Gou is practicing medicine in the clinic

Chapter 172 Is this the suture level?targeted

"A patient in bed 25? Ruan Xiaoqin, isn't this the bed you are in charge of?" Professor Wu looked at the middle-aged doctor with a sharp mouth and monkey cheeks.

It turned out that this person was called Ruan Xiaoqin.

"I'm in charge. This patient is the one we treated yesterday, the woman you personally directed the bone cementing."

Ruan Xiaoqin stood up with a panicked expression.

It is true that the hospital has a three-level ward round system, but the attending doctor bears the greatest responsibility.

Sometimes when the patient in hand has some problems, the attending doctor may be more anxious and worried than the family members.

As for some negative news, it is pure nonsense that the doctor is cold and doesn't care about the patient's life or death.

Most of the patients that doctors don't care about are mild, so it's right to have fun secretly.

For patients who really have problems, the doctor will definitely run to the ward every time, and it is impossible not to care about the patient's life and death.

"Go, take a look!"

When Professor Wu heard that the patient was treated by him personally yesterday, he got up and rushed to the ward.

"Who is that, don't be dazed, join us in the rescue immediately!"

Professor Wu did not forget to order Li Jingsheng around.

Liwei means more.

It is to tell Li Jingsheng that in the orthopedic surgery department, he has the ability to direct Li Jingsheng's work, so that Li Jingsheng should not be too arrogant, and it is better to keep a low profile with his tail between his legs.

Officials crushed 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 young doctor who is more enchanting.

According to the doctor's regulations and the hospital's relevant regulations on emergency and critical cases, Li Jingsheng has no way to refuse in this case.

He simply got up and followed to the ward.

Just to see the first aid level of Professor Wu and others.

Orthopedic surgery generally rarely accepts critically ill patients, because those with serious injuries are usually sent directly to the ICU.It is not until the vital signs are stable and the surgical standards are met before consideration of extraskeletal surgery.

No out-of-skeleton doctor would foolishly accept a patient who is seriously injured, dying, or at extremely high risk.

For the simplest rib fracture, if pulmonary edema is caused, a thoracotomy will cost at least 20 yuan.

When encountering older patients, doctors generally recommend catheterization and drainage, and then conservative treatment.

What do you mean?

Just let the ribs heal on their own.

If the fracture is severely displaced, it is often a malunion.

Li Jingsheng followed him to the door of the ward, already feeling the heavy and tense atmosphere.

When an emergency occurs, the entire department usually rushes to rescue it.

Larger departments are usually divided into groups.

If the doctors in the group can handle it, then handle it by yourself.If you can't solve it, you can only bow your head and ask for help from other groups.

"Professor Wu, the patient's blood pressure is still dropping, and there is a big problem with breathing!"

The intern in charge of the bed was about to cry.

Few interns can remain calm in such emergencies.

Many doctors who have been trained for two or three years do a lumbar puncture, and their hands are still shaking like nothing.

The family members were crying anxiously.

The patient is a woman about 40 years old, her face is pale, with fine beads of sweat constantly appearing on her forehead, and her expression is very painful.The breathing is heavy and short, and the person is already in a light coma.

The eyes opened a small slit in a daze, and the whole person was unconscious.

"What's the blood pressure?"

"Systolic blood pressure 78mmhg, diastolic blood pressure 49mmhg."

Nurses are counting.

Normal blood pressure for adults is between 90-139mmHg systolic and 60-89mmHg diastolic.

The blood pressure mentioned above belongs to the ideal normal blood pressure.

Now the patient's high and low pressure are all 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 Hg, which is an extremely dangerous signal.

"Two minutes ago, the patient's blood pressure was still 2mmhg, and it was dropping rapidly."

The intern added aside.

"I'll check the wound on the leg first!"

Professor Wu removed the gauze on the patient's knee, and he could see the sutured surgical wound.

It appears that bone cement was poured into one of the bones in the knee joint.

Bone cement came out in about 60s, and began to be widely used clinically in 80s.Our country only started clinical research in this area in the 90s, and it was only in [-] that some hospitals began to use it in clinical practice and achieved success.

Relatively speaking, it was developed relatively late.

Bone cement has the advantages of low price, safety and reliability, stable performance and quick effect.

Many bone disease patients can walk on the ground the next day after the bone cement is done.

For patients, this must be a great boon.

However, because it is a new technology, many patients themselves have some concerns and concerns about the use of cement in the body, so its overall use cases are not many.

This also leads to its clinical application experience is not as rich as imagined.

The Second Hospital is considered a large hospital, and the level of orthopedic surgery 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 word-of-mouth and reputation it has won for the orthopedic surgery department of the Second Hospital, as well as the influence it has brought are inestimable.

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 results are even more favored by the hospital.

For example, Dr. Xu, if no one could replace him in the Second Hospital, he would have been dismissed 800 years earlier.

Professor Wu, a doctor with good academics and scientific research, has become a favorite instead.

The wound is slightly red and swollen, which is normal.

The operation itself was completed yesterday, and it takes a few days to recover slowly.

Li Jingsheng discovered that the wound was sutured vertically.

The level of stitching is actually...not much better than him.

I don't know which doctor sewed it?
It must not have been sewn by Professor Wu himself.

Otherwise, it would be ridiculous for a chief physician to sew like this.

Li Jingsheng's current vertical mattress suture is proficient, which is equivalent to the level of a senior resident physician.

It stands to reason that an excellent attending physician in surgery can basically achieve this level of suturing.

If the director's sewing is beyond the level of a resident doctor, the director's moisture is a little too much.

"The wound is well sewn, and there is no problem. The filling of bone cement in the tibia of the lower extremity will cause local discomfort at most, and it is impossible to cause the patient to lose consciousness... What does she eat in the morning and at noon?"

After Professor Wu inspected it, he seemed calm on the surface, but in fact his brows were already wrinkled into knots.

It is estimated that there is also a group of panic in my heart.

To be honest, this kind of situation in orthopedic surgery is very rare.

"My mother eats soy milk and buns in the morning, and fried pork with green beans, Chinese cabbage, and stewed pork ribs at noon. They are all bought in the hospital cafeteria, so there should be no problem."

The patient's daughter is already a pretty girl.

He was wearing pale-washed sky-blue jeans, and a buff short-sleeved shirt with white circle spots.Wearing a ponytail, there are no traces of makeup on his face, only wet tears.

There were still tears in the eyes, and the eye sockets were slightly red.

Looking at her young face, she is estimated to be around 20 years old at most.

No other family members were seen.

She was alone by the bedside.

Her mother's sudden critical illness made her extremely frightened and flustered for her who hadn't experienced much social baptism.The only way to relieve the anxiety and sadness in my heart is to cry.

"Professor Wu, do you think the patient will be poisoned after eating green beans?"

Ruan Xiaoqin with sharp-mouthed monkey cheeks offered his personal opinion.

"This possibility is not ruled out. Did the patient have symptoms such as vomiting and dizziness before coma?"

Professor Wu asked the family members and the doctor in charge of the bed.

"There was vomiting, chest tightness, and feeling uncomfortable all over."

The bed doctor replied.

"After eating steamed stuffed buns in the morning, my mother started to complain that she felt a little uncomfortable, and then she kept saying that her chest was uncomfortable. Then she vomited. I ate very little at noon, and I seemed to have finished eating green beans."

The family members also confirmed the symptoms of vomiting.

Professor Wu's face twitched twice, and he vomited after eating the buns. He hadn't eaten green beans at that time, how could he be poisoned?

"Are you sure you vomited after breakfast?"

"Sure! My mother retched twice after lunch, but she didn't spit it out."

"That shouldn't be green bean poisoning."

Professor Wu turned to look at Ruan Xiaoqin.

"Dr. Ruan, the patient vomited after eating breakfast, have you checked her?"

"I checked my body temperature, it was 38.6 degrees, and my heart rate exceeded 120 beats per minute."

Most adults have a heart rate between 60 and 100, and it slows down as we age.

For a 40-year-old woman, if she has no heart disease, her heart rate should be only [-] to [-] beats per minute in a steady state.

Now the heart rate is obviously tachycardic.

"At that time, based on some of her symptoms and the descriptions of her family members, considering that the patient felt hot and uncomfortable last night, he opened the window and blew against the window all night. The possibility of catching a cold was relatively high. I prescribed a fever-reducing medicine for the patient. medicine."

Ruan Xiaoqin's handling was obviously too casual.

If you can't judge this kind of thing by yourself, you should report it to the superior doctor.

"Can a cold cause a sudden coma in a patient? You are too careless."

After Professor Wu finished listening, his face turned dark.

Anyway, people over 50 years old must have more clinical experience.

He already realized that something was wrong.

The patient is likely to start showing obvious symptoms this morning, and it may even start to feel uncomfortable last night.

Carelessness really kills people!

"Who is that, you immediately ask Director Hua to come over."

Professor Wu turned to look at Li Jingsheng.

It's this time, and I still don't forget to take the opportunity to kill Li Jingsheng's prestige.

"It is recommended to put the patient on a ventilator immediately, otherwise it may be too late to rescue."

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 Department of Respiratory Medicine and the Emergency Department of the No. [-] Hospital, and he has a little rescue experience.

Coupled with the current low-level respiratory diagnosis and proficient cardiovascular internal diagnosis ability, after the initial diagnosis of this patient, although the cause of the disease has not been found out.But you can't go wrong with a ventilator.

"Director Wu is here to direct the rescue, and still use you as a resident doctor to worry about it? Hurry up."

Ruan Xiaoqin yelled at him.

Seeing the patient's condition getting worse and worse, Ruan Xiaoqin also knew that something had happened.

The mood has gone to the extreme.

At this time, Li Jingsheng was asked to ask for help, but he was still here to give them advice on rescue.Who do you think you are?

This new doctor is outrageous.

Simply ignorant.

"Professor Wu, you can look at the patient's fingertips. They have begun to cyanosis. This is an obvious signal of hypoxemia. In addition, the patient's blood pressure is dropping rapidly, the heart rate is too fast, and it is accompanied by high fever. The ventilator must be ready. , otherwise it may be too late."

Li Jingsheng ignored Ruan Xiaoqin.

Instead, he looked at Professor Wu with a serious face.

After speaking, he didn't stay any longer, but quickly went to Director Hua to rescue the patient together.

The patient's current condition is not particularly serious, so Professor Wu can calmly think about the cause.With the rapid progress of the disease, Professor Wu will not even have a chance to be rescued.

In clinical rescue, when encountering such a situation, some life support is usually performed first.

For example, if blood pressure is low, raise blood pressure.

If you can't breathe well, take oxygen or put on a ventilator.

For veteran doctors with certain rescue experience, they will make a preliminary assessment based on the patient's condition.If there is still time to think about the cause, they will 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.

Most of the directors and chief physicians are aged 40 or above.

An older doctor, at the age of 42, can be rated as a senior professional title, which is considered a very young chief physician.

Many of them are rated in their 50s, and even stop at the sub-high school all their lives.

"Director Hua, the patient in bed 25 suddenly fell into a coma and is in a very bad condition. Professor Wu asked me to invite you to rescue the patient together."

"I'll go right now!"

When Director Hua heard of this dangerous situation, most of his sleepiness instantly woke up.

He stood up and hurried outside.

"Don't you work in the outpatient department? Why does Professor Wu ask you to run errands in the inpatient department?"

Director Hua didn't recruit him to do odd jobs, but to hold up half the sky and work in the outpatient clinic.

"I came over to rest for a while at noon, and happened to meet a patient who was being rescued, so Professor Wu called me to help."

Naturally, Li Jingsheng would not say in front of Director Hua that Professor Wu gave him small shoes and suppressed him.

That's too low.

At Director Dehua's level, 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 of another leader in front of one leader.

"How is the patient?"

Director Hua asked.

"The patient's blood pressure is dropping very fast now, the systolic blood pressure is only 78mmhg, the heart rate is as high as 120 beats per minute, the breathing is heavy, light coma, and hypoxemia. The patient's treatment is to perfuse bone cement in the knee tibia, and I will not do anything else. It's all too clear."

Li Jingsheng briefly explained what he knew.

"It should be the patient whose osteomyelitis caused the cavity in the tibia. How did he become unconscious after treating a leg? It's just a small operation on the lower limbs!"

Director Hua was also a little confused.

Sometimes you can't stop things from happening.

Often unexpected events occur.

The two entered the ward and had already used some rescue measures for 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.

"I didn't find out. I just pushed two kidneys to boost the blood pressure, and the effect is a little bit, not very good. Considering that the patient has hypoxemia, let her try to inhale oxygen 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.

"The patient's blood oxygen index has risen to 87%."

Ruan Xiaoqin said beside him.

"The blood pressure has also stabilized, and it has risen a bit. The systolic blood pressure is 80mmhg."

Good news keeps coming.

The symptomatic treatment of Western medicine is often immediate.

Clinical rescue can basically achieve good results.

Li Jingsheng was not optimistic about the result.

He has a strong sense of crisis. The improvement of the patient's physical signs is just a flower in the water, and the moon is in the mirror, and he will be beaten back to his original shape soon.

Because the real cause has not been found.

Of course, it is also a good way to use this method to gain more rescue time.

Some causes of disease want to find out, very laborious, need more time.

"Can I see the patient's condition?"

Li Jingsheng asked Director Hua for instructions.

Now that Director Hua is the commander-in-chief, Li Jingsheng can win some opportunities to perform meritorious service.

If this case is rescued, he can give constructive suggestions, and his status in the department will be greatly improved.

Although manipulative 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 uses a scalpel.

The chain of contempt will always exist.

"Yes, how do you need to check, let the doctors and nurses in charge of the bed cooperate with you. Young doctors should be like you, be active, instead of being timid and afraid of taking responsibility."

Director Hua readily agreed, and when talking about the latter, his eyes glanced over Ruan Xiaoqin and the others intentionally or unintentionally.

Ruan Xiaoqin and the others naturally watched Li Jingsheng examine the patient with disdain.

If the strength is not enough, no matter how active the performance is, it is useless.

After getting permission, Li Jingsheng went to the bedside to examine the patient.

Physical examination is always the most intuitive and effective way of first diagnosis.

Trying to lift the patient's eyelids, he found ecchymosis under the patient's conjunctiva.

Then he pinched 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 his addiction and listened to the patient's heart and lung sounds.

Professor Wu and others naturally had no hope for this newcomer, and even felt that Li Jingsheng was a little eager to show off and had a strong sense of utilitarianism.

Because he had a conflict with Li Jingsheng for the first time, he has always had a bad impression of Li Jingsheng.

Director Hua, Professor Wu and others have already started discussions in the ward.

Carefully check every possible risk link.

After listening to the patient's heart and lung sounds, Li Jingsheng already had some confidence in his mind.

The small-level respiratory medicine diagnosis is still very good.

When listening to the lung sounds, he heard the relatively dull voiced sound, moist rales, especially on percussion.

According to his diagnostic experience, the patient is likely to have developed pulmonary edema.

Reminiscent of the patient clamoring last night that it was very stuffy and that he needed to open the window for ventilation.Did the patient have problems with his lungs last night?

This possibility is very high.

After the edema of the lungs occurs, it will be difficult to breathe and feel oppressed.

The weather in Lijiang City last night was not bad, and it didn't have the sweltering heat before it was about to rain.

When the patient had symptoms of stuffy heat at that time, there should have been a problem.

Pulmonary edema, subconjunctival ecchymosis, high fever, rapid heart rate, rapid drop in blood pressure, and light coma... These symptoms combined to enrich Li Jingsheng's diagnosis.

Just like doing a word problem, every time a known condition is added, the answer will be more accurate.

The difficulty will also be reduced a lot.

"How is your mother's urination since the operation? Is it much less than usual?"

Li Jingsheng asked the girl.

She probably thought that Li Jingsheng was relatively young, so she was somewhat unwilling to talk to him.

Out of politeness, just a token nod.

"more or less!"

Li Jingsheng did not ask his family members now, but directly picked up the nursing record card.

After the operation, the urine output and blood pressure must be recorded.

"There is a significant reduction in urination!"

Pretty much what he predicted.

"The patient underwent tibial bone cavity filling bone cement surgery. Symptoms such as pulmonary edema and high fever occurred after the operation, and allergies and infections were excluded. What would it be?"

He began to think hard, trying to find a solution through dialectics.

(End of this chapter)