Gou is practicing medicine in the clinic

Chapter 320 Professor Wu stuffed his burden, the cause of hypotonicity
When the patient had such a serious problem, Ou Qinglan immediately reported it to the superior doctor on duty.

Then he called and reported to Professor Wu.

"Dear, what should we do with that patient?"

After Ou Qinglan made the call, she asked Li Jingsheng for help.

"Intravenous water and sodium replenishment! The patient's serum sodium is lower than the normal value of 135mmol/l, which can be basically diagnosed as hypotonic dehydration. You can just give him an intravenous infusion of 5% glucose saline and 4.5g of sodium today."

On the first day of supplementary payment, half of the daily requirement may be supplemented.

The rest can be observed and replenished the next day.

This patient has not yet developed severe sodium deficiency, and the treatment is actually relatively simple.

If you are a patient with severe sodium deficiency, you need to replenish your blood volume first.

Human body fluids can transform into each other.

More than [-]% of the human body is made up of water. When dehydration is severe, blood volume will decrease.

What needs to be done at this time is to replenish the blood volume first and improve the patient's microcirculation and tissue perfusion.Then do other treatments.

Severe dehydration can cause shock or even death.

So don’t underestimate the dangers of dehydration.

Some people may be overconfident or not aware enough of danger when traveling, and are most likely to become dehydrated.If you cannot replenish water in time, coupled with exercise consumption and sweating in hot weather, which will lead to further loss of water, danger will soon arise.

Just like carbon monoxide poisoning, by the time you realize you are in danger, you no longer have the strength to open the window or crawl outside the door.

"The doctor on duty has taught me how to do these treatments for patients. What I'm asking is what should I do next?"

Ou Qinglan wants to do more than just solve the patient's immediate problems.

She also wants to find out the cause and solve the underlying problem.

"Shouldn't this matter be handled by Professor Wu? There are many causes of hypotonic dehydration. You can just diagnose and think about it in private. Why should you take the lead!"

Li Jingsheng is not the kind of novice doctor with no office experience.

It is good for young doctors to be aggressive and motivated, but try not to do things that are beyond the scope of their responsibilities and beyond their own abilities and experience.

Otherwise, if you get into trouble, the superior doctor will not only not be grateful to you for helping him share his worries, but will scold you bloody.

There will be no good days for a long time.

It is even possible to be directly thrown into the cold palace.

A typical example of hard work and no effort.

"He said that there is no way to come to the hospital now. There is an important academic meeting to attend tomorrow morning, and he asked me to find a solution."

Ou Qinglan said honestly.

"Did you tell him that I would stay with you in the office?"

Li Jingsheng immediately realized something was abnormal.

Under normal circumstances, when a patient has such a big problem, Professor Wu, as the attending doctor, cannot ignore it.

He had guessed a bit when he was adjusting the patient's steel frame.

Because it is impossible for a doctor with a higher level of skill to grasp the tightness of a steel frame.

Because of his limited skill, Professor Wu was afraid that the patient would cause problems if he moved erratically, so he would rather make the patient more uncomfortable and tighten the steel frame.This is at least a little safer.

In fact, fracture reduction does not mean that the tighter the compression, the better.

Moderate strength is best.

It's really crowded, and the bone cross section is under strong pressure all the time, which is not necessarily a good thing.

It may not be conducive to the formation of callus.

At the same time, it will also cause patients to suffer a lot of pain.

The second hospital implements the first-diagnosis responsibility system.

Professor Wu accepted the patient and performed the operation. Now that the patient has a problem, he must be more anxious than anyone else.

But to throw such a difficult problem to Ou Qinglan, a novice resident physician, is so unreasonable.

There was only one reason that Li Jingsheng could think of. Professor Wu was having sex with a young beauty. When he heard that Li Jingsheng was accompanying Ou Qinglan in the hospital, he immediately and cleverly left the problem to Ou Qinglan.

He knew that it was impossible for Li Jingsheng to ignore his girlfriend.

"I didn't mean to say that. After I reported the problem to him at that time, he felt very strange and praised me, "Xiao Ou, that's good. He suddenly made such a big progress and was able to keenly detect the presence of hypokalemia in patients. And decisively applied for an examination, which is very good. I dare not take your credit, so I just said that Dr. Li happened to come over and it was Dr. Li who discovered it.

Then Professor Wu praised me a few words and said that this patient was a very good training opportunity and asked me to handle it well.

It was me who was too stupid and didn't come to my senses at the time.

Now that you remind me, I understand... Professor Wu is too..."

Before Ou Qinglan could finish speaking, Li Jingsheng interrupted directly.

"Professor Wu actually sees that you are a nurturing talent and intends to cultivate you. It's okay. I will accompany you to analyze the real cause of the patient's disease and try to find out the cause. If it doesn't work, it's not too late to ask Professor Wu for advice tomorrow."

Li Jingsheng also made the same mistake as Ou Qinglan back then, speaking without restraint and speaking directly out of his mouth.

It is a taboo to speak ill of leaders and superiors.

Especially when other colleagues are present in the office, you must control your mouth.

There are now three other doctors on night shift in the office, including Qin Fei.

She scolded Professor Wu for being cunning. There was no ill intention in the first place, but when it reached Professor Wu's ears, she might immediately make him dissatisfied.

Even for the sake of Li Jingsheng, Ou Qinglan was not allowed to wear small shoes.

At least the intensity of training her will definitely be reduced.

If she has the opportunity to exercise, she will be taken care of first.But in the future, I will definitely give priority to taking care of others.

When she encounters problems in clinical work, Professor Wu will no longer give her the same careful guidance as before.Everyone is like this.

Ou Qinglan's office experience is still very weak, and there are too many areas that need improvement.

"So that's it! Professor Wu is so kind to me!"

Although she is inexperienced, fortunately Bingxue is smart and knows everything.

Apparently he understood Li Jingsheng's good intentions and changed his tune on the spot.

"Can you help me analyze this case now? Every time I encounter electrolyte imbalance or dehydration, I get a headache. I don't know where to start."

She sat down next to Li Jingsheng.

"No problem. Just turn on the computer and pull out the patient's information!"

Li Jingsheng readily agreed.

Perhaps he was still worried that his girlfriend would be disadvantaged because she didn't know how to survive in the workplace, so he took out his cell phone and sent her a quick message while Ou Qinglan was logging in and adjusting patient information.

"Be sure to watch your mouth next time and never say anything bad about your leader, superiors, or colleagues to anyone."

After she received the message, she took out her phone and took a look.

Then he glared at Li Jingsheng.

Then, Li Jingsheng received a reply from her.

"Mama Li!"

Li Jingsheng felt suffocated and deprived of oxygen. This little girl actually found him too verbose.

"Good girl!"

He responded quickly with a message.

This time it was Ou Qinglan's turn to breathe heavily.

Fortunately, the two of them are not married yet, otherwise, Mr. Li might have to kneel on the washboard when he comes home.At least I have to sleep on the sofa.

"Help me find out the cause of this patient's illness, and I will forgive you. Otherwise..."

She made a small gesture to pinch him.

"Girl, violence and coercion are no longer popular nowadays. A woman's greatest weapon is gentleness, do you understand?"

"You are so beautiful! All the patient's information is out, so hurry up and get to work."

The two bickered and then carefully analyzed the cause of the patient's illness.

"It is better to teach a man how to fish than to teach him how to fish. Let me teach you step by step!"

Not to mention how powerful Li Jingsheng's current level is, it is at least far superior to Ou Qinglan.

"The most important things to monitor the patient's electrolyte balance are serum sodium, serum potassium, and chloride ion concentration. I believe I don't need to explain this in detail. Just follow the textbook standards. All you have to do is pay attention to the patient's Symptoms, and then learn to make comprehensive judgments. For example, this patient today, when he reacts weakly to you and is a little groggy, you should be alert to whether there are changes in his body at this time.

Rather than taking it for granted that it is caused by lack of rest after surgery.Then, I really judged that he probably had hyponatremia and made this preliminary diagnosis after seeing him drink water.

Under normal circumstances, patients are unlikely to be thirsty for a long time after surgery.

I dare not say that every patient who is thirsty after surgery has a problem. At least nine out of ten patients who are thirsty for a long time will have a problem. "

Seriously share your diagnostic ideas with her.

"After talking about diagnostic awareness, let's analyze the causes of electrolyte balance disorders. I don't need to say more about the treatment methods. You can just copy it from the textbook. If it doesn't work, I can give you a clinical surgery manual. Just flip through the book. . But you must summarize more. After all, the content in the book is dead. In many cases, it is necessary to flexibly increase or decrease the dosage of medicine, or combine medicines, or adjust the method of administration.

No textbook can teach you this practical knowledge. "

The growth of a doctor does involve all aspects.

Those who only know medical knowledge by rote memorization are nerds.

Such people can neither diagnose the cause nor cure the disease.

Only doctors who are good at constantly summarizing in practice and then making improvements will become stronger and stronger and become true masters.

She kept nodding her head, carefully remembering the improvement methods he taught her like a good student.

For any new doctor, such a good teacher is needed to guide the direction of progress.

"Let's analyze several types of electrolyte balance. If the serum sodium measurement result is within the normal range, but the blood volume is reduced and extracellular dehydration occurs, it is isotonic dehydration. The most important thing to be wary of is circulatory failure.

When isotonic dehydration occurs, it is often acute dehydration, which progresses very quickly. As soon as it is discovered, corresponding treatment measures must be taken immediately and decisively.

Second, if the measured value of serum sodium is higher than 150mmol/L, a lot of water is lost, or even more water is lost than sodium is lost, which can basically be concluded as hypertonic dehydration.This often causes diarrhea, profuse sweating, diabetes, etc.This patient's serum sodium is lower than the normal value. It is obviously not hypertonic dehydration, so it can be ruled out directly.

That leaves only the last two, one is water intoxication.

It is often caused by drinking a large amount of water in a short period of time. Although this patient drank more water, symptoms appeared before he became thirsty, which can directly rule out the possibility of water intoxication.

The last type is hypotonic dehydration. The patient's serum sodium at this time is lower than 135. If you have insufficient diagnostic experience and the conditions are met, you can also measure the plasma osmotic pressure again. If it is less than 280mmol/L, then it is basically Can be diagnosed. "

Li Jingsheng first analyzed her several types of electrolyte disorders and why it was determined that this patient was hypotonic dehydration.

She was taking notes quickly.

Some empirical clinical knowledge is not easy to learn from textbooks.

It is equivalent to the teacher combining the knowledge in the book with practice and turning them into living teaching materials.

After Ou Qinglan digested what he said, she asked, "Tell me more about the causes of hypotonic dehydration!"

"No problem. There are about three types of clinically common causes of hypotonic dehydration. The first one is persistent loss of gastrointestinal digestion, such as constant vomiting and chronic intestinal obstruction. This patient did not have continuous vomiting, but chronic intestinal obstruction. Obstruction is a cause for alarm.”

"The second type is chronic exudation from a large wound. I have carefully observed the patient's surgical wound and found no obvious abnormalities for the time being. However, we must closely observe the patient's other symptoms, such as fever, severe pain in the surgical wound, etc., then we should be vigilant. It is whether necrosis has occurred in the surgical wound.

According to my personal experience, if it is really exudation caused by necrosis of the surgical wound, and if it is an external wound, you can see a large amount of pus and yellow water oozing out with the naked eye.The time usually occurs more than two days after surgery.

This patient can basically rule out the possibility of this situation.

When you encounter similar patients in the future, the factor of wound necrosis must be taken into consideration. "

She recorded quickly.

"What about the third type? You have so much clinical knowledge. I used to think that after studying with Professor Wu for several years and doing a lot of clinical work, I have some experience. Now I understand that following the superior doctor to diagnose and treat patients, Independent diagnosis and treatment are two completely different concepts."

He looked at Li Jingsheng with extremely admiring eyes.

Qin Fei and two other interns on night shift also came over and even took notes on the spot.

Qin Fei was a little embarrassed at first.

Because he was about to be promoted to attending physician, so he just listened to Li Jingsheng's lectures and took notes on the spot. How embarrassing?

Later, I felt that the knowledge explained by Li Jingsheng was very practical, and they were valuable experiences that could be used clinically at any time.He went all out, regardless of whether it was embarrassing or not, he took some notes first and waited for them to be digested and recited slowly.

This is a real benefit.

As long as you learn it, your clinical medical skills will be improved immediately.

It can save the patient's life at critical moments.

"You don't have to work?"

Li Jingsheng noticed that there were a few more people around him and looked up at a few of them.

"Hey, isn't this what Teacher Li said wonderfully? We also want to make progress with Dr. Ou. If there is an emergency, the nurse will come in and call us."

An intern doctor said with a dry smile.

"Oh, hurry up and tell us! If there is an emergency in the hospital bed later, we won't be able to hear it."

Ou Qinglan urged him.

"The third type is excessive renal drainage and sodium excretion. This can be inferred by measuring urinary sodium. Patients usually urinate frequently, and the urine output increases significantly. I have seen more serious cases where the urine output is not only large, but also watery. Metabolism is amazingly fast. After drinking a large glass of water, it normally takes half an hour or more for us to feel the urge to urinate.

Apparently, this patient's urine output was relatively normal, and his urine sodium measurements were acceptable.can be excluded. "

Li Jingsheng explained the three main causes of hypoosmosis.

Then asked Ou Qinglan, "Qinglan, can you tell me what is the most likely cause of hypoosmosis in this patient?"

"Do I need to say this? You have analyzed it so carefully for me. I will go to the ward later to check whether the patient has a history of chronic intestinal obstruction."

She replied simply.

When it comes to talent and understanding, the higher the IQ, the stronger.

Ou Qinglan's performance is very good and she is a very good student.

At least Li Jingsheng was very comfortable teaching her the principles of life and clinical knowledge.

Unlike some students, she has no abilities and likes to question the teacher in all kinds of ways.

You even have to do something different to feel that you are different.

When he meets that kind of student, Li Jingsheng promises to say goodbye to him the next day.

A good doctor never lacks students.

Other attending doctors are trying their best to get more places for intern doctors.Because the more interns there are, the more people will work.

Li Jingsheng never lacks assistants.

Because his job is very special, all he needs is a student with some medical knowledge to occasionally help hold the patient or pull him while he performs manual reduction on some difficult cases.

Of course, it would be better if his doctors could improve quickly and share more work tasks for him.

"It's time for me to go back. The patient should first replenish fluids and sodium to correct the electrolyte balance. If there are no special circumstances, you must not treat him randomly. It does not necessarily mean intestinal obstruction. There are many reasons for hypoosmosis. I will list What comes out are only the most common clinical causes.”

Li Jingsheng warned her before leaving.

Perhaps she might have excitedly thought that with Li Jingsheng's guidance, she would be able to cure the patient's illness.

Acute intestinal obstruction is still difficult to diagnose, and chronic intestinal obstruction is even more difficult to diagnose.

"Dr. Li, I will analyze some typical cases for you next time when I have time! After listening to your explanation today, I feel that all I have read before is a bookworm."

"Haha, you are such a big talker. There are so many skilled doctors in orthopedic surgery. Director Hu, Director Chen, Director Hua, Director Ou and others are much better than me. Do you really think so? If you make progress, you can pester them to explain classic cases. Let's go, I hope you won't be so busy at night."

Li Jingsheng waved goodbye to several doctors.

Back at the clinic, the staff had already left work.

After looking at the sales volume, offline sales have basically stabilized.

Even though he was on the hot search a while ago, it did not bring much increase in offline sales.

The national market share of health care drugs is huge, but there is an upper limit at the local level.

For potential customers who are too far away, even if they trust Sunshine Clinic and have the need to buy medicines, it is not realistic for them to drive for an hour or two, or even several hours to buy two boxes of medicines.

Because Li Jingsheng is not the only seller of Modu Youyao, there are them everywhere.

Everyone's prices are basically the same.

The lower rent cost here is an advantage for Li Jingsheng, so the price of selling medicines is a little lower than others.

But it cannot be too low, otherwise it will disrupt the market.

Modu Youyao will not agree, and neither will other dealers.

Moreover, it is too cheap and can easily be misunderstood as fake medicine.Therefore, Li Jingsheng has never considered a price war.

At most, it is a few cents or one yuan cheaper than others, making patients feel that buying medicine here is the most affordable.

When it comes to common medicines, that goes without saying.

Basically the market prices are almost the same.

Because the profit itself is very low.

(End of this chapter)