Deaths from venous embolism occur every year for many reasons.
For example, sitting or lying down for a long time can slow down the blood flow. Especially the lower limbs are prone to obstruction of blood return, accumulation of red blood cells, and eventually thrombosis.
In addition, the blood in the body is in a highly coagulated state, especially after burns and scalds, this phenomenon is most likely to occur.
The rest is atherosclerosis, or narrowing of arteries, etc., which are prone to blood clots.
The most harmful thing is definitely pulmonary vein thrombosis.
Mainly, it is not easy to find. When the diagnosis is made, it is often at the autopsy stage.
"You are right, the patient died of pulmonary vein thrombosis. It was also the death of that patient that made me realize that manual bone reduction is not just about reducing the fracture site, but also paying attention to checking the patient's vascular damage and blockage. Your current You should have reached a certain level of bone palpation, right?"
When Dr. Xu talks about the death cases that year, he still feels frightened even after many years.
Every patient's death or major change in condition will be deeply remembered by doctors.
"I should now have reached the fourth level of bone touching. I can feel the patient's bone vitality, subtle bone images, and the damage to ligaments, blood vessels, and soft tissues. But I feel there is still a lot of room for improvement."
Li Jingsheng didn't hide it either.
In fact, based on Dr. Xu's level, one can definitely see Li Jingsheng's true level from his practical operations.
"It is very good to be able to reach such a high bone palpation level in such a short period of time. When your bone palpation level is stronger in the future, you can feel more subtle changes in the patient's bones, blood vessels, and ligaments. For example, in the blood vessels Blood flow rate. If you find that the blood flow rate slows down, especially in the lower limbs, you must be extra vigilant about vascular embolism."
Taking the bone palpation technique a step further, you can actually feel the blood flow rate in the blood vessels.
It's a bit incredible to think about it.
Li Jingsheng is full of yearning for higher levels of proficiency.
His bone-touching technique is currently at the Xiaocheng level. If he wants to advance to the next level, he needs 1,000 proficiency levels, which is still several hundred short.
It seems like you have to work hard!
Next, Dr. Xu talked with him about a lot of clinical knowledge about bone correction and reduction.
These things are difficult to learn from books.
They are all accumulated by doctors themselves or taught by other doctors.
As for some surgical techniques, even original techniques, combined medications, etc., they all need to be taught by teachers.
The conversation was almost over, and Li Jingsheng was about to stand up and leave.
"Teacher, there is one more thing I would like to ask your opinion on. The Second Hospital wants to recruit me to the Orthopedic Surgery Clinic. I will work three days a week. I will be paid as a regular employee. I can be evaluated on professional titles, hire attending physicians, etc. Personally, I am quite excited. I am worried about harming your interests, so I decided to ask your opinion first."
The rule of survival that Li Jingsheng learned in the old streets in the south of the city is that one mountain cannot accommodate two tigers.
Compared with the last time he opened Fredo Pharmacy, both his and Lao Zhao's clinics were greatly affected.
Patients who were going to the clinic to buy medicine were directly attracted to it.
A carrot and a pit.
There are only so many patients and customers who need to buy medicines in Chengnan Old Street, so naturally one goes down and the other goes up.
In the past two days, the business of Sunshine Clinic has been extremely hot, and Lao Zhao must be suffering.
However, the customers and patients who come to Li Jingsheng's clinic are not from this small area, and some come from other areas in the city. It can be considered that there is some initial siphon effect.
Now, if Li Jingsheng agrees to work in the surgical reset clinic of the Second Hospital, wouldn't it mean that his apprentice is stealing his master's job?
"How are you harming my interests? Don't worry, don't tell me that you only work there three days a week. Even if you work seven days a week, it won't affect me. When I stayed at the Second Hospital, Director Hua kindly invited me. Even though I only know how to manipulate bone and reduce it, and I can do it all over the world, as long as I can do it, I can get good treatment in any hospital I go to."
When Dr. Xu said this, he had a proud expression on his face.
His eyes were stern, looking proudly into the sky.
This is true.
Doctors are an industry that relies on technology. As long as you are excellent in one field, you can do very well.
"It's a good thing that you entered the Second Hospital. Don't underestimate professional titles and qualifications. In almost more developed countries around the world, professional titles are particularly important. And if you enter the Second Hospital, it is equivalent to leaning against a big tree. The area south of the city can be more confident.”
Dr. Xu also mentioned this matter implicitly.
It seems that more advanced doctors know that this area in the south of the city is not simple.
Think about it too.
There is only one second hospital in the south of the city of Nuovo University, which is extremely abnormal in itself.
"If you are talking about admission to the second hospital in the past two days, I can cooperate with you. I happen to be sick, and there is no substitute there. If you don't say you are waiting for a price, at least you can ask for a good price. Then There are some additional conditions that can be mentioned, such as not working overtime, not attending hospital meetings during non-working hours, etc. I can see that your kid likes to go wild. When signing the contract, you can mention some additional conditions appropriately so that you can have more privacy. free."
Dr. Xu treated him really well.
Not only was he not worried about Li Jingsheng taking his job, but he helped Li Jingsheng get a good price.
"Since you agree, I'm going to talk to Director Hua tomorrow."
Li Jingsheng is also worried about long nights and many dreams.
Some opportunities are difficult to get again if you miss them.
"Be confident when talking about it. I'm not bragging. Although there are many doctors who know how to manipulate bones and bones, there are very few who can reach a higher level. Your current level is not very good, but looking at the entire Jiangli City, basically The above is to choose a general among the dwarves. You already have some foundation. As time goes by, you will definitely become more powerful, so you must have some confidence when negotiating terms.
Director Hua is a pretty good person, but when it comes to interests, he is definitely on the side of the department and the hospital in many matters.
There are many things that you need to fight for on your own. "
Dr. Xu said these heartfelt words because he regarded him as his disciple.
…
It was almost ten o'clock in the evening when Li Jingsheng returned to the clinic. He gained a lot from this visit to his mentor.
It will be better to talk to Director Hua tomorrow about admission and employment.
What he has to consider now is that after joining the Second Hospital, he will be away from the clinic for three days a week. Who will do the diagnosis and treatment?
Recruit another certified doctor?
If it’s less than 7,000 yuan/month, it’s basically a no-brainer.
And the quality of those recruited cannot be guaranteed.
Doctors who are willing to work in small clinics are basically half-qualified.
However, there are times when things are missed. It would be ideal to recruit a doctor who knows how to deal with the problem and has some real skills.
Clinics generally don't handle anything serious, just common colds, fevers, diarrhea, headaches, etc.
After much thought, he decided to recruit another doctor who could take his place.
On the one hand, it can maintain a legal business, and only a licensed physician can prescribe it. Even if Tang Ping and Han Siying knew some clinical medicine, they couldn't prescribe prescription drugs.
Otherwise it is illegal.
But what to say about this kind of thing? They prescribed the prescription in the name of Li Jingsheng. Even if the superiors checked it, nothing would happen.
The only weakness is not to have an accident.
Just one accident and he can immediately become a pawn and destroy the marshal.
Nowadays, the industry's handling of medical accidents is basically a high-pressure situation. As long as problems are found, the minimum penalty is suspension for investigation, and the more serious penalty is the revocation of the medical license.
This risk is too great and Li Jingsheng cannot bear it.
It is basically a common phenomenon in hospitals for unlicensed doctors to write medical orders in the name of senior doctors.
Better graduates can easily obtain this privilege.
But there is no comparison between a clinic and a hospital.
The clinic's ability to resist risks is small, and the hospital has multiple inspection and control systems.
If there is a problem with the medical order prescribed by the intern, the nurse will immediately find out and call back in time to ask the intern to reopen the order.
There is only one nurse in his small clinic, Tang Ping.
She has been working in the clinic for nearly a year, and her professional sensitivity and level have definitely declined.
"No, if the clinic's business can be stable at 20 patients a day, then hire another certified doctor."
Li Jingsheng finally decided to put safety first.
If you want to reduce expenses, you can also discuss with the other party that you only need to work three days a week, and the doctor can find another job during the remaining time.
His salary at the second hospital must be higher.
When the time comes, there will still be money to be made if they offset each other.
After clearing his thoughts, a relaxed smile appeared on his face.
The development of the small clinic and his personal development are very compatible, and the future is brighter.
Once he becomes the attending physician of the Second Hospital, his social status and medical status will be greatly improved. The influence in this area south of the city will also increase.
After taking a shower, he picked up a medical book on orthopedics and traumatology to read.
Only by living and learning can you become a truly strong person.
The ocean of medicine is vast and boundless, and one can never learn enough in his lifetime.
Because he has the golden finger of the attribute panel, he boldly wants to take a multi-field development route. There is more to learn than an ordinary doctor.
At around 11:30 in the evening, while he was reading a book, his cell phone suddenly rang.
Who is calling so late?
Could it be that little girl Ou Qinglan couldn't sleep and wanted to talk to him on the phone?
Obviously, he thought too much.
It's an unfamiliar phone number.
"Hello!"
Li Jingsheng answered the phone.
"Are you the doctor from Sunshine Clinic?"
A young girl's slightly anxious voice came.
"I am! What's the matter with you?"
"We went to your clinic today and bought a bottle of safflower oil from the girl who sprained her knee. Do you still remember it?"
"It's you, I have an impression! Is your leg injury feeling better?"
Li Jingsheng had a deep impression on this young female patient.
I also specifically asked Dr. Xu for advice.
"I don't have the phone numbers of other doctors. I happened to take a photo of your clinic during the day and found the phone number on the sign, so I tried to call. I'm not the one who sprained my knee. I'm her friend, staying with her. The girl who went to your clinic. After Zhao Qi applied safflower oil, she said she felt much better. But I just came back from evening self-study and found her lying on the bed. She was a little groggy and her face was slightly purple. …”
This girl can really drive people to death.
Although he was obviously very anxious, he still talked a lot of nonsense.
Before she could finish speaking, Li Jingsheng immediately became anxious when he heard about the injured girl's condition.
The overseas case of death due to toe injury mentioned by Dr. Xu must not be repeated again.
"You're at school now, right?"
"Yes, we are in the school dormitory."
"Call 120 immediately and send her to the hospital. Also, if she is lying on her back, try to raise her feet as high as possible. It is best to have the height higher than her head. You can tell the doctor directly that you suspect that your friend has something wrong. Pulmonary venous emboli, she is very dangerous now.”
Li Jingsheng didn't expect that this kind of thing would really happen.
He was a little uneasy when he saw the girl's leg injury.
I thought it was a hidden danger such as a torn meniscus or ligament, but I didn't expect that a venous emboli eventually occurred.
Of course, I'm not sure yet.
This is a young life. Even if there is only a hint of doubt, he will think about the most serious problem.
The girl was horrified to hear him speak so seriously.
I hung up the phone in a panic and quickly dialed 120 for help.
A few minutes later, she called again.
"Doctor, I have called the emergency call according to your instructions and reported it to the dormitory manager and the teacher. What should I do next? Zhao Qi's breathing is very heavy now. It's scary!"
On the other end of the phone, the girl asking for help was crying.
"Don't panic, ask someone to lift the person down together, so that when the ambulance arrives, he can be lifted into the car for emergency treatment as soon as possible. Try to have the patient lie flat with his feet elevated. If respiratory arrest occurs, cardiopulmonary resuscitation can be performed."
Li Jingsheng calmly guided the first aid.
The significance of cardiopulmonary resuscitation for pulmonary vein embolism is relatively small, but doctors are like this. They only have 1% hope, but they are willing to use 200% efforts to rescue.
"Okay, okay, thank you!"
She hung up the phone again.
After this happened, Li Jingsheng was no longer in the mood to read, and quietly waited for the results.
First-year colleges usually have school doctors, but the level of school doctors is often very limited.
If you want to save people, you have to call the hospital for emergency treatment.
If emergency doctors could be less rigid and bring thrombolytic and anticoagulant drugs, the patient might still be able to be saved.
Although pulmonary venous emboli is scary, there are still many rescue methods as long as it is discovered in advance.
About ten minutes later, the call came again.
Still the same girl.
"The emergency doctor is already here. He is a doctor from the Second Hospital. He wants to understand the situation with you. Can you please take a look?"
"Give him the phone!"
Li Jingsheng naturally would not refuse.
"Hello, are you the doctor from Sunshine Clinic?"
"Yes, I am Li Jingsheng from Sunshine Clinic."
"Hello Dr. Li, I am the doctor on duty in the emergency department of the Second Hospital and I have heard of your name. This patient is now in a state of slight coma, with mild cyanosis of the face and nails, difficulty breathing, and obvious visible signs on the right knee. Sprain and traces of safflower oil application. Do you suspect she has venous thrombosis?"
Now Li Jingsheng has gained some fame in the emergency department of the Second Hospital.
This made him very helpless.
Lao Zhao alone contributed two first aid opportunities.
During the recent period, the ambulance from the Second Hospital came to his clinic several times to pull people away.
It's considered 'famous'.
"I suspect that this patient may have pulmonary venous emboli. If you have brought thrombolytic drugs, you can give her them first. If she is taken to the hospital, she may miss the best opportunity for rescue."
In the face of such emergency patients, doctors have certain autonomy in administering medication.
Even if the wrong medicine is used, there is a high probability that the patient will be innocent if the family members take him to court.
"good!"
After hesitating for about two or three seconds, the other party only answered with one word.
The phone should have been returned to the girl again, without hanging up or talking to him again.
"Try giving her intravenous injection of urokinase! If it works, add anticoagulants immediately."
The male doctor's words came faintly.
Urokinase can activate plasminogen, accelerate fibrinolysis, and promote the dissolution of thrombus in veins.
Recombinant streptokinase, alteplase, reteplase and other drugs are also commonly used for thrombectomy.
Aspirin enteric-coated tablets, clopidogrel bisulfate tablets, tirofiban hydrochloride sodium chloride injection and other drugs are also commonly used in intravenous thrombolysis. However, routine blood tests and prothrombin tests are often required before medication.
In this kind of emergency rescue, intravenous injection of urokinase is a relatively quick-acting method.
Li Jingsheng wanted to hear it again, but the call had been hung up.
Time passes by minute by second, and I don’t know what the result of the medication will be?
About twelve o'clock, he had just fallen asleep when the ringing of the phone woke him up.
At first glance, it was the girl calling again.
"Dr. Li, thank you, thank you. My classmate Zhao Qi is temporarily out of danger after rescue! The doctors and nurses in the hospital are praising you, saying that your judgment is very accurate. Zhao Qi really has venous thrombosis, and it is Pulmonary embolism. They say the survival rate for this disease is extremely low. Thank you so much."
The girl on the other end of the phone was endlessly grateful to him.
"You're welcome, this is what I should do. If you injure your lower limbs while playing basketball in the future, you must be alert to venous emboli."
Li Jingsheng was very happy to hear that the patient was out of danger after rescue.
The anger at being disturbed from his nap has long since dissipated.
After ending the call, he took a look at the properties panel.
Amazing.
Calling to rescue a patient actually increased his health by 100 points.
Then in the diagnosis column, there is an extra thoracic diagnosis.
This can be considered an unexpected surprise.
Thoracic surgery diagnosis covers a wide range of fields. In its early days, it was inseparable from cardiac surgery diagnosis.
Later, as the number of hospitals increased, major hospitals were severely overwhelmed, and doctors worked hard to evolve their housekeeping skills. Eventually, cardiothoracic surgery was split into cardiac surgery and thoracic surgery.
It is worth mentioning that the status of thoracic surgery is relatively low.
In the past, the cardiothoracic surgery department was a top surgical department. After being dismantled, the cardiothoracic surgery department is still very good, and the status of the thoracic surgery department is a bit embarrassing.
However, in recent years, with the increase in the incidence of tumors, the status of thoracic surgery is rapidly improving.
Extrathoracic surgeries are mainly performed on the lungs, mediastinum, esophagus, etc. are also within its scope.
Then in recent years, the rise of video-assisted thoracic surgery has made this long-dusted department shine again.
For Li Jingsheng, extrathoracic diagnosis is basically useless now.
Don’t overwhelm yourself with many skills, put them aside and improve them later when you need them.
(End of chapter)
