Gou is practicing medicine in the clinic

Chapter 368 Conservative treatment is kindness, terrible complications

After just one glance, he shook his head.

"This patient is already terminally ill and cannot be cured with any medicine or stone."

Li Jingsheng runs a clinic. To be honest, he can basically judge whether a patient can be saved by just looking at it twice and asking about the general situation.

Li Jingsheng always stayed away from patients like this who had not been cured for a long time and had begun to suffer from various complications.

If it were Boss Zhao of Kuaikang Clinic, he would have immediately advised patients to harm other families.

"If it's easy to cure, why should I look for you? Just think of it as helping me and giving advice together!"

Lian Tao was obviously prepared.

None of the seriously ill patients admitted to the Department of Internal Medicine can be cured, and basically all of them are fighting for their lives.

Moreover, the characteristics of seriously ill patients treated in each internal medicine department are different.

For example, patients with respiratory failure in the Department of Respiratory Medicine will die immediately.

If he couldn't take a breath or get out, he would die.

Sometimes, the parameters of the ventilator are clearly adjusted, but in the middle of the night, the patient's condition suddenly changes.By the time the problem is discovered, it already needs rescue.

Some patients are intubated for a long time, and infection inevitably occurs, and there is no cure.

Even if the patient has phlegm stuck in his mouth and the phlegm is not suctioned in time, it will be fatal in minutes.

Patients in the Department of Neurology are diverse, including intracranial hemorrhage, tumors, cranial trauma, etc.When patients here die, they often leave quietly without even saying hello.

Severely ill patients in the Department of Gastroenterology mainly suffer from extreme weight loss and weakness, and a large number of complications.

For example, this old man now, who is 76 years old, was sent to the hospital for treatment because of long-term vomiting and diarrhea, and eventually developed a fever and even lost consciousness.

Lian Tao didn't know what he was thinking about admitting such a seriously ill patient.

According to the process, such patients generally have two options.

If the family's financial situation is good and the children or wife are willing to spend money, then they can be sent directly to the intensive care unit for a few days.After that, the family can decide whether to continue.

Many of them are just a little effort, but the cost is as high as [-], [-], or even [-] or [-] a day, which many families cannot afford.

If the patient's condition does not improve after staying for a few days, the tube may be extubated directly.

If things get better and can be transferred back to the general ward, everyone will be happy.

There is another situation that is relatively common. After the patient is admitted to the ICU, the condition does not improve, but it does not continue to worsen.

At this time, it's basically just a few pipes holding the breath.

Those with a high reimbursement ratio can endure it and continue to treat it.

Li Jingsheng has even seen such critically ill patients staying in the ICU for more than half a year.

Breathing is maintained by a ventilator, and a hemodialysis session is required after a period of time. After that, a nurse injects food through a nasal tube.

Although this elderly man with diarrhea has not yet met the criteria for admission to the ICU, his physical condition is in terrible condition.

The old man has a history of hypertension for decades.

I got high blood pressure when I was [-] or [-] years old, and I have been taking medicine to control it.

This is the first time Li Jingsheng has encountered this kind of patient who has had high blood pressure for nearly 60 years.

Although the patient had a history of high blood pressure for 60 to [-] years, he had not developed heart disease and his lungs had always been healthy.

This shows that although high blood pressure is scary, as long as it is controlled well, it will basically not affect life span.

"The patient now has many symptoms, but the most important ones are diarrhea and vomiting. After a cardiopulmonary examination, there are basically no problems. Therefore, I think that as long as the cause of diarrhea and vomiting can be found and then treated correctly and standardized, the patient should be cured. good."

Lian Tao said seriously.

It can be seen that he is very determined to save this old man.

"But have you ever thought that the patient has begun to have some obvious complications. You may try your best, but in the end you still can't save the person. First of all, I am not utilitarian, I just think that the patient has been treated that should be treated. , but the trend of disease progression is unstoppable. Is conventional treatment more friendly to patients and their families?
If you insist on tormenting, the patient may suffer from three situations.

The best one is to get better after treatment and return to basic health.It is more likely that the patient will end up in the ICU after treatment, and I think this is the most likely.

Moreover, after being admitted to the ICU, the patient was ultimately unable to be saved.

There is also a situation where the patient dies directly after treatment. "

When Li Jingsheng was working at the First Hospital a long time ago, the department director gave them a very vivid lesson.

That patient was in a similar condition to the old man. His condition was very serious and he began to suffer from various complications.

The family repeatedly requested doctors to provide full treatment.

The director of the Department of Internal Medicine couldn't bear to see the family members fall into great grief.

Finally, it was decided to treat the patient with all his strength.

However, things went against expectations. After one and a half months of resuscitation, the patient finally passed away.

In order to save the patient, the family sold their only house.

I also borrowed more than 60 yuan in foreign debt from relatives, friends and various channels.

The patient was hospitalized for 46 days and spent a total of more than 170 million yuan.Basically, the reimbursement rate is very low, and many of the drugs used are imported.

In the end, even ECMO, the ultimate life-saving tool, was used.

The person is gone, the house is gone, and there is a huge debt.

The patient's wife also missed work due to her husband's hospitalization, funeral and other matters, and eventually lost her job.

She lived in an old-fashioned two-bedroom apartment with her two children and two elderly people.

In the end, she couldn't bear the blows from all sides and chose to abandon her two young children and jump off the building.

The two old men were deeply saddened by the death of their son.

Now that they see their daughter-in-law commit suicide by jumping off a building, they feel that they have become a burden to their daughter-in-law, which has caused her to go to a dead end.In addition, he owes huge debts that he cannot repay.

I don’t even have the shame to see my relatives and friends.

The old couple finally chose to commit suicide. One hanged himself in the bathroom, and the other committed suicide by taking a large amount of sleeping pills.

What was originally a good home was left with two children who had no one to take care of them.

The 52-year-old department director's voice choked up several times during department meetings.

Let everyone remember this bloody lesson.

If the family members were told directly at that time, it would be difficult to save the patient. It would be better to show some humanistic care and try to alleviate the patient's pain.Use some more conservative treatments.

In this case, even if the patient dies, there are still three adults in the family, plus two children, and they can live a good life.

After a while, you can get over the grief of losing a loved one and live a new life.

That incident left a deep impression on Li Jingsheng.

At that time, I was still a junior resident who had just transferred to another position and had very little clinical experience.

But since then, he has encountered patients whose conditions are too serious, such as terminal cancer, or serious diseases that are extremely difficult to cure and may bring down the patient's entire family.In the end, both people and money were lost.

He will decisively persuade patients and their families to accept more affordable treatments.

"Jingsheng, I understand what you mean, and I admire your kindness for truly considering the long-term for patients and their families. But this patient's situation is very special.

First of all, the patient's family background is acceptable and he has access to publicly funded medical care.

As for the treatment fee, we basically don’t have to worry.Secondly, this patient was very inspirational when he was young.His high blood pressure was caused by excessive pressure when he was studying for the college entrance examination when he was young.

He devoted his life to benefiting mankind.

A treatise he was completing has not yet been completed, and he especially hoped to live longer so that he could complete the treatise before leaving this world.

I am willing to accept this hot patient, not because I am stupid, nor because I have problems with my own future and ratings.I just want to use my little ability to help this admirable old man. "

After listening to Lian Tao's explanation of the reasons, Li Jingsheng nodded and said nothing more.

When doctors see patients, they often encounter some admirable patients.

For example, the old scavenger Li Jingsheng met clearly knew that his retirement salary would allow him to live a decent and comfortable life in his later years.But he chose to pick up trash just to collect a little more money and donate it to children in poor areas to help them get a chance to sit in the classroom and study.

Such patients have sparkling souls, which are naturally admirable.

Doctors will also try their best to help them.

Li Jingsheng began to carefully check the patient's information.

The patient's current physical condition is very poor, he is mentally lethargic, and his skin and sclera are not jaundiced.

Neck resistance is abnormal.

No abnormalities were found in the heart and lungs, which is good. At least there is a fairly good basis for treatment.

The abdomen is soft and non-tender.

Bowel sounds 6 times/min.

This is normal and quite active.

Normal bowel sounds are three to five times per minute.

The patient's blood routine test showed that the WBC count was 25.6 times ten to the ninth power per liter.This alone scared Li Jingsheng, it was more than twice the normal value.

In fact, the normal white blood cell count for many adults is around 4.

According to medical textbooks, between 3.5 and 9.5 is considered normal.

There are many reasons for an elevated white blood cell count, the most common of which is infectious diseases.

In addition, hemolytic Streptococcus, Haemophilus influenzae, leukemia, early stage of myelofibrosis and adult Still's disease, etc., may cause an increase in white blood cell count.

For this old man’s second item, the GR ratio reached 93%.

The normal neutrophil ratio for adults should be between 50% and 70%.

The old man's neutral cell ratio was also significantly higher than the normal value.

Moving on to the old man's other auxiliary examination results, the platelet count was still normal, 267 times ten to the ninth power per liter.

No abnormalities were found in the stool routine.

The liver function was normal and the heart rhythm was a very standard sinus rhythm.

Just broad and flat T wave.

Generally speaking, there are many reasons for flat T waves, the most common of which is patients with high blood pressure.

This patient has had high blood pressure for nearly 60 years, and it is normal for the T wave to appear flat.

Li Jingsheng continued to check the patient's other data, including hypokalemia, hyponatremia, and hypochloremia.

High blood pressure, systolic blood pressure of 160mmhg, diastolic blood pressure of 100mmhg.

However, his blood oxygen saturation level was still 99%.

For elderly people who are very frail, having this blood oxygen saturation is quite good.

It also indirectly shows that the patient's lung function and blood oxygen exchange are not bad.

Li Jingsheng picked up the patient's electrocardiogram and checked it.

Sinus rhythm, but with extensive T wave inversion, multiple premature atrial contractions, and somewhat low R waves in the precordial leads.

After seeing the electrocardiogram, he realized that the patient had acute myocardial infarction.

Of course, the patient has been admitted to the hospital for some time and must have been dealt with in a timely manner.

"Brother Lian Tao, this patient's left ventricular function seems to be a little incomplete!"

"Hey, that's good. You can see this at a glance. It seems that your diagnostic skills in cardiology have been greatly improved!"

Lian Tao smiled and praised him.

It’s not surprising to see this, as many experienced cardiologists can diagnose it at a glance.

Li Jingsheng often goes to cardiothoracic surgery for surgery these days, and he has learned a lot.

There have been great advances in medical clinical knowledge and experience in cardiovascular medicine and cardiothoracic surgery.

"After we admitted him, we have given him diuretic and vasodilator treatment to increase his volume. At present, the symptoms in this area have been significantly improved."

The People's Hospital deserves to be a strong hospital, and its strength is indeed very strong.

All aspects of diagnosis and treatment procedures are also extremely standardized.

As long as the patient can be admitted to the hospital, it is almost equivalent to getting a life-saving card.

Medical staff will provide them with professional treatment.

Qiao Bang feels a little slacker.

But if it can become a top compound, it can't be any worse.

At most, they are not so friendly to patients who are not admitted.

"Aren't you using aspirin, fosinopril, bisoprolol, simvastatin and other drugs for preventive treatment?"

Li Jingsheng felt that diuresis and volume expansion alone were not enough.

It is very necessary to use some secondary prevention drugs for coronary heart disease.

"Hey, young man, I haven't seen you for a few days. It's impressive! Your use of medicines for treating cardiovascular diseases has obviously made great progress compared with before! Where have you been studying recently?"

After hearing this, Lian Tao couldn't help but look at Li Jingsheng with admiration.

"Just hang out in our Second Hospital, where else can I go! If I want to talk about further education, I really have advanced my studies. I recently went to your People's Hospital and learned a lot from Professor Wang Weiwei and Professor Luo Binggang."

Li Jingsheng unknowingly met many famous experts and professors.

It was also appreciated and taught by them.

"No wonder, no wonder, that's what I'm telling you! This patient will be handed over to you today, don't give up, otherwise you won't be able to live up to your abilities."

After hearing this, Lian Tao suddenly realized.

If you can learn from a top cardiovascular medicine expert like Wang Weiwei, can your level rise quickly?

It's so enviable.

"Brother Tao, is this patient's current diarrhea and vomiting still being treated as acute gastroenteritis?"

"Yes! Because no other cause of the disease was found. You may not believe it. On the first day after being admitted to the hospital, the patient's cardiovascular system was still fine. But by yesterday, the patient had already suffered from acute myocardial infarction. Fortunately, we discovered it in time, otherwise the consequences would be disastrous. Now after treatment, myocardial infarction should be no big problem."

Complications are the most dangerous condition for this patient.

(End of this chapter)