"Patients in bed 25? Ruan Xiaoqin, isn't this the bed you are responsible for?" Professor Wu looked at the middle-aged doctor with a sharp mouth and monkey cheeks.
It turns out that this person’s name is Ruan Xiaoqin.
"I am in charge. This patient is the one we just treated yesterday, the woman who personally guided the cement filling."
Ruan Xiaoqin stood up with a somewhat panicked expression.
It is true that the hospital has a three-level ward rounding system, but the attending doctor bears the greatest responsibility.
Sometimes the attending doctor may be more anxious and worried than the family members when something happens to a patient in their care.
As for some negative news about doctors being cold-blooded and not caring whether their patients live or die, that is pure nonsense.
Most of the patients for whom doctors don't care much have mild illnesses and can just enjoy themselves secretly.
For patients who really have problems, the doctor will definitely rush to the ward again and again. It is impossible for him to not care about the patient's life and death.
"Let's go and take a look!"
As soon as Professor Wu heard that this patient was treated under his personal guidance yesterday, he got up and rushed to the ward.
"Who is that, don't be stunned, join us in the rescue immediately!"
Professor Wu did not forget to call Li Jingsheng.
The significance of establishing prestige is even greater.
He just wanted to tell Li Jingsheng that he had the ability to direct Li Jingsheng's work in the orthopedic surgery department, so that Li Jingsheng should not be too arrogant and it was best to keep a low profile with his tail between his legs.
The first level of officialdom crushes people to death.
In hospitals, superior doctors do have this status and power.
Of course, it’s hard to say whether you can suppress a rather evil young doctor when you meet him.
According to the doctor's regulations and the hospital's regulations on rescuing emergency and critical cases, Li Jingsheng could not refuse in this situation.
He simply got up and followed him to the ward.
Just in time to see the first aid skills of Professor Wu and others.
Orthopedic surgeries rarely admit critically ill patients, because patients with serious injuries are usually sent directly to the ICU. Extraskeletal surgery will only be considered after the vital signs are stable and the surgical criteria are met.
No extraskeletal doctor would be foolish enough to admit a patient who is seriously injured and dying or who is at extremely high risk.
The simplest rib fracture, if it causes pulmonary hydrops, requires a thoracotomy of at least 200,000 yuan.
For older patients, doctors usually recommend catheter drainage and then conservative treatment.
What does it mean?
Just let the ribs heal on their own.
If the fracture is severe and displaced, it is often malunion.
Li Jingsheng followed Gang Gang to the door of the ward and already felt the heavy and tense atmosphere.
When an emergency occurs, the entire department usually rushes to the rescue.
Larger departments are usually divided into groups.
If the doctors in the team can handle it, then handle it yourself. If you can't solve it, you will definitely have to lower your head and ask for help from other groups.
"Professor Wu, the patient's blood pressure is still dropping, and he has serious breathing problems!"
The intern in charge of the bed was almost crying.
In such an emergency, few intern doctors can remain calm.
Many doctors who have been trained for two or three years perform lumbar puncture, but their hands are still shaking.
The family members nearby were so anxious that they cried.
The patient is a woman about forty years old, her face is pale, beads of sweat are constantly appearing on her forehead, and her expression is very painful. Breathing was heavy and short, and the person was already in a state of light coma.
His eyes opened a tiny slit, and he was already unconscious.
"What's your blood pressure?"
"Systolic blood pressure 78mmhg, diastolic blood pressure 49mmhg."
The nurse is counting the numbers.
Normal blood pressure values for adults are systolic blood pressure between 90-139mmHg and diastolic blood pressure between 60-89mmHg.
The above blood pressure is a relatively ideal normal blood pressure.
Now the patient's high and low blood pressure are both lower than normal, which means that the symptoms of hypotension are obvious.
In clinical practice, as long as the systolic blood pressure is lower than 80mmhg, the patient's life will be endangered.
Now, the patient's blood pressure has dropped below 80 mercury, which is an extremely dangerous signal.
"Two minutes ago, the patient's blood pressure was still 81mmhg and was dropping rapidly."
The intern added next to him.
"Let me check the leg wound first!"
Professor Wu removed the gauze on the patient's knee and could see the sutured surgical wound.
It seems that bone cement was poured into a certain bone in the knee joint.
Bone cement has been around since the 1960s, and has been widely used clinically since the 1980s. Our country only started clinical research in this area in the 1990s, and it was only around 2006 that some hospitals began to use it in clinical practice and achieved success.
Relatively speaking, it developed relatively late.
Bone cement has the advantages of low price, safety, reliability, stable performance and quick results.
Many patients with bone diseases can walk the next day after getting bone cement.
This is certainly good news for patients.
However, because it is a new technology, many patients themselves have some worries and concerns about using cement in the body, so the overall use cases are not many.
This also results in that its clinical application experience is not as rich as imagined.
The Second Hospital is considered a large hospital, and the level of orthopedic surgery treatment is far from excellent. In the past two years, its orthopedic surgery business has gradually improved greatly, and a large part of the credit should belong to the manual reduction clinic.
The reputation and reputation it has won for the Orthopedic Surgery Department of the Second Hospital, as well as its influence, are immeasurable.
It's just that the current situation in the medical field is such that those who can really cure diseases are not popular. Those doctors who write good papers and have amazing scientific research achievements receive preferential treatment from the hospital.
For example, Dr. Xu would have been fired eight hundred years ago if no one could replace him at the Second Hospital.
Professor Wu, a doctor with excellent academic and scientific research, has become a hot commodity.
The wound may be slightly red and swollen, which is normal.
I just had the surgery yesterday and I need to wait a few days to recover slowly.
Li Jingsheng discovered that the wound was sutured using vertical mattress sutures.
The level of stitching is actually... not much better than him.
I don’t know which doctor did the sewing?
It was definitely not sewn by Professor Wu himself.
Otherwise, it would be a bit shocking for a chief physician to sew like this.
Li Jingsheng's current vertical mattress suturing is at the proficiency level, which is equivalent to the level of senior residents.
It stands to reason that attending surgeons with excellent surgical skills can basically achieve this level of suturing.
If the director is able to sew to the level of a resident doctor, this director is also a little too wet.
"The wound was sewn very well, and there is no problem. The filling of bone cement in the tibia of the lower limb's knee will only cause local discomfort at most, and it is unlikely to cause the patient to become comatose... What did she eat in the morning and lunch?"
After Professor Wu checked, he looked calm on the surface, but in fact his brows had turned into knots.
I guess I was also panicking a lot.
To be honest, this situation is very rare in orthopedic surgery.
"My mother ate soy milk and steamed buns in the morning, and fried pork with green beans, Chinese cabbage, and stewed pork ribs with lotus root for lunch. They were all bought in the hospital cafeteria, so there should be no problem."
The patient's daughter is already a tall and graceful girl.
Wearing washed sky blue jeans and a light yellow short-sleeved shirt with white round spots. With her hair tied in a ponytail, there were no traces of makeup on her face, only the traces of wet tears.
There were still tears in his eyes, and they were slightly red.
Judging from her youthful face, she is probably around twenty years old at most.
I didn't see any other family members.
She was the only one at the bedside.
Her mother suddenly became critically ill. For her who had not experienced much social baptism, she was extremely frightened and panicked. I can only cry to relieve my inner anxiety and sadness.
"Professor Wu, do you think the patient will be poisoned after eating kidney beans?"
Ruan Xiaoqin, who has a sharp mouth and monkey cheeks, expressed his personal opinions from the side.
"This possibility cannot be ruled out. Did the patient have vomiting, dizziness and other symptoms before coma?"
Professor Wu asked the family members and the doctor in charge of the bed.
"I had vomiting, chest tightness, and general discomfort."
The bed doctor replied.
"After eating steamed buns in the morning, my mother started to complain that she felt a little uncomfortable, and then kept saying that her chest was uncomfortable. Then she vomited. She ate very little lunch, and she seemed to have finished eating the green beans."
Family members also confirmed that he had vomiting symptoms.
Professor Wu's face twitched twice, and he vomited after eating the steamed buns. He hadn't even eaten green beans at that time, so how could he be poisoned?
"Are you sure you're vomiting after breakfast?"
"Sure! My mother retched twice after lunch, but she didn't spit it out."
"That's probably not kidney bean poisoning."
Professor Wu turned to look at Ruan Xiaoqin.
"Dr. Ruan, the patient vomited after eating breakfast. Have you examined her?"
"I checked my body temperature, it was 38.6 degrees, and my heart rate was over 120 beats/minute."
Most adults have a heart rate between 60 and 100, and as we age, our heart rate slows down.
For a forty-year-old woman, if she does not have heart disease, her heart rate should be only sixty or seventy beats per minute under steady conditions.
Tachycardia is now evident.
"Based on some of her symptoms and the description of her family members, considering that the patient felt hot and uncomfortable last night, she opened the window and blew on the window all night, and she was more likely to catch a cold. I prescribed a fever-reducing prescription. medicine."
Ruan Xiaoqin's handling was obviously too casual.
If you are unable to judge such a matter yourself, you should report it to your superior doctor.
"Can a cold cause a patient to suddenly become comatose? You are too careless."
After hearing this, Professor Wu's face turned dark.
After all, people over fifty years old must have rich clinical experience.
He had realized something was wrong.
The patient may have started to have obvious symptoms this morning, or even started to feel uncomfortable last night.
Being careless can really kill people!
"Who is that? Please ask Director Hua to come over immediately."
Professor Wu turned to look at Li Jingsheng.
It's already this time, but I still don't forget to take the opportunity to kill Li Jingsheng.
"It is recommended to put the patient on a ventilator immediately. If it is too late, it may be too late to save him."
Li Jingsheng stared at the patient for so long, and basically understood the patient's treatment process. He realized that the patient's fatal disease was progressing rapidly.
He has worked in both the respiratory medicine department and the emergency department of the First Hospital, and has some rescue experience.
Coupled with the fact that he now has junior-level intra-breath diagnosis and proficiency-level cardiovascular medicine diagnosis capabilities, after the initial diagnosis of this patient, the cause of the disease was not found. But it is definitely not wrong to put on a ventilator.
"Director Wu is here to direct the rescue, and you, a resident doctor, are still here to worry about it? Hurry and go."
Ruan Xiaoqin shouted at him.
Seeing the patient's condition getting worse and worse, Ruan Xiaoqin knew that something was in serious trouble.
My mood was extremely bad.
At this time, Li Jingsheng was asked to ask for help, but he still acted as a gossip and gave them rescue suggestions. Who do you think you are?
This new doctor is so outrageous.
It’s simply a matter of ignorance.
"Professor Wu, you can look at the patient's fingertips. They have begun to become cyanotic. This is an obvious sign of hypoxemia. In addition, the patient's blood pressure continues to drop rapidly, his heart rate is too fast, and he is also accompanied by high fever. The ventilator must be prepared. , otherwise it may be too late.”
Li Jingsheng ignored Ruan Xiaoqin.
Instead, he looked at Professor Wu with a serious face.
After saying that, he did not stay any longer, but quickly went to find Director Hua to come over and rescue the patient together.
The patient's current condition is not particularly serious, so Professor Wu can think about the cause of the disease relatively calmly. As the condition progressed rapidly, Professor Wu did not even have a chance to rescue him.
In clinical rescue, when encountering this kind of situation, some life support is usually provided first.
For example, if your blood pressure is low, raise your blood pressure.
If you can't breathe well, take oxygen or put on a ventilator.
For experienced doctors with certain rescue experience, they will make a preliminary assessment based on the patient's condition. If there was still time to think about the cause, they would not act rashly.
Li Jingsheng ran directly to Director Hua's office.
Knock on the door.
After a while, Director Hua's slightly confused voice came from inside.
"Please come in."
This is taking a nap.
Many directors and chief physicians are in their forties and up.
For older doctors, a 42-year-old can be considered a very young chief physician to be awarded a senior professional title.
Many people reach the rank of deputy high-ranking officer only when they are in their fifties, and even stay at the rank of deputy high-ranking officer for the rest of their lives.
"Director Hua, the patient in bed 25 suddenly fell into coma and is in very bad condition. Professor Wu asked me to ask you to come over and rescue the patient together."
"I'll be there right away!"
When Director Hua heard about this dangerous situation, he woke up from his sleep in an instant.
He stood up and hurriedly walked outside.
"Don't you work in the outpatient department? Why does Professor Wu ask you to run errands in the inpatient department?"
Director Hua recruited him not as a handyman, but as a supporter of the clinic.
"I came here to take a rest at noon, and happened to be rescuing patients, so Professor Wu asked me to come with him to help."
Naturally, Li Jingsheng would not say in front of Director Hua that Professor Wu put small shoes on him and suppressed him.
That would be too LOW.
At the level of Director Hua, as long as many things are described truthfully, Director Hua will have a clearer judgment.
It is a taboo in the workplace to make a small report about another leader in front of one leader.
"How is the patient?"
Director Hua asked.
"The patient's blood pressure has dropped very quickly. His systolic blood pressure is only 78mmhg. His heart rate is as high as 120 beats/min. He is breathing heavily, is in a slight coma, and has symptoms of hypoxemia. The patient's treatment is to inject bone cement into the knee and tibia. I don't want to do anything else. It’s so clear.”
Li Jingsheng briefly explained what he knew.
"It should be the patient whose osteomyelitis caused a cavity in the tibia. How could he be in a coma after treating his leg? It's just a minor surgery on the lower limbs!"
Director Hua was also a little confused.
Sometimes something happens and you can't stop it.
These are often unexpected emergencies.
The two entered the ward and had already used some rescue measures on the patient.
"Has the cause been found?"
As soon as Director Hua came in, he immediately became the one with the highest status.
The overall command of the rescue automatically fell into his hands.
"Nothing was found. I just pushed two kidneys to increase blood pressure, and the effect was a little bit, not very good. Considering that the patient has hypoxemia, I will try to let her inhale oxygen for the time being to see the effect."
In the end, Professor Wu did not adopt Li Jingsheng’s suggestion, but chose the most convenient bedside single-nostril oxygen inhalation method.
"The patient's blood oxygen index has risen a little to 87%."
Ruan Xiaoqin said next to him.
"The blood pressure has stabilized and has risen a bit. The systolic blood pressure is 80mmhg."
Good news comes frequently.
Symptomatic treatment with Western medicine often provides immediate results.
Clinical rescue can basically achieve good results.
Li Jingsheng was not optimistic about the result.
He has a strong sense of crisis. The patient's current physical improvement is just a flower in the water, and the moon in the mirror will soon be restored to his original state.
Because the real cause has not been found.
Of course, it is also a good idea to use this method to gain more rescue time.
Diagnosing some causes is very laborious and requires more time.
"Can I see how the patient is doing?"
Li Jingsheng asked Director Hua for instructions.
Now that Director Hua is the commander-in-chief, Li Jingsheng can get some opportunities to perform meritoriously.
If he can give constructive suggestions for the rescue of this case, his status in the department will be greatly improved.
Although manual bone setting is a technical job, in the eyes of many doctors, it is just a 'rough job'.
Just like internal medicine despises surgery and only knows how to use a scalpel.
The chain of contempt will always exist.
"Okay, let the medical staff in charge of the bed cooperate with you on how you need to check. Young doctors should be like you and be more proactive, instead of being timid and afraid of taking responsibility."
Director Hua readily agreed. When talking about the latter part, his eyes swept over Ruan Xiaoqin and others intentionally or unintentionally.
Ruan Xiaoqin and others naturally looked at Li Jingsheng examining the patient with disdain.
If your strength is not good, it will be useless no matter how positive your performance is.
After getting permission, Li Jingsheng walked to the bedside to check the patient.
Physical examination is always the most intuitive and effective way of initial diagnosis.
Trying to open the patient's eyelids, he discovered subconjunctival ecchymosis.
Then he pinched open the patient's mouth and looked at it. There were no symptoms such as oral bleeding or blisters.
"Lend me your stethoscope!"
Li Jingsheng also checked for addiction and listened to the patient's heart and lung sounds.
Professor Wu and others naturally had little hope for this newcomer, and even felt that Li Jingsheng was a little eager to perform and had a strong utilitarianism.
Because he had a conflict with Li Jingsheng when he first met, he has always had a bad impression of Li Jingsheng.
Director Hua, Professor Wu and others have already started discussions in the ward.
Carefully investigate every possible risk link.
After listening to the patient's heart and lung sounds, Li Jingsheng already had some confidence.
Diagnosis of respiratory medicine at junior level is quite good.
When listening to the lung sounds, he heard dull dullness and crackles, which were especially obvious during percussion.
Based on his diagnostic experience, the patient may have developed pulmonary edema.
I think of the patient complaining that it was very hot last night and that he needed to open the window for ventilation. Did the patient's lungs already have problems last night?
This possibility is very high.
After pulmonary edema occurs, difficulty breathing and feeling stuffy will occur.
The weather in Lijiang City last night was pretty good, and there was no sweltering heat before it started to rain.
When the patient developed symptoms of stuffy heat, there should have been a problem.
Pulmonary edema, subconjunctival ecchymosis, high fever, fast heart rate, rapid drop in blood pressure, and slight coma...these symptoms together enriched Li Jingsheng's diagnostic basis.
Just like solving word problems, every time you add a known condition, the answer will be more accurate.
The difficulty will also be reduced a lot.
"How has your mother's urination been since the surgery? Is it much less than usual?"
Li Jingsheng asked the girl.
She may have thought that Li Jingsheng was relatively young, so she was somewhat reluctant to pay attention to him.
Out of politeness, I just nodded symbolically.
"Roughly the same!"
Li Jingsheng did not ask the family members, but directly picked up the nursing record card.
Urine output, blood pressure, etc. must be recorded after surgery.
"There is a significant reduction in urination!"
Pretty much what he predicted.
"The patient underwent a bone cement filling operation in the tibial bone cavity. After the operation, symptoms such as pulmonary edema and high fever occurred. If factors such as allergies and infections are ruled out, what could it be?"
He began to think hard and work hard to identify and solve the problem.
(End of chapter)
