Gou is practicing medicine in the clinic

Chapter 162 Master-student Collusion Saved Another Life
Deaths from venous thrombosis occur every year for many reasons.

For example, sitting or lying down for a long time will cause the blood flow to slow down.Especially the lower extremities are prone to blockage of blood return, accumulation of red blood cells, and eventually thrombus.

Also, the blood in the body is in a highly cohesive 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 thrombosis.

To say that the most harmful, it must be pulmonary vein thrombosis.

The main reason is that it is not easy to find. When the diagnosis is made, it is often the stage of autopsy.

"You're right, the patient died of pulmonary vein thrombosis. It was the death of that patient that made me realize that manipulative bone-setting reduction can't just reset the fracture site, but also pay attention to checking the patient's blood vessel damage and congestion. Your current bone palpation should have reached a certain level, right?"

When Dr. Xu talked about the death case that year, even after many years, he still had lingering fears.

The death of every patient or a major turning point in his condition will be deeply remembered by doctors.

"I should have reached the fourth level of bone palpation. I can feel the patient's bone vitality, fine bone images, ligaments, blood vessels, and soft tissue damage. But I still feel that there is still a lot of room for improvement."

Li Jingsheng didn't hide it either.

In fact, with Dr. Xu's level, we can definitely see his true level from Li Jingsheng's practice.

"It's very good to be able to reach such a high level of bone palpation 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, the blood flow rate in the blood vessels. If you find that the blood flow rate slows down, especially in the lower limbs, you must be extra vigilant against vascular embolism."

Going a step further with the bone palpation technique, you can actually feel the blood flow in the blood vessel.

Thinking about it feels a little weird.

Li Jingsheng yearns for a higher level of proficiency.

His Bone Touching Technique is currently at the Xiaocheng level, and if he wants to rise to a higher level, he needs 1000 proficiency, which is still several hundred.

It seems that I still have to work hard!
Next, Dr. Xu talked with him a lot about clinical knowledge about bone setting and reduction.

These things are hard to learn from books.

It is accumulated by the doctor himself or taught by other doctors.

As for some surgical skills, even original techniques, combined medications, etc., they all need to be learned from teachers.

After chatting almost, Li Jingsheng was about to stand up and leave.

"Teacher, there is one more thing I would like to ask for your opinion. The Second Hospital wants to recruit me to the orthopedic surgery clinic. I will work three days a week and be paid as a regular employee. I can evaluate titles, hire attendings, etc. I am personally quite tempted. I am worried that it will harm your interests, so I decided to ask your opinion first."

The survival rules that Li Jingsheng learned in Chengnan Old Street are that one mountain cannot accommodate two tigers.

Compared with his last opening of Fredo Pharmacy, both his and Lao Zhao's clinics have been greatly affected.

Patients who were going to the clinic to buy medicines were attracted directly.

A radish and a pit.

There are only so many patients and customers who need to buy medicine in the old street in the south of the city, so naturally one ebbs and another.

In the past two days, the business of the Sunshine Clinic has been extremely hot, and Lao Zhao must have been suffering.

However, the customers and patients who come to Li Jingsheng Clinic are not from this small area, and some of them come from other areas in the city.It can be regarded as a preliminary siphon effect.

Now, if Li Jingsheng agrees to work in the outpatient room of the second hospital, wouldn't it mean that the apprentice is robbing the master's job?
"Which harms my interests? Don't worry, don't say 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 in the Second Hospital, Director Hua kindly invited me. Don't look at me. I only know how to reset the bone, and I can use 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, a proud expression appeared on his face.

His eyes are staring at the sky with disdain.

This is true.

Doctors are an industry that relies on technology. As long as one field is excellent, you can do well.

"It's a good thing that you entered the Second Hospital. Don't underestimate the title and qualifications. In almost a little developed country in the world, the title is very important. And if you enter the Second Hospital, it is equivalent to relying on a big tree with your back. You can have more confidence in this area in the south of the city."

Dr. Xu also vaguely mentioned this matter.

It seems that the doctors who are a little more advanced know that this area in the south of the city is not easy.

Think about it too.

There is only one second hospital in the south of Nuoda, which is extremely abnormal in itself.

"If it's a matter of discussing admission with the Second Hospital in these two days, I can cooperate with you. It happens that I'm sick, and there's no replacement there. You don't say it's for sale, at least you can ask for a good price. And then there are some additional conditions that can be put in, such as not working overtime, not attending hospital meetings during non-working hours, etc. I can see that you like to go wild. When signing the contract, you can properly mention some additional conditions, so that you can have more personal freedom."

Doctor Xu treated him really well.

Not only did he not worry about Li Jingsheng robbing him of his job, but he helped Li Jingsheng ask for a good price.

"Since you agree, I'm going to talk to Director Hua tomorrow."

Li Jingsheng was also worried about having long nights and many dreams.

Some opportunities are difficult to have if they are missed.

"Be confident when talking about it. I'm not bragging. Although there are many doctors who know how to set bones, there are very few doctors who can achieve a higher level. Your current level is not very good, but looking at the entire Jiangli City, you are basically a general among dwarfs. You already have some foundation. In time, you will definitely become better, so you need to be confident when negotiating conditions.

Director Hua is not a bad person, but when it comes to interests, he must be on the side of the department and the hospital in many things.

Many things need to be fought for by yourself. "

Dr. Xu said these heartfelt words because he regarded him as an apprentice.

……

It was almost ten o'clock in the evening when Li Jingsheng returned to the clinic. This visit to visit his mentor was very rewarding for him.

It will be better to talk to Director Hua about admission to the hospital tomorrow.

What he has to consider now is that after joining the No. [-] Hospital, he will not be in the clinic for three days a week. Who will be in charge of diagnosis and treatment?

Hire another licensed doctor?

If it is less than 7000 yuan/month, there is basically no need to think about it.

Moreover, the quality of recruits cannot be guaranteed.

Doctors who are willing to work in small clinics are basically half-baked.

However, there are also times when there are mistakes, and it would be very ideal to recruit a doctor who is capable of doing things and has some real skills.

Clinics generally do not accept any major services, just common colds and fevers, diarrhea, and headaches.

After much deliberation, he decided to hire another doctor who could take his place.

On the one hand, it can maintain a legal operation, and only a licensed physician can prescribe a prescription.Even if Tang Ping and Han Siying knew some clinical medicine, they couldn't prescribe prescription drugs.

Otherwise it is illegal.

But how to say this kind of thing, they prescribe the prescription in Li Jingsheng's name, even if the higher authorities check it out, it's fine.

The only culprit is that there can be no accidents.

As long as there is an accident, he can immediately become a pawn and marshal.

At present, the handling of medical accidents in the industry is basically in a high-pressure situation.As long as a problem is found, the lightest is suspension for investigation, and the more serious is the revocation of medical license.

The risk was too great for Li Jingsheng to bear.

In hospitals, it is basically a common phenomenon for unlicensed regular training doctors to issue medical orders in the name of superior doctors.

A better Gui Peisheng can easily obtain this privilege.

But a clinic is nothing compared to a hospital.

The clinic's anti-risk ability is small, and the hospital has a multiple inspection and check system.

If there is a problem with the doctor's order issued by the intern, the nurse can find out immediately, and call back in time to ask the intern to reopen it.

Tang Ping is the only nurse in his small clinic.

She has worked in the clinic for nearly a year, and her professional sensitivity and level must have declined.

"No, if the business of the clinic can be stabilized at 20 patients per day, then hire another licensed doctor."

Li Jingsheng finally decided to focus on safety.

If you want to reduce expenses, you can also discuss with the other party. You only need to work three days a week, and the doctor can find another job for the rest of the time.

His salary in the second hospital must be higher.

At that time, offsetting each other will still make money.

After sorting out his thoughts, a relaxed smile appeared on his face.

The development of the small clinic and his personal development are well compatible, and the future is brighter.

After he has the status of an attending physician in the Second Hospital, his social and medical status will improve a lot.The influence of this area in the south of the city will also increase.

After taking a shower, he picked up a medical book from the Department of Orthopedics and Traumatology to read.

Only by living and learning can one become a real strong man.

The ocean of medicine is boundless, and Chiongji has never been able to learn it all his life.

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 the average doctor.

At about 11:30 in the evening, he was reading a book when his cell phone rang suddenly.

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 there!"

Li Jingsheng answered the phone.

"Excuse me, is this a doctor from the Sunshine Clinic?"

A young girl's slightly anxious voice came.

"I am! What's the matter with you?"

"We bought a bottle of safflower oil at your clinic today. It's the girl with a sprained knee. Do you still have any memory?"

"It's you, I have an impression! Is the leg injury better?"

Li Jingsheng had a deep impression on this young female patient.

I also specifically asked Dr. Xu for advice.

"I don't have any other doctor's phone number. I happened to take a photo of your clinic during the day and found the phone number on the signboard, so I tried to dial. I'm not the one who sprained her knee. I'm her friend, the girl who accompanied her 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, a little groggy, and her face was slightly purple..."

This girl can really scare people to death.

He was obviously very anxious, but he said a lot of nonsense in a leisurely manner.

Before she could finish speaking, Li Jingsheng became anxious when he heard the condition of the injured girl.

Do not repeat the foreign case of death caused by toe injury that Dr. Xu mentioned.

"Are you at school right now?"

"Yes, we are in the school dormitory."

"Call 120 immediately and take her to the hospital. Also, if she is lying flat, try to raise her feet as high as possible. The height should be higher than the head. You can tell the doctor directly that your friend is suspected of having a pulmonary vein embolism. She is now very dangerous."

Li Jingsheng didn't expect that such a thing would really happen.

Looking at the girl's leg injury, he felt a little uneasy.

I thought it was a hidden danger such as a torn meniscus or ligament, but I didn't expect that a venous embolism would eventually occur.

Of course, I'm not sure right now.

This is a young life, even if there is only a trace of suspicion, he will think about the problem in the most serious direction.

The girl was terrified to hear him speak so seriously.

I hung up the phone in a hurry, and quickly dialed 120 for help.

A few minutes later, she called again.

"Doctor, I have called the emergency number according to your instructions, and I have also reported to the dormitory manager and the teacher. What should I do next? Zhao Qi's breathing is very heavy now, so scary!"

On the other end of the phone, the girl calling for help was already crying.

"Don't panic, find someone to lift the person down together, so that the ambulance can be lifted into the car for emergency treatment as soon as the ambulance arrives. Try to make the patient lie flat and raise both feet. If breathing stops suddenly, you can do cardiopulmonary resuscitation."

Li Jingsheng calmly directed the first aid.

The meaning of cardiopulmonary resuscitation for pulmonary vein embolism is relatively small, but doctors are like this. There is only 1% hope, and they are willing to use [-]% effort to rescue.

"Okay, okay, thank you!"

She hung up the phone again.

After this kind of thing happened, Li Jingsheng was not in the mood to read anymore, and quietly waited for the result.

Freshman colleges usually have school doctors, but the level of school doctors is often very limited.

If you want to save the person, you have to go to the hospital for emergency treatment.

If the emergency doctor can be less rigid and bring thrombolytic anticoagulant drugs, maybe the patient can still be saved.

Although pulmonary vein embolism is terrible, as long as it is discovered in advance, there are quite a lot of rescue methods.

About ten minutes later, the call came again.

It's still that girl.

"The emergency doctor has come. It's a doctor from the Second Hospital. He wants to understand the situation with you. Can you see it?"

"Give him the phone!"

Naturally, Li Jingsheng would not refuse.

"Hello, is this a doctor from Sunshine Clinic?"

"Yes, I am Li Jingsheng from Sunshine Clinic."

"Hello, Dr. Li. I'm the doctor on duty in the emergency department of the Second Hospital. I've heard your name. The patient is now in a light coma state, his face and nails are slightly cyanotic, and he has difficulty breathing. There are obvious sprains and traces of safflower oil on his right knee. Do you suspect that she has a venous embolism?"

Now Li Jingsheng has already 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 a 'reputation'.

"I suspect that this patient is likely to have a pulmonary vein embolism. If you bring thrombolytic drugs, you can give her first and take it to the hospital. It is very likely that the best time for rescue will be missed."

In the face of such emergency patients, doctors have a certain right to self-medication.

Even if the wrong medicine is used, there is a high probability that the family members will be innocent if they are brought to court.

"it is good!"

After hesitating for about two or three seconds, the other party only answered one word.

The phone should have been returned to the girl again, she didn't hang up, and didn't talk to him again.

"Give her an 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 thrombolysis.

Drugs such as aspirin enteric-coated tablets, clopidogrel bisulfate tablets, and tirofiban hydrochloride sodium chloride injection are also commonly used in intravenous thrombolysis.However, routine blood tests and prothrombin tests are often required before medication.

For this kind of emergency rescue, intravenous injection of urokinase is a quicker way to get results.

Li Jingsheng wanted to listen again, but the phone had already been hung up.

Time passed by every minute and every second, and I don't know what the result of the medication is?

At about twelve o'clock, he just fell asleep when the phone rang and woke him up.

I saw that it was the girl calling again.

"Dr. Li, thank you, thank you, my classmate Zhao Qi is temporarily out of danger after being rescued! The doctors and nurses in the hospital are all praising you, saying that your judgment is very accurate. Zhao Qi is really a venous thrombosis and a pulmonary embolism. They said that the survival rate of this disease is very low. Thank you so much."

The girl on the other end of the phone is full of endless gratitude to him.

"You're welcome, this is what I should do. In the future, if your lower limbs are injured while playing basketball, you must be alert to venous thrombosis."

Li Jingsheng was also very happy to hear that the patient was rescued from danger.

The little anger of being disturbed while sleeping has long since dissipated.

After finishing the call, he checked the properties panel by the way.

Amazing.

Calling to rescue a patient also gave him 100 health points.

Then in the diagnosis column, there is an extra chest diagnosis.

This is also a pleasant surprise.

Thoracic surgery diagnosis involves a wide range of fields, and it was inseparable from cardiac surgery diagnosis in the early days.

Later, as there were more and more large hospitals, the major hospitals were overwhelmed, and the doctors were also desperately evolving their own housekeeping skills.Eventually, cardiothoracic surgery was split into cardiothoracic surgery and thoracic surgery.

It is worth mentioning that the status of thoracic surgery is relatively low.

The former cardiothoracic surgery department was a top-notch surgery department. After dismantling it, the cardiothoracic surgery department is still very good, and the status of the thoracic surgery department is a bit embarrassing.

However, with the increase in the incidence of tumors in recent years, the status of thoracic surgery is rapidly improving.

Extrathoracic surgery mainly focuses on lung surgery, mediastinum, esophagus, etc. are also its scope.

Then the rise of thoracoscopic surgery in recent years has also made this long-lost department shine again.

For Li Jingsheng, chest external diagnosis is basically not used now.

Don't overwhelm yourself with too many skills, put them aside, and improve them when you need them later.

(End of this chapter)