reported promptly.
The patient in bed 73 was so ill. If Yu Xin handled the case well, she would certainly get extra points in the eyes of the senior doctors. But if something went wrong, it would be a big deal. The risk was too great.
She was in the middle of the situation and couldn't see clearly.
Zhou Can saw it very clearly.
"You mean, if I handle it on my own, the risk is very high?" She still didn't give up.
"The risk is extremely high. I can tell you firsthand that the patient could develop sepsis or septicemia at any time. Right now, he has already developed the initial symptoms of typhoid fever."
Zhou Can said it very affirmatively.
I'm afraid she won't believe it and will insist on giving it a try.
A bright future may be ruined by this test.
"Understood. I'll call Director Shang right away."
Fortunately, she is a female doctor and is relatively timid.
After hearing Zhou Can describe the situation so seriously, and considering that Dr. Zhang, the doctor in charge of the patient, was a previous example, she didn't dare to take the risk.
The report was completed quickly.
She also breathed a long sigh of relief, and the expression on her face was obviously much more relaxed.
"Director Shang was asked to go to the emergency room and pediatrics for consultation . He asked me to correct the patient's water and electrolyte imbalance and rehydrate him first, and he will come back to deal with it personally later."
Yu Xin took the initiative to tell Zhou Can the results of the report .
"fine."
Zhou Can nodded.
"I'm worried that the rehydration won't be effective because he's vomiting quite a lot." She said this, obviously wanting to hear Zhou Can's opinion.
Being able to become a trainee and being recruited by Director Shang to be personally taught in the group, she must be familiar with various methods of fluid replacement.
"If the vomiting is really severe, just choose intravenous fluid replacement. It's not that we doctors don't want to save treatment costs for patients, but the patient's condition does not allow it." Zhou Can knew what she was worried about.
In the past, Zhou Can would pay special attention to helping patients save treatment costs during the treatment process.
Save where you can.
Later, he almost got into trouble twice, and both Dr. Xu and Director Shen of the Orthopedics Department educated him about this.
Gradually, Zhou Can realized that he should not save money when he should not. Otherwise, although he saved a small amount of money on the surface, it might actually lead to the patient not achieving the ideal treatment effect and causing complications that could have been avoided, which would increase the cost.
Saving a little money will lead to a big expense. This is true not only in life but also in medical treatment.
From then on, Zhou Can also learned the key points of using medicines and consumables from the chief physicians.
When treating some key diseases, imported drugs and imported consumables should be used, and domestic ones should never be prescribed.
Some domestic pharmaceutical factory owners are extremely unscrupulous. The active ingredients detected in a bottle of anti-cancer drugs are zero. They still claim that the treatment effect is very good, and sell the drugs for more than 3,000 yuan per bottle.
But in developed countries, this phenomenon is almost impossible.
If this really happens, the pharmaceutical company will be sued and go bankrupt.
All we can say is that there are always some unscrupulous businesses that can exploit legal and regulatory loopholes and, in order to make huge profits, they can unscrupulously harvest the money of poor cancer patients.
I believe that such unscrupulous pharmaceutical companies will one day receive the punishment they deserve.
Doctors sometimes feel helpless when faced with such pharmaceutical companies.
The poor performance of domestically produced drugs is not limited to anti-cancer drugs from certain unscrupulous manufacturers, but also includes many other drugs. For example, drugs for treating gastrointestinal bleeding are completely ineffective when made domestically and must be imported.
There are too many examples of this.
Of course, the ineffectiveness of domestically produced drugs for treating gastrointestinal bleeding is not entirely due to the unscrupulousness of the manufacturers, but rather the fact that there is still a large gap between domestic pharmaceutical technology and that of developed countries.
Yu Xin prescribed medical advice to the patient and provided treatment promptly.
Zhou Can continued to leisurely read his group's cases in the office.
When you first arrive, it takes two to three days to look through all the cases.
According to Zhou Can's practice, after finishing the cases of his own group, he would start to check the cases of the entire department.
The Department of Gastroenterology alone has more than 130 beds.
Even if the number of hospitalized patients is calculated on a three-day basis, it is still an extremely terrifying number.
The patients in this group are not only inpatients, but also outpatients. Doctors will not hospitalize some patients who can recover at home after interventional surgery or simple medication.
But Zhou Can also needs to study and learn these cases.
It is said that the Department of Gastroenterology at Tuya Hospital has an annual outpatient volume of over 140,000.
Based on the average number, the number of patients seen per day is as high as over 385.
He wanted to finish seeing all the cases the department had seen that day in one day, but it was simply impossible.
We can only choose key cases to study.
Not long after, Director Shang returned from the emergency room and pediatric consultation.
Patients in the emergency room usually have acute illnesses, so Director Shang will definitely give priority to going to the emergency room for consultation.
Zhou Can had been in the emergency department for a few months. Usually, for general emergency patients, they would ask a specialist to come for consultation, and it was considered good to send an attending physician. This time, Director Shang was dispatched in person, which meant that the patient's condition must be very serious.
"Xiao Zhou, come with me to the ward."
Director Shang hurried into the office, put down his things, and immediately walked out.
Appears to be in a hurry.
Zhou Can was excited when he heard Director Shang's call. He thought Director Shang had forgotten him.
It seems that it has not been forgotten.
It’s because Director Shang is too busy.
"I went to the emergency department today, and Director Lou stopped me and talked to me before I left. He asked me to take care of you more. I told Director Lou that you were doing an excellent job in the gastroenterology department. Even if Director Lou didn't say hello in person, I would still take good care of you."
Director Shang talked as he walked.
"thank you!"
While Zhou Can expressed his gratitude to Director Shang, he couldn't help but feel secretly grateful to Director Lou.
This reminded him of a saying: If you fall in love with a city , it must be because there is someone you like in this city.
His relationship with the emergency department began a year and a half ago.
But it's getting deeper and deeper.
There are many people he likes in the emergency department, including his mentor Dr. Xu, nurses Qiao Yu and Ye Tingting, Director Lou... These people have made him have a deep affection for the emergency department.
Director Lou took the trouble to greet Director Shang and asked him to pay more attention to Zhou Can's affairs. If Director Shang had not brought it up on his own initiative, Zhou Can would never have known about it.
This kind of silent help is more sincere and touching.
Following Director Shang to the ward, I saw that the patient in bed 73 was already receiving intravenous fluids.
Yu Xin was taking notes beside the bed, not daring to be careless.
"Yu Xin, how is the patient's condition?"
Director Shang entered the ward, and the head nurse and the attending physician in charge of the ward all rushed over upon hearing the news.
The status of chief physician is so awesome.
Especially the powerful chief physicians are more respected in the hospital and have a transcendent status.
This is what studying medicine is like. The period from medical student to residency is particularly difficult. There are many hurdles to overcome.
As long as you can get through it and be promoted to chief physician, life will be better.
This is also the reason why many medical students choose to pursue a master's and doctoral degree simultaneously.
It’s not that my family has a mine, nor is it that I don’t want to go out and earn money early to ease the financial pressure on my family.
But for a better future.
After graduating from a doctorate, you only need one year of work experience to be promoted to chief physician. The subsequent evaluation of associate senior and senior professors is much easier than that of undergraduates.
Therefore, as long as you have the talent for studying and can endure loneliness, the higher the academic qualifications, the better.
"The patient just vomited again and has had diarrhea four times. He is almost exhausted. His heart rate is a little fast and his temperature is still high." She has been treating the patient carefully, fearing that something unexpected might happen.
Now that Director Shang has arrived, she no longer has to bear the pressure alone.
Senior doctors are powerful, have high status and high income, but when something happens, they have to bear the responsibility as the chief.
No matter how difficult the patient is to treat, we have to go ahead and treat him.
"Well, the rehydration operation is quite good. When you give fluids to patients, remember that patients with mild to moderate dehydration should be given oral rehydration as much as possible. But for patients like this one, who are vomiting quite a lot, you must decisively choose intravenous rehydration. Doctor Yu did a great job on this point."
Director Shang briefly checked the patient's infusion situation, and then highly praised Yu Xin's approach.
After receiving the praise from Director Shang, Yu Xin's face showed an unconcealable happy smile.
She couldn't help but look at Zhou Can with gratitude.
It was Zhou Can who gave her the idea.
Originally, she planned to use the simplest oral rehydration method.
"If you encounter a patient with severe poisoning symptoms and circulatory failure, even if there is no vomiting, intravenous fluid replacement is necessary. If necessary, glucocorticoid treatment should also be used."
Director Shang explained the key points of fluid replacement to his two interns.
Zhou Can had learned some of this knowledge in the Department of Critical Care Medicine, but he felt that what Director Shang said was more comprehensive.
"If the patient has no complications, there is no need to use antibiotics. For the elderly, the young, the immunocompromised, and those with typhoid fever, sepsis, and local suppurative infections, antibiotics must be used. And this course of treatment takes about two weeks, depending on whether the condition is effectively controlled."
Sepsis and purulent infections are both very serious conditions.
If antibiotics are not used at this time, the condition will rapidly worsen and the patient will soon die.
If you are stabbed by rusty nails, knives, or sharp objects, you must get a tetanus shot in time.
If sepsis occurs, the cost will far exceed the money spent on the tetanus vaccine.
