Gou is practicing medicine in the clinic

Chapter 298 The weakest department, hypokalemia
As for specifically mentioning Director Mu's recommendation, it was just because he was afraid of being rejected by Li Jingsheng.

"Okay, I'll be right over here!"

Li Jingsheng was unexpectedly cheerful.

He never refuses to rescue critically ill patients.

Even when he was very poor in medical skills at the First Hospital, as long as there was rescue, he would run forward and backward to contribute his own strength.

It's just because the superior doctors knew that his skills were average and saw his enthusiasm. Although they couldn't bear to refuse, they only dared to let him 'wave the flag' and play a minor role.

No senior doctor dared to let him start some important practical operations.

It is true that his level is not high, but Li Jingsheng can do everything from adjusting the ventilator to performing chest compressions.

Not to mention taking electrocardiograms and blood pressure measurements.

These are his daily tasks.

It seemed like it was the first time that I was invited by a chief physician of the department to attend a consultation on critically ill patients.

As long as he can help, he is more than happy to provide any support he can.

"Dr. Chen, Teacher Li, please let the waiting patients wait for a while. I will go to the endocrinology department for a consultation and will be back soon."

Li Jingsheng asked the two of them to explain and comfort the patients.

Outpatient doctors are not very good at this.

If there is an emergency, the patient in hand must be handled properly.

This is a bit like a bus breaking down on the way. You can't just leave a whole bus of passengers there, right?
The most common approach at this time is to arrange for passengers to take the next bus.

When outpatient doctors encounter emergencies, they can also distribute the remaining patients to other outpatient doctors.

Everyone is in the same department and knows each other.

If you put it through, people will understand.

But Li Jingsheng's situation is very special. Only he or Dr. Xu can handle his patients.Other outpatient doctors are simply not equipped to handle it.

Now Dr. Xu is still hospitalized and unable to come to work. Li Jingsheng can only deal with the patients on his own.

Fortunately, this time he was attending an emergency consultation in another department, so the people in the medical department would not be so mad as to deduct his salary after receiving a complaint call.

Leaving work without authorization is a very serious problem.

Rushed to the inpatient department of the endocrinology department.

To be honest, it's pretty shabby here.

His first impression was that it was small, occupying only about one-third of this floor.

There is no way, the hospital wards and office space are already very tight, and they are all allocated according to needs.

Endocrinology departments have few patients, small business volume, and weak revenue generation, so they can only enjoy this kind of squeezed treatment.This is considered a good thing, but some departments have shrunk severely and were eventually merged directly into other departments. That would be tragic.

Many people think that all departments in the hospital are fixed, which is simply naive.

The departments in large hospitals are relatively complete, and because the signs are there, all kinds of patients can be treated.The outpatient and emergency volume is very high, which means that small and unpopular departments can at least pick up enough patients to support the department.

But like the Second Hospital, or some of the rapidly declining old tertiary A and tertiary B hospitals, some departments initially had them, but then slowly disappeared.

As for the tertiary C hospitals, in Li Jingsheng’s eyes, some tertiary C hospitals are not as good as the second class hospitals.

Many Class II hospitals with strong growth momentum have a high reputation in the local area, and the business development of general departments and powerful departments is very good.What is presented is the effect of a hundred flowers blooming.

There are also some Class II hospitals that were originally Class III or Class B. In order to increase the reimbursement ratio for patients, they voluntarily applied to be downgraded to Class II hospitals.

This approach is actually quite great.

However, some Grade III-C hospitals have unsatisfactory ratings and have been downgraded from Grade III-B or even Grade III-A.

It's a downgrade.

When a hospital starts to be downgraded, there's a big problem in itself.

Therefore, some tertiary level C hospitals are regarded by many people as "poor students" among tertiary level hospitals.

The more such a hospital is, the less people go to it.

In the end, it will definitely be downgraded to a second-level hospital soon.

If there are no strong measures to stop the decline, some hospitals will eventually be lost in the long river of history.

The ratings of the Second Hospital in recent years have been triple B, with scores above 750 and below 900.

It can be said that he is neither above nor below, and he is an average student in a tertiary hospital.

In recent years, thanks to the efforts of President Fu and the hospital leadership team, the ratings of the Second Hospital have increased year after year, showing a gratifying trend.

This year, because of the monster Li Jingsheng and the combined efforts of multiple departments, the scoring is expected to achieve a major breakthrough.

It is very possible to be ranked among the top three.

The Department of Endocrinology only has a small territory, but Li Jingsheng does not look at people through colored glasses.

The nurse's station is shared.

But the nurses in the two departments each sit and work on one side.

There are only two nurses in the endocrinology department, and there are five nurses in the gastroenterology department.

"Beauty, may I ask if your director Kuo is here?"

Li Jingsheng asked the two nurses with a smile.

One is 38 or 20 years old, and the other is a pink and tender young man in his early [-]s.

There is no way, nurses will try their best to escape from a department with poor business like this.There is no need to tell anyone who is relevant, just say hello and enter the important department.

It's a bit tiring, but the income is high and the benefits are good.

If you enter a department with poor professional skills, not only will your status be low, but your income will also be miserable.

Salaries are paid uniformly by the hospital's finances, so as long as the hospital can make money, there is no need to worry about not being able to pay salaries, no matter how bad the department is.

Looking at this situation, it's probably due to lack of manpower and a new nurse was lured in from nowhere.

"What's up?"

The older nurse looked at Li Jingsheng and asked calmly.

wipe!
Looking at her dim-sighted look and her cold and arrogant attitude, she probably didn't even know who Li Jingsheng was.

Otherwise, he wouldn't have treated Li Jingsheng with such an attitude.

"Your director, please invite me here for consultation!"

Li Jingsheng said directly.

Damn it, seeing such an arrogant old nurse, he really wanted to have her arrested and whipped.

If the patient presses the bell when something happens, the nurse, who is an experienced nurse, promises to deal with it slowly.

He even casually sent his trainee nurses over to deal with it.

If anything happens, she is more vicious than the family members, blaming everything on the family members and patients.

This kind of nurse will only be honest when she encounters a family member with such a bad temper.

I'll whip you if I don't agree with you.

"Ward 6103!"

After listening, she still reported the room number of a ward in a leisurely manner.

This is the sixth floor, and all wards begin with six.

Li Jingsheng was puzzled. Consultations were rarely held in the ward, but in offices or consultation rooms.

It is also convenient for playing PPT pictures.

6127, 6126...

He just searched in one room after another.

This was actually a waste of time, but looking at the old nurse's arrogant face, he was sure that if he asked a few more questions, she would get an impatient look on his face.

Find the end, Ward 6104.

Opposite is a small room where cleaning tools such as mops are kept.

I didn’t see Ward 6103!
Li Jingsheng began to walk back and looked at the wards on both sides of the corridor, including the water closet, hot dining room, and washroom, but still did not find Ward 6103.

"Beauty, is there a mistake? I didn't see Ward 6103!"

Li Jingsheng spoke with a hint of anger this time.

People's lives were at stake, and he had left the outpatient patients all the way to come to save them, but this female nurse acted in such a "official" manner, which was really infuriating.

"Wait!"

She lowered her head and was busy, not knowing what she was looking at on the computer.

Li Jingsheng subconsciously stretched his head to see what she was doing.

What I saw was that I was browsing the authenticity identification screen of LV bucket bags.

Seeing Li Jingsheng stretching his head to look at her screen, the older female nurse instantly became angry.

"what are you doing?"

"I still want to ask you what you are doing! I was invited by your director Kuo to come over to help save people, but you were impatient and told me a wrong ward number. This is the first time I have seen this kind of work attitude. arrive."

Li Jingsheng was really angry.

Any doctor with a little bit of blood would not be able to bear it.

"What are you yelling at me for? Ward 6103 is over there. You can't find it yourself. You are still yelling at me here. You are as stupid as a pig. You are so embarrassed! That's true!"

The female nurse also used English words when she cursed.

If Li Jingsheng hadn't held back, he would have punched her in the face.

"Damn it, I knew ward 6103 was on the other side, but you didn't tell me earlier. If that patient had any shortcomings, you would be the murderer!"

Li Jingsheng quickly ran over there.

At this time, the mobile phone rang again.

"Dr. Li, are you here? My patient here is very anxious. Can you please help me!"

Director Kuo called. He almost spoke in a pleading tone.

It could be heard that he was really worried about the patient's condition.

"We're here, the nurse here didn't explain it clearly just now, so I looked in the wrong place."

"I'll tell her later, and I'll pick you up!"

After Director Kuo heard this, he actually took a protective attitude towards the female nurse.This instantly made Li Jingsheng's impression of this department extremely bad.

Save people first.

I won’t invite him next time.

He has no control over the affairs of this rotten department.

Walking to the corridor on the other side, I found that there are three wards here, namely 6101, 02, and 03.

A skinny old man, wearing a white coat, with a dark stubble and messy gray hair.

If he hadn't been wearing this white coat, he would have looked like a downtrodden old man.

My age seems to be over 60 years old.

"Dr. Li, I've been waiting for you! The patient is inside, please help me take a look."

There were no extra courtesy, and when he saw Li Jingsheng coming over, it was the expression of joy after seeing the savior.

Li Jingsheng secretly wondered that this rich director showed the image of a good doctor who was worried about his patients.Why are you so protective of that female nurse?

If he doesn't understand, he won't ask any more questions.

Entering the ward, there are four beds, two of which are empty.

Lying on one of the beds was a male patient in his 40s.

His face looked slightly gray, a little cyanotic, his breathing was rapid, and his breathing was very heavy.

It means breathing is particularly laborious.

An oxygen tube was worn in one nostril.

Single-nasal oxygen inhalation is a commonly used clinical method to improve patients with dyspnea and low blood oxygen saturation.

The overall rescue idea of ​​Western medicine is to first find ways to stabilize the patient's physical signs, and then find the cause and provide some targeted treatment.

This method is clinically effective and indeed saves the lives of many patients.

When encountering critically ill patients, if you don't try to stabilize their physical signs, they will die in minutes.

"It looks like you have some breathing problems. Didn't you ask Director Mu for consultation?"

Li Jingsheng is okay in the Hu Nei field.

His in-breath diagnosis is currently at Dacheng level, which is equivalent to the level of deputy chief physician.

"Please, he asked me to invite you to come over and take a look."

The family member is a woman about 40 years old, who should be the male patient's wife.

But at the moment, he was playing with his mobile phone and seemed indifferent to Li Jingsheng's arrival.

In other words, she doesn't care much about her husband's condition.

"What problem did he have to be hospitalized for?"

Li Jingsheng decided to find out about the patient's condition first.

To be honest, he is not good at endocrinology.

He is also good at internal medicine, gastroenterology, cardiovascular medicine, and orthopedics. He is also good at these fields.

Even though he helped multiple teams or chief physicians win awards in skill competitions, his family knows his own affairs, so he is definitely not a particularly top-notch one.

It's a trick in many ways.

At least others thought there was still a lot of room for improvement.

"The patient's symptoms when he was admitted were weakness in his limbs and difficulty even walking. This was an examination done after admission."

Director Kuo showed the information to Li Jingsheng.

After the male patient's wife listened, she responded, "He has always been a loser! He can't do anything."

Say this to the patient in front of him.

This woman also looked very resentful.

Li Jingsheng glanced sympathetically at the patient on the bed.

Medical record information showed that the patient had suffered from physical weakness for more than ten years.No wonder his wife is so resentful.

If physiological needs are not met for a long time, feelings will gradually fade.

It would be better not to get divorced.

Judging from the examination results, the patient was hypokalemic.

Blood pressure is 170/110mmhg, breathing is about 28 times per minute, and body temperature should be between low fever, 36.9 degrees.

In medicine, some hospitals and doctors like to be dogmatic and believe that a patient's body temperature below 37 degrees does not constitute a low-grade fever.

Li Jingsheng despised this approach.

What I fear most when practicing medicine is meeting dogmatic and rigid doctors.

Everything is done according to the textbook.

As everyone knows, the textbooks are also written by doctors.

The content inside is only based on their summary and judgment of medical clinical experience, but it is not an imperial edict.

The situation of different patients may vary greatly, which requires doctors to treat and differentiate according to the symptoms.

Instead of following the textbook to do rigid analysis and diagnosis.

The patient is still conscious.

When he heard his wife complaining and calling him a loser, he showed a guilty expression.

The patient's serum potassium was 2.14mmol/L, and there was a U-shaped wave in the electrocardiogram.

First, the patient's serum potassium was significantly lower than the normal value.

Normal people's blood potassium should be above 3.5, and anything below 5.5 is considered normal.

Having potassium that is too low or too high is not a good thing.

There is a saying that too much is too late.

In addition to this patient's blood potassium being far below the normal value, there is a U wave in the electrocardiogram, which is also a big problem worthy of vigilance.

Under normal circumstances, if a U wave appears on the electrocardiogram clinically, the patient's bradycardia or electrolyte imbalance can first be judged.

Even myocardial infarction.

Myocarditis, which scares doctors, can also cause U waves.

Li Jingsheng is not good at diagnosing and analyzing diseases in the endocrine field, but he has a very high level in the cardiovascular field.

The patient also had difficulty breathing.

He can perform comprehensive analysis using cardiovascular diagnostics and intra-respiratory diagnostics.

The most common causes of bradycardia are arrhythmia, cardiomyopathy, or cervical spine trauma.

Bradycardia caused by cervical spine trauma is common in car accidents or accidental injuries.

Then let’s analyze the second reason for the occurrence of U waves, electrolyte imbalance.

This is mostly caused by disorders of water and sodium metabolism or hypokalemia.

When the above situation occurs, it will cause abnormal concentration of body fluids and electrolytes, thereby affecting the system function of the heart organ.

If the patient has U waves caused by the second reason, it will also be accompanied by another symptom, which is nausea and vomiting.

This patient happened to have severe hypokalemia. Li Jingsheng's first focus was on the U wave caused by electrolyte imbalance.

"Do you feel nauseous or want to vomit?"

Li Jingsheng asked the patient.

"Yes. I feel very panicked and uncomfortable in my heart, and I also feel very uncomfortable in this area."

The patient weakly pointed to the location of the pericardium and the area where the stomach was.

Someone once joked that if you want to capture a man or woman's heart, capture their stomach.

Because the stomach is the closest place to the heart.

Let’s not talk about whether it makes sense or not. At least from the perspective of medical anatomy, this sentence makes sense.

The stomach is just below the heart, located in the upper left abdomen of the human body.

Many people are stupid and cannot tell the difference between the positions of the stomach and the heart.

If you have stomach bloating, you think it’s heartache, and you’ll rush to the hospital’s emergency department nervously, using the green channel for chest pain and stroke.In the end, when the doctor checked, it turned out to be simple gastritis, which was a joke and a false alarm.

When a person has eaten a full meal, he or she can generally feel the presence of the stomach with his hand on the left upper abdomen.

Of course, overeating is not a good thing.

From the perspective of traditional Chinese medicine and health care, it is most appropriate to eat seven to eight times full.

In the past two years, a form of starvation therapy has even become popular among wealthy people abroad.They believe that starving the body can awaken its vitality and make people younger.

Naturally, people are not being stupid when they do this.

It does have some scientific basis.

In recent years, many surveys have shown that moderate hunger in the human body has benefits.

Being too full can lead to various problems.

Some people jokingly call it the disease of wealth.

In ancient times, landlords and wealthy people usually lived so much that their life span was five or sixty years old.

In fact, it is not simply eating too much that leads to short life.

First, the average life expectancy of people in ancient times was originally short. In that era, there was a lack of medical treatment and medical treatment was quite a luxury.

Finding a good doctor is even harder.

Secondly, in ancient times, wealthy landowners had many wives and concubines, and they had excessive pleasures, which also consumed their lifespan.

Li Jingsheng heard that the patient clearly stated that he had symptoms of nausea and stomach discomfort, and he had basically identified the cause of the U wave in the electrocardiogram.

The cause of this patient's disease is not complicated, but hypokalemia caused a series of symptoms and lesions.

The main reason is that it took too long.

It took more than ten years.

Treating hypokalemia is not difficult, and unless the cause is special, treatment is not expensive.

I really don’t understand why this patient didn’t go to the hospital for treatment earlier?
(End of this chapter)