My medical skills can add experience points Chapter 118 The growth history of qualified doctors and the abnormalities of surgical patients
Zhou Can only put plaster on this woman, as for her son, no matter how unfilial he is, it is not the doctor's turn to take care of him.
On the first day of their internship in Tuya, their teachers warned them that doctors only do what they should do.
Don't have too much sense of justice, and take care of the patient's family and private affairs.
He also told them that doctors should learn how to protect themselves while saving lives.
Zhou Can didn't understand the advice given by his teacher at the time.
How did such a selfish person become a teacher?
It wasn't until later, after he personally experienced it, that he realized that what the teacher said were all good words. Zhou Can still remembers the first experience of meddling, when a 26-year-old young woman was injured and hospitalized.
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It was obvious that someone had beaten him.
But she said it was a fall, and the doctor who treated her, the nurse in charge of the bed, and the doctor didn't meddle in their own business.
Zhou Can just didn't understand why she was lying.
Also did not dig out the patient's privacy.
Until that evening, he was on the night shift.
Accidentally found the woman's husband in the ward, he slapped the woman twice and punched her on the head.
She was sitting on the hospital bed crying.
Seeing this kind of thing, Zhou Can was furious.
I finally understood how the woman's injury came about.
Rushing into the ward to stop the man from continuing to attack. The man was very arrogant and warned Zhou Can not to meddle in his own business, it was his family business. Zhou Can didn't get used to him, and angrily accused him of beating his wife as an illegal act.
The man became angry and stretched out his hand to push him.
Zhou Can was not used to this man, and he had practiced Sanda himself, so he threw the domestic violence man to the ground with one move.
This time the matter can become a big mess.
The woman cried and asked Zhou Can not to hurt her husband.
The man called the police.
The superior doctors in charge of the ward and the leaders of the hospital departments were all alarmed.
The facts couldn't be clearer. As a result, when the police questioned her, the woman helped her husband speak, saying that Zhou Can was meddling in his own business, and beat her husband first. The man even threatened to send Zhou Can to jail.
At that time, Zhou Can's heart was bleeding.
It is obviously doing good deeds, upholding justice, and helping the weak.
As a result, the woman not only didn't appreciate it, but even bit her back. Together with her husband, she framed Zhou Can.
Doctors beating family members, the impact is too bad.
Losing money is a trivial matter, and it will definitely be punished by the hospital.
Fortunately, a family member in the ward recorded the scene at that time, and secretly handed it over to the police afterwards, so that the truth of the matter could be restored.
Zhou Can was not punished, nor did he lose money.
But no praise either.
Instead, the director of the department and the teaching teacher went to talk to him separately and criticized him.
That incident left Zhou Can with an unforgettable memory.
Since then, he has never been too busy.
In the process of receiving patients, he learned how to protect himself little by little.
The person who should sign must ask the family to sign.
Never agree to patients or family members because of overflowing sympathy.
This is a qualified doctor.
…
Under the guidance of Dr. He Zhang, Zhou Can successfully put a plaster on the female patient's left arm.
This is the first time he has completed a plaster cast independently.
Not particularly well done.
Finally, it was successfully completed.
He also earns 1 experience point.
According to Dr. He's instructions, after putting the plaster on the patient, observe for about 20 minutes to confirm that there is no abnormality before leaving.
During this waiting process, Zhou Can couldn't help but look at the patients in the nearby beds.
There are male and female patients, and there are not a few young people.
Some have undergone surgery and need to be hospitalized for a period of time. Some are waiting for the operation, or lying on the hospital bed in pain under traction.
Zhou Can's eyes finally fell on a bed next to him.
The patient was a middle-aged man in his forties who was sleeping with his eyes closed. Compared with other patients, he seemed extraordinarily quiet.
A middle-aged woman with a haggard face was lying on the side of the bed looking at her sleeping husband with a sad face.
When disaster strikes, husband and wife, parents, and children are the three most reliable types of relatives.
This middle-aged couple happened to be old on the top and young on the bottom.
Belongs to the pillars of the family.
The middle-aged man collapsed suddenly, and the consequences for the family were almost disastrous. The woman should be worrying about what to do if her husband cannot recover?
Not only can't make money during the hospitalization, but also has to pay a lot of money, which is undoubtedly worse for the family.
"He was hospitalized due to a car accident, and his calf was crushed and fractured. I heard that the tibia of the calf was a disjointed fracture and part of the tibia was comminuted. The operation took a full eleven hours. It is estimated that the bones, blood vessels, and nerves need to be anastomosed and connected. .It was just after five o'clock this morning and I came out after the surgery."
Dr. He Zhang carefully introduced the patient's situation to Zhou Can.
"Doctor Zhou, I don't have much work for you to help with now. That's all right, you should check the conditions of the patients in the ten beds first, and you may need to be on duty at night."
The squeeze between doctors is just like Dr. He's.
The superior doctors will give some chores, dirty work, and tired pistons to the subordinate doctors to do. Working the night shift is very hard work, which is basically covered by the training doctors and interns.
In a large department, it is not bad to have an attending-level night shift at night.
Intensive care is not included here.
When a patient in there has an accident, if the correct rescue is not done within a few seconds, life may be lost.
For example, some patients have a sudden drop in blood oxygen, or sudden cardiac arrest, etc.
This is why novice nurses and doctors are not qualified to be on duty in the intensive care unit.
Because it really tests the ability of doctors and nurses to deal with various emergencies. This requires rich experience, solid medical knowledge, and skilled rescue skills to support it.
The critical care departments of almost all hospitals gather elite medical staff.
Faced with Dr. He's oppression, Zhou Can actually had no room for bargaining.
Only obey.
Zhou Can got to know the situation of the patients in every hospital bed.
Patients and family members generally have a cold attitude towards young doctors like him.
These days, family members and patients are shrewd.
In the morning, during the rounds of the ward, the director and the attendant shouted and hugged. They knew that this was the person in charge.
Each of them will show flattering smiles, and their attitude will be very enthusiastic.
Answer whatever you ask.
After Zhou Can took a look around the patients in the ten beds, Dr. He, who was in charge of the beds, had already left.
Bed doctors need to write medical orders for patients, check the cases written by interns and regular trainees, and then write their own summaries, and report the abnormalities of some patients to the superior doctors in time, etc.
They have a lot going on.
Sometimes when a patient has an emergency, the nurse or intern doctor calls him, and he has to run over immediately to check and deal with it properly.
Zhou Can went back to the bed of the female patient who was wearing plaster and checked the plaster.
The plaster has set.
It feels firmer to the touch.
The female patient was still moaning and shouting that she was going to die.
Her son only cared about the games on his mobile phone, and neither urged the doctor when to schedule the operation, nor asked the doctor to give his mother painkilling injections.
Zhou Can shook his head and looked at the middle-aged man who had just finished the operation on the hospital bed next to him.
At this moment, the middle-aged man was still sleeping with his eyes closed.
Judging from his blinking eyelids and moving his head from time to time, he should not be asleep.
"Is his condition okay? Did he feel any discomfort after the operation?"
Zhou Can just asked out of habit.
In the past, when he was an intern in charge of the bed, he was also responsible in the same way.
As long as it is a hospital bed under his management, he will run over to check it every once in a while. Take the initiative to ask the patient's situation.
"Everything else is fine. My husband always says that his left leg is a little swollen."
She responded to Zhou Can.
"Generally just after the operation, it is normal to experience symptoms such as swelling, soreness, and numbness. Don't worry too much."
"Doctor, I feel like there is a big bug in my leg. It's very uncomfortable."
The man opened his eyes.
Perhaps because of poor sleep for a long time, coupled with injuries, his vitality was greatly weakened, and his eyes were bloodshot.
The mental state of the whole person is also quite poor.
"Let me check it for you."
Zhou Can lifted the quilt and checked the man's legs. The crushed parts have been operated on and wrapped with gauze.
This is to prevent the wound from becoming infected.
The specific surgical plan is not clear, but it is certain that the bone is broken and must be connected. It is possible to add steel plates and steel nails. Blood vessels, nerves, and tendons all need to be anastomosed and repaired.
Damaged muscles need to be removed.
You can imagine how complicated this operation is.
Below the surgical site, the ankle and foot of the patient appear to have more skin folds. The color is obviously paler than the knees and thighs above the surgical site.
But there is a certain blood.
It means that the blood supply should be fine.
At most, it was just after the operation, and the blood supply was a little bit worse.
Zhou Can touched the patient's right foot, and the temperature was okay. Slightly lower than normal body temperature.
It appears the operation was a success.
After the operation is completed, the blood supply is no problem, the body temperature of the severed limb can be restored, and the patient can basically survive.
"Can I feel it when I touch the back of your foot?"
Zhou Can asked the patient.
"Yes! It's just a little numb." The patient replied.
Zhou Can nodded, staring at the patient's ankle and other parts carefully.
There are some purple patches, hidden under the skin.
Kind of like subcutaneous veins.
Zhou Can thought so at first.
But when he tried to touch the upper part of the patient's ankle, it was noticeably stiffer to the touch.
Based on experience, this is the tactile sensation of edema.
"In general, everything is in good condition. There seems to be edema in the ankle area. I will check on you every two hours. Please rest assured."
Zhou Can said to the patient.
Postoperative edema is related to many factors.
Both normal and possibly abnormal.
Further observation is required based on the duration of edema.
Zhou Can felt that the patient's condition should be reported to the doctor in charge of the bed.
He walked to the doctor's office.
Along the way, he thought about the middle-aged man's edema near the surgical end of his left leg and a faint purple spot on the inside of his ankle.
What does this mean?
The operation was obviously a success.
The blood flow is smooth and the temperature of the feet is okay.
This kind of situation cannot be learned in medical books at all. You can only diagnose and think for yourself.
During these three months in the emergency operating room, Dr. Xu gave him a lot of guidance.
Coupled with the accumulation of surgical experience.
Zhou Can's diagnostic level has been significantly improved compared with the past.
"Due to long-term ischemia, the terminal limbs have necrosis?"
There is such a possibility.
The phenomenon of gigantism and corpse spots after death is comparable to the edema and purpura in the extremity of the patient's left extremity.
Moreover, ischemic necrosis is difficult for doctors to detect in a short period of time.
Dr. He is checking the medical records written by the interns.
Whenever he found a problem, he would point it out immediately.
The intern nodded humbly, and wrote down the points that needed to be revised one by one.
At the beginning, Zhou Can was often scolded for not writing his medical records well.
After patiently waiting for Dr. He to finish instructing the intern, Zhou Can said, "Dr. He, I found that the patients in bed 120 had some abnormal postoperative reactions."
"What's wrong?"
Dr. He was taken aback, his face was full of tension.
"During the process of questioning, I learned that the man kept yelling that his legs were swollen and painful, as if there was a big bug crawling around in it!"
After hearing Zhou Can's reaction, Dr. He calmed down a bit and let out a sigh of relief.
This newcomer, Gui Peisheng, frightened him to death.
"His leg was run over by a car, and the damage was serious. It is normal to have pain after surgery. You tell the patient that it will gradually get better in two days."
Doctor He explained.
"When I checked the patient, I found that there was edema and mild purpura at the proximal end of the operation."
Zhou Can continued to report his findings.
With his diagnostic ability, it can be determined that the patient must be abnormal.
"I'll go and have a look! Is the edema serious?"
Doctor He didn't dare to be careless, and decided to go and see for himself.
"The edema is mild, but I predict that this is only the initial stage. It is likely to be more swollen later."
Zhou Can has performed two cases of finger replantation.
Although finger replantation is incomparable with 120-bed patients. But the principle is the same.
Swelling at the severed limb site is a very bad sign.
Often indicates surgical failure.
Out of the attitude of learning and curiosity, the two interns also followed to check.
In order to improve the level of doctors, in addition to reading more books and practicing skills, it is also necessary to continuously accumulate experience in dealing with these abnormal situations.
The four came to bed 120, and the patient and his wife saw four doctors coming.
Can't help but nodded gratefully to Zhou Can.
It means that the young doctor reported the situation to his superiors.
Patients and families love this kind of responsible doctor.
"Is the situation okay? I heard that you reported pain in your legs?"
Dr. He asked the man on the hospital bed.
"The pain comes and goes, and it's a little sore, which is quite uncomfortable."
The man responded truthfully.
Dr. He nodded, uncovered the quilt, and carefully examined the man's operated leg.
Tuya's safety mechanism and responsibility mechanism are there, and no doctor dares to neglect his duties and not take it seriously.
After all, the jobs of doctors in Tuya Hospital are very good. If they mess up, they will destroy their bright future.
"There should be no major problem. The upper part of the operation is quite normal, and there is slight edema at the lower part near the surgical site. As for subcutaneous purple spots, this is relatively common. Usually it is mild subcutaneous congestion. Judging from the color of the flesh and the temperature of the feet , less likely to have muscle necrosis."
Although Dr. He is just a resident doctor in charge of the bed, his level is really not bad.
Experience and diagnostic ability are even stronger than those of municipal hospitals.
The more famous the hospital, the greater the volume of diagnosis and treatment business, and the richer the knowledge and experience of the doctors.
A surgeon at a municipal hospital confessed frankly.
He has mastered liver surgery and is fully capable of doing it well. However, there are not many liver surgery patients in a year. Some patients even ran away from their hospital when they heard that they were going to undergo liver surgery.
As long as the patients have a slightly serious disease, they all go to the big hospital.
Don't go to their hospital at all.
The scale of municipal hospitals is actually not small, and they are already large hospitals. Even hospitals of this level find it difficult to receive patients, and it is even more difficult for county-level hospitals and district hospitals below to receive patients undergoing major surgeries.
Failure to receive patients means no opportunity to practice.
Surgical and diagnostic capabilities cannot be improved, and experience cannot be accumulated.
The ultimate result of this vicious circle is that super-large hospitals become stronger and stronger.
Small and medium hospitals are getting weaker and weaker.
After Zhou Can listened to Dr. He's observations, he still felt that it was not that simple.
He frowned, thinking hard.
When the book is in use, I hate less.
He only hates that his medical knowledge is not profound enough, and his diagnosis level is not strong enough.
Obviously knowing that the patient's condition is wrong, but I just can't figure out where the problem is? +Bookmark+