Chapter 255: Blood pressure drops due to sweating, Dr. Huang Liang's surrender
By this time, Zhou Can had finished helping Yu Xin see the patient in bed 65, and he walked straight out of the ward.
He wouldn't bother himself with the patients in Director Zheng's group!
Sometimes when one is overly enthusiastic, others may not appreciate it and may even think that he is showing off his skills.
"Doctor Yu, I'm going back to the office to write the medical records and course of disease. If you have any questions, you can come to me at any time. After nine o'clock, you will have to wait until I finish the operation before I can help you."
Zhou Can said to her.
"Okay, thank you!"
Yu Xin was very envious of Zhou Can's special treatment in the Department of Gastroenterology. He could perform surgery with Director Shang or Deputy Director Shi every day, and whenever Director Shang was in the outpatient clinic, he would always ask Zhou Can to come along.
Not to mention the trainees, even the resident doctors would be jealous of these treatments.
Take Dr. Huang Liang for example. He is considered a leader among the residents, but he still only has one day a week to practice in the outpatient clinic. He has no one to guide him, so he has to sit in the outpatient clinic by himself.
Although the outpatient volume of the Department of Gastroenterology at Tuya Hospital is very large, the outpatient clinics of these resident doctors are all empty without exception.
Even though the registration fee is only 8 yuan, few patients choose to see these resident doctors.
Sometimes, the appointments of the experts, deputy chief doctors, and attending physicians are all taken, so the patient has no choice but to get an appointment with a resident physician, and the patient and his family members still look disgusted.
They would rather rush to get an appointment with the director which costs dozens of yuan than to get the cheapest appointment with the resident physician.
No one visits, which means there are not many opportunities to exercise.
What Zhou Can gained from a day of seeing patients might not be as much as what he gained from following Director Shang to diagnose a patient.
Because the patients who make appointments with special experts are basically those with complicated or serious conditions. Only by diagnosing such patients can we learn the real things.
Zhou Can returned to the office and hurried to write the medical records and medical progress notes.
It was easier to write about one or two patients, but with eleven patients, the workload was too heavy. There were many things to worry about.
The medical advice for each patient in each bed must be verified repeatedly, and the wards need to be checked at least twice a day.
Zhou Can has to take care of everything, including discharge, surgery, etiology examination and medication for all patients.
If he only had to take care of these eleven patients, he would be able to handle it.
The key is that he has to take out half a day to perform surgery or accompany Director Shang to see patients. There are only 24 hours in a day, and the working hours are eight hours.
In fact, he works more than ten hours a day.
Sometimes when there is a complicated endoscopic surgery or the patient he is in charge of has a condition, he will get off work even later.
For example, the day before yesterday, there was a patient who vomited blood, and it was almost time to get off work when he was admitted to the hospital.
At that time, the patient vomited blood from time to time, and the situation looked really scary.
In this situation, it is really difficult for Zhou Can, as the attending physician, to resign.
The patient's illness is handed over to the doctor on duty without being clear about the cause of the illness or bringing the condition under control. Even if the doctor doesn't say anything, he will definitely curse you in his heart.
Out of a doctor's sense of responsibility, if I encounter a patient like that and don't treat him well before leaving get off work, I will feel uneasy!
What if the patient dies during the night?
While I was writing the medical record, Duan Zifu ran over panting.
"Doctor Zhou, Doctor Zhou, please go and help Yu Xin! The blood pressure of the lady in bed 65 has suddenly started to drop for some reason."
Seeing Duan Zifu's anxious face, Zhou Can couldn't help but think of five words: "the goddess's licker".
Duan Zifu seems to be interested in Yu Xin and has been trying to pursue her.
But she always remained aloof to Duan Zifu and never smiled at him. She was very frugal with her words when talking to him. But Duan Zifu didn't care and kept showing her all kinds of courtesy.
When we meet, I will make sure I am the first one to greet her with a smile on my face.
Many times, even though the two of them worked in different wards, Duan Zifu would still take the initiative to go find her.
"Blood pressure suddenly dropped? What did Auntie do again?"
When Zhou Can heard that the patient's blood pressure had dropped, he immediately became nervous.
The old lady had just been transferred out of the intensive care unit and her condition had worsened. If not treated properly, the patient would die.
Often, a drop in blood pressure is a sign of a rapid deterioration and worsening of the disease.
Zhou Can ran to the ward, where Yu Xin was nervously measuring the old lady's blood pressure.
"Doctor Zhou, the patient's blood pressure has suddenly dropped and is still dropping. Please help!"
Yu Xin was so anxious that a layer of sweat broke out on her forehead.
"The doctor's instructions for the medication haven't changed, have they?"
The first thing Zhou Can suspected was the problem with the medication.
This is also the most likely reason for the patient's blood pressure to drop.
"No, there is absolutely no change. He is a patient who had just been transferred out of the intensive care unit. How dare I change the doctor's orders!" Yu Xin bit her red lips and shook her head repeatedly to deny it.
Zhou Can carefully checked the infusion bottle and saw the name of the drug written on it with a black marker, and he was indeed correct.
The possibility of using the wrong medicine or overdosage is ruled out.
He looked at the patient, his forehead wet with sweat.
I lifted the blanket slightly and saw that the patient was covered with a thick coat and a hospital blanket on top.
Is this sweating?
"When did you put on the coat?"
Zhou Can asked.
"About an hour ago! What happened? Is the sudden drop in my mom's blood pressure related to the clothes she was wearing?"
The family members asked in confusion.
"When I left, the patient was not sweating yet. But after less than 40 minutes, she was already sweating profusely. This means that the drop in her blood pressure was probably caused by excessive water loss in a short period of time."
After careful observation, Zhou Can made a preliminary conclusion .
The possibility that the patient suffers from myocardial infarction, hypothyroidism, adrenal cortex insufficiency and other causes can basically be ruled out.
This made Zhou Can even more certain that it was caused by the patient's sweating.
"Oh, I was so anxious just now. Why didn't I think of this?"
After hearing Zhou Can’s explanation of the cause of the disease, Yu Xin suddenly understood.
After rehydrating the patient, remove the covering clothing to prevent further sweating.
Not long after, the aunt's blood pressure returned to normal.
Yu Xin breathed a sigh of relief.
The sudden situation just now really scared her.
"Okay, it was all just a false alarm."
Zhou Can shrugged, stood up and prepared to leave.
The intern in charge of bed 67 came closer and said to Zhou Can respectfully and nervously, "Doctor Zhou, could you please help take a look at the patient in our bed? We haven't found the cause of the disease yet. The patient had diarrhea not long ago, and the abdominal pain symptoms have not been alleviated."
For patients with abdominal pain, especially those with acute enteritis, the symptoms of abdominal pain will generally be relieved after diarrhea.
The patient had been suffering from stomach pain for more than fourteen hours and the symptoms had not improved at all, which made Dr. Huang Liang, who had almost been in trouble not long ago, extremely nervous.
He was very afraid that the patient had another serious disease such as intestinal perforation.
Unlike interns, he is already a senior resident and his job is more than just a bed manager.
And need to be responsible for the patient's entire treatment process.
To put it simply, it is the attending physician.
Zhou Can turned to look at Bed 67, only to see Huang Liang standing there with an awkward look on his face, forcing a stiff smile at him.
This guy is really interesting.
He was too proud to ask Zhou Can for help, but instead he asked his intern to come and ask Zhou Can for help.
"My level is also very limited. I can only help you with your advice. The advice I give may not be correct."
Zhou Can is very humble.
He walked to bed 67 and began to conduct a simple facial examination of the patient.
"Doctor Zhou has diagnosed many difficult cases recently. Director Zheng asked us to learn more from you. You are too modest! This patient's condition continues to deteriorate. Although I have made some diagnosis, I am worried about misdiagnosis, so I would like to ask Doctor Zhou to help take a look."
Huang Liang gritted his teeth and spoke.
There was an intention of praising Zhou Can in his words, but he was unwilling to put himself down too much.
"I wonder if Dr. Huang could give us his diagnosis?"
Zhou Can asked him.
"Based on the patient's symptoms, I am more inclined to believe it is acute gastrointestinal perforation or acute cholecystitis." Huang Liang gave two diagnostic opinions, which showed that he had no idea at all.
Even so, he still pretends to be the big shot in front of Zhou Can.
Zhou Can didn't expose him either.
Instead, he took the patient's information and began to look through it carefully.
The patient's abdominal B-ultrasound showed no abnormal shadows, and the abdominal plain film also showed no abnormalities.
The patient, 31 years old, was in the prime of life. He drank and ate hot pot with a few friends last night. After eating, he felt unbearable pain in the upper abdomen. After several hours of pain, the symptoms did not ease, so he ran to Tuya Hospital for emergency treatment. After the anti-inflammatory treatment in the emergency department, there was no effect. The emergency department's diagnosis and treatment capabilities were limited, so the patient was sent to a specialist for further diagnosis and treatment.
The patient had vomited several times, and the vomitus were the contents. The pain did not transfer, there was no chest pain or tightness, no fever or chills, no urinary urgency or pain, no blood in the stool or vomiting...
After the examination, Zhou Can made a psychological assessment of the patient's condition. It was an emergency, but not as serious as he had imagined.
It should be an acute disease caused by overeating.
Hotpot is usually spicy, strong in flavor, and very hot.
Coupled with drinking, the body's hidden diseases are directly triggered.
The patient's WBC: 22*109/L, blood sugar 15.3mmol/L. Heart rate 85 beats/min, no family history of diabetes...
The patient's cardiac enzymes were normal.
Blood calcium decreased, blood sugar was high, blood lipids increased significantly, and blood amylase also increased.
Cholecystitis is a real possibility.
However, acute gastrointestinal perforation is unlikely.
Zhou Can tried to press the patient's abdomen, but the patient screamed in pain when he pressed the upper abdomen. The patient did not respond when he pressed other parts of the body.
"Try bending your knees to your chest."
Zhou Can said to the patient lying on the bed.
The patient did as he was told and a comfortable expression appeared on his face.
“It doesn’t seem to hurt that much anymore!”
The patient's pain was relieved, and he couldn't help but have more trust in the young doctor's medical skills.
"Have you ever had similar abdominal pain before?"
After Zhou Can temporarily relieved the patient's pain, he continued to ask.
"No, it's never hurt this much."
The patient shook his head.
His girlfriend was by the bed, looking haggard. Anyone who stayed by the patient's side for a night and was worried and frightened would probably be in the same state.
"Do you smoke?"
"suck!"
"Has he always looked this yellow?"
"It seems not! She used to be quite fair." The patient's girlfriend thought for a moment before answering.
"Doctor Huang, based on the patient's symptoms and various auxiliary examination data, mild jaundice, and no abnormalities found in the abdominal B-ultrasound and plain film, my diagnosis is acute pancreatitis. I think his jaundice is likely caused by the enlarged pancreatic head compressing the common bile duct, which is the cause of mild jaundice. Elevated blood amylase is an important basis for diagnosis."
After examining the patient, Zhou Can made a preliminary diagnosis based on a combination of test data and the patient's symptoms.
"Not acute cholecystitis?"
Huang Liang's expression changed after hearing this.
He guessed two diagnoses, but unfortunately neither of them was correct.
"Probably not."
Zhou Can shook his head lightly.
"When I examined the patient just now, in addition to upper abdominal tenderness, there was also abdominal muscle tension. In addition, a number of auxiliary examination data can also indirectly prove that acute adenitis is more likely. The pathogenesis is mainly the activation of zymogen in the acinus, which triggers a series of chain reactions, which is closely related to the patient's overeating."
Zhou Can’s current pathological diagnosis level is at the lower attending level and is moving towards the middle attending level.
He has the diagnostic bonus of the special medical skill of first aid and emergency response.
In addition, he has studied under many chief physicians, so his diagnostic level is really not comparable to that of senior resident doctors like Huang Liang.
He can pinpoint the root cause of the disease through symptoms and examination data.
If other doctors are not competent enough and lack diagnostic experience, they will be confused.
"But the B-ultrasound did not reveal any obvious abnormalities in the pancreas!"
Huang Liang still asked somewhat unwillingly.
"If we check the B-ultrasound now, I believe we will be able to find that the pancreas is obviously enlarged."
Zhou Can's tone was filled with a hint of confidence.
B-ultrasound data will continue to change according to the progress of the patient's condition. For some diseases, it is necessary to do two more B-ultrasound examinations.
Of course, such repeated examinations within a short period of time may be incomprehensible to patients and their families.
Doctors need to be patient in explaining and communicating.
Let patients understand that doctors are not trying to make money from unscrupulous examination fees, but are trying to help patients identify the cause of the disease , find the lesions, and relieve their pain.
After listening to this, Huang Liang pondered for about twenty or thirty seconds and finally made up his mind.
"You have heard what Doctor Zhou just said. I am going to immediately apply for another B-ultrasound examination for the patient for a re-examination." Huang Liang looked at the family members and the patient.
This kind of repeated examination definitely requires the understanding and consent of family members and patients.
"Okay, I believe in the ability of this doctor Zhou."
The patient was always conscious, and Zhou Can's behavior was indeed different from Huang Liang and others. He had the calmness and confidence that only a chief physician could have.
This is the legendary general style.
It can naturally convince people from the bottom of their hearts.
Huang Liang ordered an abdominal B-ultrasound examination for the patient on the spot. Perhaps the intestinal perforation patient a few days ago had left him with a psychological trauma. After applying for the examination, he did not dare to delay and personally accompanied the patient for the examination.
Generally speaking, you don't have to wait in line if you are accompanied by a doctor for the examination.
Especially for some emergency patients, the examination department also has the responsibility to give priority to this type of patients for examination.
For example, patients with chest pain can go directly through the green channel of the chest pain center when they enter the hospital.
Soon, the test results came out.
As Zhou Can diagnosed, the patient was suffering from acute pancreatitis.
Through this incident, Huang Liang's attitude towards Zhou Can completely changed. He finally let go of the last bit of pride in his heart and sincerely convinced Zhou Can. Sometimes it may not be so easy to distinguish the level of medical skills.
However, when the levels of two people are very different, it is still easy to tell who is better.
In both diagnoses, Huang Liang was obviously inferior to Zhou Can.
I believe Huang Liang knows this very well even if others don’t say it.
Just then, Luo Jingyi, a graduate student under Director Shang, ran over and shouted at Zhou Can from the door of the office.
"Doctor Zhou, Director Shang asked me to ask you if you have handed over the patient. The interventional operating room is preparing for surgery soon."
The chief physician took the initiative to invite a resident trainee to perform the surgery. Huang Liang was extremely envious of such treatment.
At the same time, deep down in his heart, he was even more convinced of Zhou Can.
"Okay, okay, I'll go right over with you."
Zhou Can now has experience and has to hand over the patients on hand to the resident chief Luo Shengsheng or other doctors in the team before 8:50 .
Because when Director Shang, Deputy Director Shi, or Doctor Huang Xinggui performs surgery, it is mostly around nine in the morning.
