I really don't want to be a doctor

Chapter 152 How about you try it?

Next, in the No. 1 emergency room, Jing Xiaoran followed Zhu Zhu, occasionally recording the patient's vital signs, and occasionally helping to deliver something.

"Xiao Jing, go to the nurse's station and help me get the ultrasound." Zhu Zhu shouted to Jing Xiaoran who was recording the patient's fluid volume, "It's not a big ultrasound machine, it's a portable ultrasound machine, the small one that can be held in the palm of your hand .”

Jing Xiaoran nodded, then walked towards the central nurse station.

The nurses at the central nurse desk have a very clear division of labor. Some are in charge of beds, some are in charge of proofreading doctor's orders, and some are in charge of discharge from the hospital.

"Nurse sister, I want to ask where is the portable ultrasound?"

Jing Xiaoran said to a young nurse who was proofreading the doctor's order.

In fact, in other departments, the nurses who proofread the doctor's orders are generally older nurses, but it is different in the intensive care unit of the Cardiology Department.

The workload here is more than half that of other departments. In addition to proofreading doctor's orders, they usually also help rescue patients.

"Dr. Tan seemed to take it to see 20 patients just now." The young nurse said softly.

In a sense, young nurses are not only eye-catching, but also generally have a much better attitude than older nurses.

Especially when it comes to treating interns or training students, the attitude of young nurses is often respect for interns.

Unlike those "old fritters" nurses, no matter whether you are a master or a doctor, they will start scolding you when they catch your mistakes.

"Thank you sister nurse." Jing Xiaoran smiled.

He glanced at the badge of the young nurse, her name was Guan Xin.

"You're welcome." Guan Xin pursed her lips and smiled.

Jing Xiaoran quickly found bed No. 20, which was in the corner of the first large ward.

Three Gui Peisheng had already surrounded the patient on bed 20, and they were watching an attending doctor checking the patient's heart with a portable ultrasound.

"In fact, pericardial effusion can be seen in many sections, such as the long axis and short axis of the ventricle, or the four-chamber heart and three-chamber heart. These sections can be seen, but the most commonly used clinically is the four-chamber heart under the xiphoid process. section."

The attending doctor explained to the students around him while holding the ultrasound machine.

As an excellent cardiologist, not only the diagnosis and treatment of internal medicine, but also cardiac ultrasound is one of the essential skills.

"Ms. Tan, how can we identify fluid accumulation in the pericardium?" said a Gui Peisheng.

Dr. Tan smiled and said: "This is a beginner's question. In ultrasound, liquids are all displayed as black. Our medical term is called liquid dark area!"

"Oh." This Gui Peisheng nodded, "Teacher, we can usually see some pericardial effusion on chest CT. I think it will be more accurate to see pericardial effusion on CT?"

"That's not true." Dr. Tan shook his head, "Fluid is flowing, and the amount of fluid seen from different angles is different. When doing CT, our human body is lying flat, and the fluid will flow into the gaps between tissues and organs. There is a certain error in judging pericardial effusion."

"Whether it is pericardial effusion, pleural effusion, or peritoneal effusion, ultrasound is the most accurate way to see all effusions. We can judge the amount and depth of effusion from multiple directions and angles, and provide us with the next step. One-step puncture preparation."

Ultrasound is difficult for beginners. You may only see black and white on the ultrasound screen, and you cannot recognize normal tissue structures at all.

I don't know if the three students around have understood, anyway, I just saw them nodding all the time, sometimes leaning over to frown for a look.

"Teacher Tan, does this patient have a lot of pericardial effusion?"

Dr. Tan shook his head slightly, "Not many, there are only a handful of them, it won't affect the patients, we just need to observe them dynamically."

Jing Xiaoran also saw the "liquid dark area" identified by Dr. Tan.

"Isn't this the fatty tissue outside the pericardium? Where is the pericardial effusion?" Jing Xiaoran murmured in his heart. At this moment, he actually had doubts about himself. "Could it be that I haven't touched ultrasound for many years, and my technique has deteriorated so obviously?" ?"

"Hey, classmate, what's the matter with you?"

At this time, Doctor Tan also saw Jing Xiaoran standing beside him.

"Oh, Mr. Tan, Mr. Zhu Zhu from our group wants to use an ultrasound to look at the heart of the patients in the No. 1 emergency room."

Jing Xiaoran said hastily.

"Okay, we just finished reading it too, you can take it quickly." Dr. Tan said and handed the portable ultrasound to Jing Xiaoran, "Remember to wipe the ultrasound probe."

"Thank you, Teacher Tan." Jing Xiaoran walked away with the ultrasound and coupling agent.

Go back to first aid room.

Zhu Zhu took the portable ultrasound and began to perform cardiac ultrasound on the patient.

Jing Xiaoran did not go far away, but stared closely at the side.

Zhu Zhu smeared the ultrasound probe with couplant and placed it on the cut surface of the long axis of the left ventricle.

The picture is blurry, and the gas in the lungs interferes with the ultrasound picture.

In the normal posture for echocardiography, the patient should be tilted sideways at 45 degrees, so that the gas in the lungs will gather in the upper part and will not interfere with the ultrasound image.

But the patient currently has an IABP placed (needs cannulation from the femoral artery), so the legs are immobilized and cannot be tilted 45 degrees.

The picture definition of portable ultrasound is not very high, so it is completely impossible to see the current patient's heart condition.

Zhu Zhu tried various heart sections, including left ventricular long-axis, short-axis, four-chamber, three-chamber, and two-chamber sections, all of which were blurred.

"Mr. Zhu, you can try the four-chambered heart section under the xiphoid process."

Jing Xiaoran suddenly said.

Zhu Zhu was taken aback for a moment, then smiled and said, "Xiaojing, do you still understand ultrasound?"

Jing Xiaoran smiled, "I've learned from online videos for a while, but I haven't practiced much in actual combat."

"Well, why don't you try the section of the four-chambered heart under the xiphoid process?" Zhu Zhu smiled, and handed the portable ultrasound to Jing Xiaoran.

"Ah? This..."

Jing Xiaoran originally just wanted to remind him a little bit, but he didn't expect to "cause trouble" on his body.

Zhu Zhu moved away from the bedside position and re-applied some gel on the ultrasound probe.

She was really curious about how difficult it is for this junior intern to really use ultrasound?
In China, doctors who are not specialized in ultrasound and critical care rarely use ultrasound. They can at most identify it, but it is impossible for them to do it.

Ultrasound is actually something that practice makes perfect, and it needs to be felt!It's not something a genius can learn in a day.

The same machine, the same aspect, different people to operate it is a completely different result.

So why do many tertiary hospitals do not recognize the examination results of secondary hospitals?
The laboratory checklist is okay, but when it comes to things like ultrasound and pathology, there is still a huge gap between doctors and doctors!
For example, for a dying head with an aging heart, the echocardiographic results of many secondary hospitals show that the cardiac ejection fraction is 63%.

This ridiculous situation is not uncommon.

Now that Zhu Zhu said so, Jing Xiaoran had no choice but to pick up the ultrasound probe and place it under the patient's xiphoid process.

(End of this chapter)