medical simulator

Chapter 422

Xue Huan, the boss of Neurosurgery, said blankly: "He has massive subdural hematoma now!"

"Surgery must be performed immediately, otherwise brain death may occur on the spot!"

Brain death, there are only two situations!

One is a complete physiological death, and the other is a vegetative state.

"No family members, no payment! Do you want to call the general on-duty authorization?" The doctor in charge also asked directly.

"Hit! Tell the person who sent him to contact his family as soon as possible."

"I can't delay."

"At least no matter what, the head window should be decompressed."

"Contact the Department of Anesthesiology and the ICU, and prepare for anesthesia and tracheostomy at any time." The general inpatient of neurosurgery just gave his own advice.

"Where is the medical record? I'll write a consultation opinion first."

……

The doctor without a badge in the emergency department finished the phone call: "The chief on duty has been authorized, you go back to the operating room first!"

"I will send the patient up here immediately. The first four items of blood transfusion and the blood type of the patient have been taken as soon as they arrive. The blood coagulation function is meaningless at present, and it may take a while. Let's catch up during the operation."

"I just need to trouble you to arrange someone to contact the blood bank to prepare blood."

"I'm really busy here."

Hearing this, only Xue Huan, who had finished writing his opinion, hurried back!
Neither Zhou Cheng nor Chu Lin from the thoracic surgery department moved.

Just stare at that medical record book!

Write your own opinion without rushing.

To help is to help, and I have to finish my task.

For emergency consultation, there is no consultation opinion, and finally there is accountability, not Zhou Cheng and Chu Lin's hypocrisy, this is the hospital's regulation.

If the emergency department is too busy, call someone.

Their specialist doctors also need to talk and sign.

Seeing this, the doctor in charge could only helplessly say, "Forget it, this classmate, you can call the blood bank for help. They said that the emergency department needs a lot of blood! Then contact the anesthesiology department for an emergency consultation!"

Wang Huan was pointed at like this.

Wang Huan was a little stunned, and looked at his teacher Zhou Cheng.

As he said that, he ran out quickly and contacted the kind person who brought the patient.

But when he goes out!
The good man is gone.

That person sent the patient to the hospital, it was his kindness.

You can't ask him to pay the money either.

He didn't scold anything, and quickly returned to the computer again to quickly open the doctor's order and write various signed materials for the conversation...

After Chu Lin finished writing his opinion, he immediately handed the medical record to Zhou Cheng and said, "Brother Cheng, we meet again!"

"Why are you two brothers working together, it seems a bit lucky."

In medical institutions, the first-diagnosis responsibility system and the consultation system are both core systems.

Among them, the responsibility of the first diagnosis is to avoid shuffling the patient and running here and there.

The essence of the consultation system is actually to cooperate in the diagnosis and treatment of diseases!

Hand over specialized issues to specialized doctors,

There is nothing wrong with this patient needing emergency surgery!
However, if Zhou Cheng and Chu Lin did not write the consultation records, once there are no consultation records and opinions except for any problems related to the department
No matter how perfect you are on the operating table, no matter how hard and tiring you are, if you make a mistake in the first step, it is all fake and you are fully responsible!
If the program goes wrong, it will be troublesome.

Basically, people who go to the clinic regularly will not make mistakes, but it does not rule out encountering some newcomers and top experts.

Or people who are not familiar with the core system are often taken over in this way.

For example, who of them called just now.

Then something went wrong with the patient.

At the least, they will be fined for talking, and at worst, their qualifications to practice medicine will be revoked.

This is the biggest difference between being a doctor and being a student.

Practice alone, be responsible alone, and need to take full responsibility for what you do.

It's not like when you are an attendant doctor or a bed doctor, the superior doctor is usually in charge.

These are all growths on the road of being a doctor.

Sometimes you have to be cold-blooded and reject something in order to survive well.Otherwise, what is waiting is the word death.

So even if the condition is urgent, Zhou Cheng and Chu Lin can only finish writing the medical records first, and then call someone to arrange surgery and other things.

Zhou Cheng finished writing quickly, and then started calling the doctor on duty in the trauma surgery department!

Tell him to prepare the consent form for emergency surgery, he will go up to get it later, he must be ready...

Wang Huan was in a daze, so Zhou Cheng asked her to help.

Zhou Cheng only needs to be responsible for the conversations related to the Department of Orthopedics, and he doesn't have to take care of other departments at all, and can't take care of them.

However, there are no family members now, so we can only call the chief on duty for authorization first!

After stepping down or the arrival of family members, the first time to make up the signature!
Zhou Cheng quickly finished writing the consultation record, and then handed it over to the elder brother in charge of the bed, saying: "Teacher, thank you for sending the patient to the emergency operating room, and I will prepare the materials later. If the family members come later Already!"

"I've already called the blood bank and the anesthesiology department."

"Please also call him at the door of the operating room, we will talk to him then."

"Thanks for your hard work."

After Zhou Cheng said that, he ran to print the materials.

The computer is connected to the Internet, and if the doctor on duty in trauma surgery is ready, he can print directly here.

And right now!
Another voice about him came from the outpatient clinic outside the emergency care unit.

"Another patient with a car accident trauma appears to have a dislocated hip."

"Call for an emergency consultation with the orthopedics department. The orthopedics department has a resident doctor in our emergency department."

This seems to be what the doctor outside said to the subordinate or the nurse!

But someone outside said: "Doctor Liu, it seems that the general hospitalization of the orthopedics department is in our emergency department."

"The patient with multiple injuries on the third bed."

"Seriously. This?"

Doctor Liu said: "Then you go and pull out the film and ask him to take a look."

"This patient has no skin trauma for the time being. I will explain to the patient first, and then I will listen to the orthopedic department for any treatment. I will check whether his chest, abdomen and head are injured."

"If necessary, call the other bosses of the orthopedics department."

There are two overriding principles of the emergency department.

Save your life first.

The bottom line is to save your life!

"Okay!" The nurse hurried in.

After hearing this, Chu Lin smiled and said, "Your orthopedics department is quite popular, here comes another one."

"Brother Cheng, I'll go first and go to the operating room early."

Zhou Cheng nodded, and before he had time to say anything, a nurse outside the door came in.

"Are you the general inpatient of the orthopedics department? Doctor Liu in the outpatient clinic called you to take a look at this film. It just came out. The patient's feet are swollen and he can't move. Do you have time to take a look?" The nurse in green clothes walked up to Zhou Cheng !

After speaking quickly, he pointed at the computer at the nurse's station.

His tone was quite polite.

There is a certain time limit for the printing of plain film, CT, MRI and other examinations, so each hospital will have an independent film reading system, as long as the examination is completed, the film can be read by computer.

However, this kind of film reading is mostly used for emergency patients, just to allow doctors to understand the condition in the first place.

Most of the regular patients have to wait.

Regular patients often appear in outpatient clinics. How can outpatient doctors have so much time to consult the inspection system for you?

The nurse just called Zhou Chengzong to be hospitalized, firstly because he was not very familiar with the orthopedic doctor system, and secondly to avoid politeness.

She has to take care of at least a dozen emergency patients a day, and each patient even comes to three or four consulting doctors!
If every doctor was polite, she would die of exhaustion.

Over time, they are replaced by the general hospital, teachers and doctors.

It's not disrespect to Zhou Cheng.

"Okay, I'll go and have a look first. I don't know when I will be on stage." Zhou Cheng immediately followed.

When I came to the computer and looked at it, a plain film was read out.

Posterior dislocation of the hip joint, and then look at the age, 54 years old, male.

This kind of medical record is very suitable for emergency manual reset, but Zhou Cheng will not make empirical and operational mistakes.

One of the charms of orthopedics is manual reduction. There are many patients who are very painful in the hospital, and it is possible to use manipulation!

It can immediately relieve the patient's pain, and even enter the hospital lying down, and walk out after ten minutes.

However, empirical mistakes must never be made.

Zhou Cheng continued to read all the layers of the CT, but found no obvious signs of fracture!
After reading it, he asked, "How is the patient's consciousness now?"

"Have you had any headaches, chest pains, or abdominal pains?"

"If not, I will directly print a template for manual reduction surgery for hip dislocation and send it to the operating room."

The nurse shook her head and said, "There is nothing like headache and chest pain, but Dr. Liu and the others are still watching related films."

"I think you can prepare the consent form for the conversation first. If there is no problem with Dr. Liu, I will send it to the emergency operating room first."

"Then I'll call you when the anesthesia is finished."

"Send this patient to the emergency operating room, right?"

"Hmm! I also have an incision and probe on my side to stop the bleeding."

"It may take a while. Just send it to the operating room and do a lumbar anesthesia. Then remember to ask Dr. Liu in the emergency department to tell the anesthetist and add some muscle relaxants. Call me later and tell me where to go to the operating room. I took the time to go over and do the reset." Zhou Cheng confided.

After the posterior dislocation of the hip, because the pain will cause muscle tension in the rear of the buttocks, muscle relaxants must be added.

He was afraid that if he met an inexperienced anesthesiologist, he would not lose his flesh if he said a word.

"Okay!" The nurse in charge didn't ask why, but felt that Zhou Cheng was a little pitiful!
The last one hadn't even started working on emergency patients yet, and a new one came in.

And it was very late to go to this point, and no one would help you unless you called your superiors for help.

She is in the emergency room, and she has to ask for every doctor's order!
There may be many patients who are gone.

Unless she can spot a particularly egregious error.

Of course, the chance of this is very small, so she went directly to execute it.

After this, Zhou Chengcheng was really busy. He quickly found a computer and printed out two consent forms for surgery.

Only the name of the operation, complications and risks are written on the surgery consent form!

The basic information of the patient has to be filled in by hand.Because the patient is not hospitalized, it cannot be pulled into the medical record system.

One is for debridement and exploration, and the other is for manipulative reset.

I thought he and Wang Huan were preparing to sign a patient's conversation by themselves.

After the hip joint was reset manually, Wang Huan could go to the operating room after talking to his family members. Unexpectedly.

When Zhou Cheng had just finished his conversation and was about to enter the operating room, another middle-aged couple ran in from outside.

Holding a crying child.

The child was three or four years old at most, with one hand drooping, and the mother supported his hand. The child's face was blurred from crying, his eyes were red and red, and he was wronged while crying.

The guide nurse immediately called the man to register first, and called his wife to take the child to the outpatient clinic first.

The woman shouted while running: "Doctor, doctor, show my baby!"

"He couldn't lift his hand all of a sudden, what's going on?" It could be seen that she was very anxious and eager to ask for help.

There are a total of three doctors in the outpatient clinic, and the one who received him was the one without a badge.

When he saw the person coming, he gave Zhou Cheng a helpless look, and said, "You need a photo first! How did you get hurt?"

"I took my baby to go shopping, so I gave him a hug!"

"Suddenly I started crying and making a fuss."

"No matter how hugged or coaxed, she doesn't listen or speak, doctor, what's going on?" She was so anxious that her hands trembled, she didn't dare to touch her child.

The man could only look in Zhou Cheng's direction: "Mr. Orthopedics, do you want to come over and have a look? Or come back later?"

"I write medical records!"

It's not that he's being lazy, or shirking responsibility!
But since Zhou Cheng is here, naturally he has to ask Zhou Cheng for his opinion.

After listening to the medical history, Zhou Cheng basically had his own diagnosis in mind.

Radial dislocation, photos are useless, and the diagnosis is basically based on medical history and physical examination.

Zhou Chengcheng immediately put the conversation list on the table, and then went up to touch the children's elbows.

The child hid while crying, and retracted his right hand at the same time!
His fingers still wanted to grab Zhou Cheng, and he cried, "I don't want it, I don't want it. It hurts, don't it."

In fact, Zhou Cheng's hand has already touched his elbow, and his eyes have confirmed through his finger movements that there is no nerve damage for the time being, and his hand can still retract, which proves that the possibility of fracture is unlikely.

Just re-identify tenderness at the radius.

And in the meantime, just hold your wrist with one hand and your elbow with the other!
Hold down the position of the radial head with the thumb, and rotate the forearm from extension to flexion of the elbow joint to reset the dislocated radial head.

He said in his mouth: "Little friend, let me check again, just check, okay?"

The child looked at Zhou Cheng, the strange man, as if he was strangling her, making her unable to move at all.

She cried and nodded, "But I'm afraid of pain."

But just when he finished speaking, Zhou Cheng heard a slight click.

Then Zhou Cheng bent the child's elbow until the elbow was very close to the upper arm!
He said: "It's all over, old man, please write a doctor's order and let the family members pay the bill."

"I'm really too busy here."

"A radial head dislocation reduction operation, another X-ray film, forearm sling suspension for a week will be fine."

Zhou Cheng just finished speaking!

The woman said, "It's all right now? Don't fool me? Baby, are you still in pain?"

"Do it manually?"

The child nodded: "It still hurts, but it's not as painful as it started."

He moved his hands while speaking.

It doesn't seem to hurt at all.

Then the woman said: "I thought something was wrong, but my baby is fine!"

"Baby, let's go! Let's go home."

Then she left.Greeted her husband who was about to come in, and left the consultation room.

One minute later, there was an arguing with the nurse at the registration desk.

Zhou Cheng frowned slightly when he heard this voice!
Then he sighed and said nothing.

It's not that he has forgotten the diagnosis and treatment procedures and principles. He has three emergency departments at the same time. It's purely a child's mischief!
Liu Xuan said: "I rarely meet such family members in the emergency department."

"My name is Liu Xuan. I just entered the emergency department this year. I haven't been admitted to the general hospital yet. What's the teacher's name?"

"It's too polite to call me teacher, you can call me Doctor Zhou or Zhou Chengcheng." Zhou Cheng replied!
Then he said: "Doctor Liu, let's talk next time when you have time. Now I am in the emergency operating room, and there are two patients waiting for me. I haven't prepared the materials for the conversation yet!"

"Brother Cheng, you go to work first." Liu Xuan is the doctor on duty in the emergency department, and he takes turns with other specialists who come to the emergency department.

Before Zhou Cheng went out, he hooked his fingers at Liu Xuan, and Liu Xuan understood the meaning, and handed the little girl's medical records to Zhou Cheng.

Zhou Cheng could only quickly complete the emergency medical records.

This little girl actually needs to wear a forearm sling, pay attention to care, if the care is not proper, the couple will come again.

Zhou Cheng also encountered such a patient in No. [-] Hospital, but that patient was a middle-aged man.

Zhou Cheng really didn't have time to be a kind person.

I left the emergency department in a hurry and went directly to the operating room. The emergency operation was really urgent...

(End of this chapter)