Chapter 589 The cause of death was not catheterization, but
The cause of the patient's death was related to a poorly fixed urinary catheter, which means the gastroenterology department needs to take responsibility.
"The patient's abdomen was swollen like a drum and his skin was brown, which means that urine and feces were retained in the body for a long time and could not be discharged. The toxins in turn attacked the body, causing severe organ failure and death. There was a high possibility that the catheter could not drain urine. There was indeed a problem."
Director Shi from the hospital infection control office also came to a similar conclusion.
They are all professionals and their analysis of the cause of death of the patient is usually accurate.
The preliminary investigation results of both people believed that there was responsibility in the diagnosis and treatment of the Department of Gastroenterology, which immediately made the attending physician and Director Shang feel very uneasy.
Including the nurse who inserted the catheter into the patient, they all had a terrified expression.
"Doctor Zhou, what's your opinion?"
Dean Qin looked at Zhou Can, who had not yet spoken.
Director Shang looked at Zhou Can for help, hoping that he could help the Department of Gastroenterology reduce the responsibility for this accident.
"The patient's death had nothing to do with the catheter!"
Zhou Can said in a firm tone.
After hearing this, Director Shang and several medical staff immediately looked at Zhou Can with expressions of extreme gratitude.
It’s Xiao Zhou who is talking about old times!
"Humph, Dr. Zhou is now participating in the investigation as a member of the Quality Control Department. You must not be biased and make inaccurate findings out of consideration for our past friendship."
Director Shi from the hospital infection control office snorted, expressing dissatisfaction with the conclusion Zhou Can gave.
He must have known that Zhou Can had once been a resident in the Department of Gastroenterology and had a certain friendship with the doctors there.
As a referee, the worst thing to do is to be unfair.
Members of the Quality Control Department must never be partial or corrupt. They must not lie because they are familiar with the department or doctor being investigated even though they have discovered problems during the investigation.
"Dr. Zhou must be careful about his stance and learn to adapt to his new identity."
Assistant Dean Qin also reminded him quietly beside him.
"I have no intention of favoring the Department of Gastroenterology. I just made a conclusion based on my own inference. The patient was unable to defecate. He used suppositories and his family helped him to pick out his stool with their hands, but it was of little use. He started urinating at around 5 a.m. yesterday and did not urinate until 3 a.m. today when he died."
Zhou Can told the patient's nursing records.
"I have seen the catheter. Although the body changes after the patient dies and the catheter is stuck tightly, there should be no problem with the depth and angle of insertion. Even if I do an autopsy, I am more than 99% sure that the catheter has entered the bladder correctly."
When it comes to implantation techniques, Director Ju of the Nursing Department and Director Shi of the Hospital Infection Control Office are probably far inferior to Zhou Can.
Especially after reaching the sixth level of implantation, Zhou Can's assessment of various implantations became more accurate. He could even tell at a glance whether the implantation was in place.
"Then why was there no urine discharge even though a urinary catheter was inserted four hours before Yu's death?"
Director Shi asked unconvinced.
"According to common sense, even if the urine volume is small, urine will be drained out after using a urinary catheter."
The bladder is a very amazing organ.
The human body's urine formation and excretion mechanism is even more ingenious.
The blood passes through the glomerular arterioles of the glomerulus. The large molecular proteins and blood cells in the blood can pass through normally. After being filtered by the glomerulus, the blood flows unimpeded in the renal arterioles and returns to the human blood system.
Most of the water, glucose, inorganic salts, and urea enter the bladder after being filtered by the glomerulus. The renal tubules also have a partial absorption function.
This is how urine is formed.
When a doctor checks a patient's urine, as long as he finds albumin and blood cells in the urine, he can conclude that there is something wrong with the patient's kidneys.
This means there is a problem .
Albumin and blood cells are very important nutrients for the body. If they are excreted through urine, the body will become weak and various symptoms will gradually appear, such as weight loss, anemia, etc.
Sometimes patients are unable to urinate because the amount of urine is too little and the bladder is not full, so the patient does not feel the urge to urinate.
If the urine volume is too little, the patient may not be able to urinate even if he wants to.
The internal pressure is not enough, and not even a little urine can be squeezed out.
However, after the catheter is inserted, the patient can basically urinate even if the amount of urine is small.
Of course, this depends on the doctor's catheterization technique.
Director Shi and Director Ju both believed that after the catheter was inserted, there was no urine for a long time, which was because the catheter was not inserted in the correct position. The patient's abdomen was swollen like a drum, and it was simply because he could not defecate, which was generally impossible to be so exaggerated.
Only when urine and feces cannot be discharged from the body will the abdomen become bloated and bulge like a pregnant woman.
The patient's intra-abdominal pressure is too high, which can cause many problems.
This is their diagnostic view.
"First of all, everyone should know that if urine is not excreted from the body for a long time, it will be reabsorbed by the body."
Zhou Can analyzed his own views.
Doctors often advise patients not to hold their urine. Regardless of whether they feel like urinating or not, it is best to urinate at least once every one or two hours.
This is because urine contains a large amount of toxins and harmful substances.
If it is not excreted from the body in time and reabsorbed by the body, it will cause great harm to the body.
It's okay to hold your urine once or twice occasionally, but if you do it frequently, all kinds of serious diseases will easily come to you.
Moreover, the skin of such people tends to lose its luster and become dull.
The eye sockets will become black and the whole person will have the appearance of a patient with uremia.
"You mean the patient's urine has not been excreted from the body for a long time and has been reabsorbed by the body?" Director Shi was obviously dissatisfied with this conclusion.
"No, I mean that the patient may have no urine before the catheter was placed. Even if there is a small amount, it may be reabsorbed by the body, resulting in anuria."
Zhou Can explained calmly.
"Where did the patient's urine go? His stomach is so swollen, you're not going to tell everyone that there's no urine in it, are you?"
There was a hint of sarcasm in Director Shi's tone.
He is a senior internist and now the leader of the hospital infection control office. It is normal for him to look down on Zhou Can, a young doctor.
Others were also not convinced by Zhou Can's explanation.
Even Shang Zhuxing, who was sitting opposite him, didn't believe it. He felt that Xiao Zhou was really loyal and was obviously helping the gastroenterology department to cover up the problem and reduce the responsibility for the accident.
"There is indeed no urine in the patient's stomach . Did you notice a detail? The patient suddenly vomited a lot of blood before dying."
Zhou Can's eyes swept over everyone.
"When I examined the patient just now, I pressed the patient's abdomen and it was soft. This means there is a lot of fluid in the abdominal cavity, not just feces."
In fact, even if you don’t have a bowel movement for a week, it is impossible for your belly to swell like that of a pregnant woman.
Because feces are mostly solid matter.
Especially for patients with difficulty in defecation, the feces stay in the body for too long, and the water is absorbed by the body, which will cause the feces to become drier.
For patients with constipation, doctors often recommend drinking more water, which is basically the same reason.
If the stool is too dry and lacks water, it will have difficulty passing through the intestines.
"I suspect that the patient must have a ruptured large artery or vein, resulting in massive bleeding into the abdominal cavity in a short period of time, which caused severe abdominal distension." He came to this conclusion.
"That's impossible! The patient has not been urinating since 5 o'clock yesterday morning. After such a long period of intra-abdominal bleeding, there must be various symptoms of blood loss. Even if the level of gastroenterology is poor, it is not that they can't find this situation."
Director Shi raised questions.
"This is exactly what I'm curious about. Is there a possibility that the patient's abdominal cavity was just bleeding slowly at the beginning. But the amount of bleeding would not be particularly small. Because the patient had severe stool retention, he must have had a lot of discomfort in his abdomen. So the pain and other symptoms caused by the bleeding were ignored."
"Because of the severe internal bleeding, the body mobilized water from other body fluids into the blood in order to maintain the normal operation of the blood circulation system. As a result, the patient was anuric for nearly a day. At night, the patient's bleeding not only did not stop, but became even heavier. This led to vomiting blood and death."
Zhou Can made a bold guess.
"Even if Dr. Zhou's inference is correct, the patient's bleeding is in the abdominal cavity. How could he vomit blood from his mouth?"
Director Ju of the Nursing Department raised questions.
The people in the medical department didn't talk anyway.
They hope that the Department of Gastroenterology will not bear any responsibility, because they are the coaches of the clinical department, and if there is a problem, they will also be held responsible for inadequate guidance.
"When patients vomit blood, it usually means there is bleeding in the upper digestive tract or the respiratory tract. This patient's bleeding is in the abdominal cavity. Normally, he should not vomit blood from the mouth. There are only two possibilities for this situation. Either there is bleeding in the upper digestive tract, or the bleeding in the abdominal cavity is in the intestines. I'm afraid we need an autopsy to find out the specific situation."
Zhou Can was also very curious about where the patient had bled and died.
One thing is certain: the patient's death was related to internal bleeding, not because the catheter was not inserted properly, resulting in inability to urinate, which led to death.
"The family believes that the dead are the most important and do not agree to an autopsy. Our hospital also hopes to keep things peaceful and bury the dead as soon as possible. Doctor Zhou's investigation concluded that the patient had massive internal bleeding, which led to his death. I wonder if Director Shi and Director Ju agree with this conclusion?"
Lao Xiong, deputy chief of the Medical Department, asked at the right time.
Zhou Can knew that Deputy Section Chief Xiong was friends with Director Shang.
Now that something has happened in the Department of Gastroenterology, Deputy Section Chief Xiong will definitely do his best to help clean up the mess and make a big thing small and a small thing nothing.
Having more friends is very helpful.
"I agree!"
Director Ju Shiman of the Nursing Department nodded in agreement with Zhou Can's conclusion.
Director Shi from the hospital infection control office was still a little skeptical and asked, "Doctor Zhou, are you sure the patient didn't have a ruptured bladder or that the catheter wasn't inserted properly?"
"I can be sure. If the bladder had ruptured, the patient would have been in extreme pain before dying. But according to the family and the medical staff on duty, the patient died in just a few minutes, and there was not enough time to rescue him. So I think the possibility of bladder rupture can be ruled out. As for the inadequate placement of the catheter, based on my personal professional level and experience, I can be sure that this problem does not exist."
Zhou Can said confidently.
It is true as he said, bladder rupture can cause great pain to patients.
It's impossible that there would be no reaction at all.
Not to mention the pampered humans, even wild antelopes would lose most of their mobility on the spot if their bladder ruptured.
Experienced old antelopes will urinate in the middle of the night instead of waiting until the next morning.
Because lions and wolves often hunt them in the morning.
This is because experienced beasts know the fatal weakness of antelopes. Herbivores eat a lot of fresh plant stems and leaves, which contain a lot of water. After a night of digestion, their bladders will be filled with urine.
Many young antelopes have no survival experience and do not know the dangers. At night, they are sleepy and seek comfort.
In the early morning, the lion roared suddenly and pounced from a distance.
They will be frightened and run away in panic.
In order to survive, the antelope will definitely run away at its fastest speed. If the bladder is full at this time, it will easily rupture when the bladder suddenly bursts. Once this happens, the antelope will almost certainly die.
Its escape speed will soon slow down because of the severe pain in its body!
At this time, it will become a delicious meal for the lion.
The old antelopes have experienced many early morning hunts by wild beasts and have summed up the experience of saving their lives. So they will overcome their sleepiness in the middle of the night and run to a far place to urinate. In this way, when they are attacked, they don't have to worry about their bladders being too full and bursting when they escape.
It also excretes a large amount of urine from the body, reduces weight, and is more conducive to increasing speed when escaping.
Humans' ability to withstand stress is far weaker than that of wild animals.
Even an antelope couldn't stand a ruptured bladder. If this dying patient had a ruptured bladder, his wailing would have been heard throughout the ward.
Therefore, Zhou Can boldly speculated that the patient's bladder did not rupture.
Of course, if verification is necessary, autopsy of the patient is the only gold standard.
"Okay, I agree with Dr. Zhou's conclusion! The patient's death has nothing to do with the catheter operation."
After listening to Zhou Can's explanation, Director Shi finally agreed with his conclusion.
Director Shang and others on the opposite side all looked happy and breathed a sigh of relief.
Assistant Dean Qin looked at Zhou Can with great appreciation.
A person's reputation is like a tree's shadow. This kid has made a name for himself in Tuya Hospital in just a few years with only a bachelor's degree. He is really capable.
Those people in the medical department already knew Zhou Can's abilities, so they seemed very calm.
Director Ju Shiman of the Nursing Department was also secretly surprised at Zhou Can's medical skills. She probably didn't expect this young doctor to be so amazing.
Of course, being able to enter the first group of the Quality Control Department is a remarkable achievement in itself.
Every spot in the first group is extremely precious.
You need to go through many tests before you can be selected.
"Doctor Zhou, you have helped the gastroenterology department clarify the responsibility, which is great. But it is difficult for us to explain to the family members. Can you further infer the cause of death without performing an autopsy? It doesn't have to be too specific, just roughly lock down an area."
Assistant Dean Qin has obviously become more dependent on Zhou Can.
