White armor

Chapter 450: No Book Is Worse Than Believing in It All
"Oh, I know. The tenth edition of the textbook, the latest one, says it can drop by 3.9-6.1mmol/L per hour." Luo Hao smiled slightly.

The ICU resident was stunned.

What does Professor Luo mean? He can tell you in detail the contents of the tenth edition of the textbook, which was only published in July 24.

The ICU hospital manager just felt a trace of disdain in his heart, but it was nothingness.

It comes quickly and goes even faster.

"Professor Luo, have you also read the tenth edition of "Internal Medicine"? "The ICU resident manager asked in a low voice.

"I scanned it once and it's generally OK, but there are some minor issues."

"!!!" The ICU resident felt that his ears were not working well. What did Professor Luo just say?
There is a small question. The subject is the tenth edition of "Internal Medicine"?
That's a textbook, a textbook!!

The ICU resident manager was yelling at the top of his lungs in his heart, and his silence was deafening.

No matter what you say at this time, it would be inappropriate. Professor Luo can say that there is a problem with the textbook, but can you say it yourself?

The hospital boss wouldn't dare.

"Well, it's better to have no books than to believe in them blindly. Textbooks are also compiled by teachers. Knowledge is always being updated and iterated. You can't believe them all." Luo Hao said with a smile when he saw the expression of the ICU resident manager.

"Well, for example?" Seeing Luo Hao so confident, the ICU manager asked in a low voice.

"For example, for patients with ketoacidosis, the recommended hourly blood sugar lowering rate should be changed from 3.9-6.1mmol/L per hour to 2.8-4.2mmol/L per hour; the indication for alkali supplementation has been changed to pH < 6.9."

The Icu boss immediately became unwilling, but then she thought of a possibility.

"Professor Luo, are the values ​​you mentioned mentioned in last year's guidelines?"

"Yes, there is a contradiction between the guidelines and the textbooks. Who do students listen to when they go to the clinic? The patient's family members complained with the textbooks, and you said that the disease was treated according to the guidelines? The patient's family members complained with the guidelines, and you said that the disease was treated according to the textbooks?"

"Isn't this inappropriate?"

Luo Hao's two questions made the ICU boss break out in a cold sweat.

This kind of thing either doesn't happen, or it's a big deal if it happens. Who can guarantee that they will have such good luck all their lives?
She immediately picked up her phone and started searching for the nearest guide.

Sure enough, just as Luo Hao said, the values ​​in the guide are different from those in the textbook.

The ICU resident manager looked solemn, holding a book and a cell phone in his hand as he walked to Luo Hao.

"Professor Luo, which value do you think is more reliable?" She asked in a low voice, as if it was a big secret that could not be heard by anyone.

"Guidelines." Luo Hao answered without hesitation. "Changes to guidelines require meetings and repeated discussions with actual cases. They are more trustworthy."

"Okay." The ICU manager immediately changed the doctor's orders and slowed down the blood sugar lowering rate first.

After making the modification, she watched the nurse adjust the speed of the micro pump, hesitated for a moment, and came to Luo Hao again.

"Professor Luo, the tenth edition of the textbook has just been published. Have you really read it?"

"I won't say anything more. I didn't look at it carefully and just scanned it." Luo Hao smiled.

"Then, then, what else is wrong?" the ICU resident doctor asked stutteringly.

"It's not wrong, it's worth discussing, and the answer may be controversial. After all, the people who compile textbooks are all top experts, and the bosses may have their own ideas." Luo Hao corrected.

"Uh~~~" The ICU resident manager was stunned.

"After working with some book editors, I found that even the best books are written by people, and each person is responsible for a part of the book. It is not easy to unify the quality of chapters, and authoritative books contain many small errors."

"..."

The ICU hospital manager didn't know how to respond to Professor Luo Haoluo's words.

It seems like no matter how I connect it, it’s not right.

Questioning the textbook? I love my teacher, but I love the truth more?

Professor Luo said it, but I can't say it myself. Not to mention saying it, even hearing one sentence, the ICU resident manager felt his ears itchy and his whole body uncomfortable.

"For example, the maximum repolarization potential of the sinus node is -65mv, and the hemoglobin concentration in men is 130-175g/L, and in women it is 115-150g/L. There are some problems with the values ​​here."

The ICU hospital manager looked confused, and then thought that this sentence was a bit vague, and maybe Professor Luo himself didn't remember it.

This should be!
She was thinking about something, but she couldn't hide it on her face, and everything she didn't say showed up.

Luo Hao smiled after seeing this, and did not explain what he had said before. Instead, he continued, "Page 737 Pioglitazone 15-30mg/d. But according to the instructions, the maximum dose can be 45mg/d."

"!!!"

The ICU resident manager immediately picked up the textbook and turned to page 737. He was shocked to see that the content written on it was exactly the same as what Professor Luo said.

As for the instructions for pioglitazone, she knew them.

There is indeed a problem.

"But dosage is something that still depends on clinical experience. In the past, Boss Zhou said that you can ignore the dosage in the instructions and use it every day without a limit."

"!!!"

"But I don't dare now. The patient's family will take the medical prescription and instructions to sue you, and they will win every time. What's wrong if the phlegm cannot be dissolved? Just take your time." Luo Hao rarely complained.

"Professor Luo, is there anything else?" The ICU resident manager was in a trance.

"There is a typo in the table on page 686 - de Quervian thyroiditis should be de Quervain thyroiditis."

"???"

The resident boss turned to page 686 of the textbook again.

What catches my eye is a spelling mistake.

"Professor Luo, there are so many mistakes." The ICU resident manager was dumbfounded.

The sacred textbook seemed to become less sacred. It took less than 10 minutes to go from a milky white glow to an ordinary book.

"Well, it's normal for bosses to make some small mistakes occasionally." Luo Hao smiled, but did not say that the boss would never review it. They were all written by his capable disciples, and then used the boss's name.

"..."

"It is better to have no books than to believe in them completely. This is probably the truth."

"But this is a textbook." The ICU resident manager was a little anxious.

What happened before her eyes overturned her three views.

"Boss, have you compared the differences between the first edition and the tenth edition of the textbook?" Luo Hao asked.

The ICU resident manager shook his head blankly.

"The difference is quite big. You wouldn't even believe that some of the content would be written this way in the first edition of the textbook," Luo Hao explained.

Then Luo Hao gave three examples.

No more, no less, just three.

The ICU hospital manager was completely confused. Are the textbooks so disregarding of human life?
"There's nothing we can do about it due to the limitations of the times. For example, when radium was first discovered, women noticed that Marie Curie's hands turned white and thought that radium had the ability to whiten the skin. As a result, some whitening and skin care products containing radioactive elements were developed."

"!!!"

"On the contrary, it is those unethical counterfeiters who only care about money and not life. Those merchants who really put radium in their products have caused countless harm to users. Why? It's not the limitation of the times."

Luo Hao explained with a smile.

"Professor Luo, is what you said true?"

"Yes, let me show you a photo." Luo Hao took out his mobile phone and started searching.

Each photo has a number and a name. The ICU resident manager didn't want to see more of Luo Hao's privacy, so he turned his head away.

"Be careful when you look at it, don't get startled."

"Ah?" The ICU resident manager was stunned.

Turning around, Luo Hao saw a glowing cadaver teacher on his phone.

"Look, this is not a cadaver, it's a specimen, sealed with a special material containing lead." Luo Hao handed the phone to the ICU resident manager, "A senior of mine who went to study in the United States sent it to the group."

The ICU resident manager stared at the glowing cadaver teacher with his eyes wide open.

How many radioactive elements are there in this? !

"It is said that the deceased lived in the 1950s and 1960s. At that time, there was a magical water that could prolong life. It is just like the health supplements sold now. But the scammers around us who use eggs to deceive old men and women are selling health supplements made of flour."

"What about this?" The ICU resident manager seemed to have guessed the conclusion, but she still asked Luo Hao.

"They really put a lot of radioactive elements in it. It is said that the deceased was a billionaire."

"!!!"

"So, you should question what others say and think more about it. Many new technologies need to be constantly refined, and you need to pay attention to the long-term efficacy."

"Luo Hao, just chat if you want to, why talk about values? Don't you think you sound too daddy-like when you talk like that?" Chen Yong's voice came from behind.

"It's not about values, I just said it casually." Luo Hao didn't care, turned around and smiled, "Is there anything wrong with you?"

"Old Meng sent Xiaozhuang home. Otherwise it would have to be Zhuzi. He is good at coaxing people, providing emotional value, and healing psychological trauma! Xiaozhuang has felt much better after playing with Zhuzi for a while." Chen Yong said proudly.

It was as if bamboo was still his spiritual pet.

"I'm glad Xiaozhuang is okay." Luo Hao thought about it, "Remind me next time not to let Xiaozhuang do this kind of work."

"Huh?" Chen Yong raised his eyebrows.

"Although everyone goes through this, for example, what are the ICU nurses best at?" Luo Hao asked.

The ICU resident manager pricked up his ears. Was he turning over?
There are more than 20 patients in the department, and almost none of them can turn over on their own and have to rely on nurses to move them.

Young nurses will develop lumbar disc herniation after working for 2-3 years.

The ICU is a place that is extremely age-sensitive, and the head nurses have even started to try to recruit male nurses into the hospital.

Boys are more resistant.

"What is it? Wiping your butt?" Chen Yong asked.

“???” The ICU manager was startled and immediately remembered... She felt ashamed that she was the manager of the ICU, but she was not as familiar with them as Professor Luo and Doctor Chen.

The main thing is that the job of cleaning up one's ass was automatically blocked by the ICU inpatient manager.

"Of course, if you want to avoid bedsores, turning over is necessary, but wiping the buttocks is the most important thing. You have to wipe it with the right amount of force and wipe it clean. There are many ways to do it." Luo Hao said.

What Luo Hao and Chen Yong meant by wiping one's ass was the literal meaning, not the extended meaning.

"Medical work itself is not a clean job. Xiaozhuang is so pitiful." Chen Yong was a little divided.

On the one hand, he thinks that if you are afraid of dirt, you shouldn't work in the medical field. On the other hand, he can't help but start to feel sympathy for women.

"Don't think too much. New soldiers will pee when they hear the sound of gunfire. It will be fine once they become veterans."

"Is this how you treat your doctors?" Chen Yong asked with a smile. "Oh, have you finished writing the medical records?" Luo Hao asked.

"It's just Lao Meng who provides you with emotional values ​​every day. What's there to write about?" Chen Yong said disdainfully, "Let me see the patient."

"Oh? Then let me ask you something."

"Ok?"

Luo Hao stood up, took another look at the patient's vital signs, checked the time again, and confirmed the urine volume.

Everything looks like that of a patient with obsessive-compulsive disorder.

"Luo Hao, your illness is getting worse." Chen Yong said with pretended concern.

"The amount of urine has begun to decrease. I guess there will be no urine tomorrow." Luo Hao sighed, "This is the result of you inducing vomiting early in the morning. If you had fed him one less spoonful of shit soup, I guess we could have given up on rescuing the patient now."

The words should be good, but they sound a bit unpleasant.

Chen Yong thought carefully about Luo Hao's words that if he fed him one less spoonful of dung soup, he felt that he was playing tricks on him.

Luo Hao walked to the computer, found a medical record at random, clicked on the doctor's order and took a look.

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"Here, take a look at the doctor's instructions and tell me what you would do if you were a family member of the patient and wanted to find fault."

Luo Hao's words made the ICU manager's scalp tingle.

A simulation exercise?
Professor Luo, are you kidding?

Chen Yong seemed to sense the challenge, pulled up a chair, sat down, and began to search carefully.

A few minutes later, various mistakes were pointed out by Chen Yong, which made the ICU resident manager sweat profusely.

You are here to see the patients, not even for a consultation. The ICU resident manager really wants to kick these two out.

These two bastards are here to cause trouble!
Fortunately, Luo Hao is not the director of the Medical Department. If Director Feng was promoted to the position of deputy dean and Luo Hao took over as director of the Medical Department, the end of clinical doctors would be here.

"Huh? You can see so many problems?" Luo Hao was a little surprised.

"You have to give lectures whenever you want. I can tell what's wrong with you just by looking at you."

Luo Hao scratched his head and sighed.

"Why are you sighing? Did I say something wrong?"

"That's right, but that's not what I want to talk about." Luo Hao said, "Look, the patient is taking penicillin for symptomatic anti-inflammatory treatment, and there is a skin test. I wanted to ask you about that."

"!!!"

"!!!"

Isn't it normal to do skin tests when using penicillin and cephalexin?
Luo Hao took a careful look at the doctor's instructions, which were so sloppy that he felt helpless.

But that's just nitpicking analysis, it's not our own medical team, so it doesn't matter, as long as the patient gets better.

Luo Hao didn't say much, and he lost interest in testing Chen Yong, so he started talking, "The 'Guidelines for Skin Testing of β-lactam Antimicrobial Drugs, 2021 Edition' states that cephalosporins only require skin testing in specific circumstances."

"Well, no need for skin tests?" Chen Yong was surprised. "I saw our patients still undergo skin tests, and I didn't hear you say anything."

"Yes, after so many years of skin tests, patients all know that they need to do skin tests. Can a guideline withstand the fixed ideas of so many patients?"

Chen Yong thought about it and roughly understood what Luo Hao meant.

Lao Meng's work is meaningful. Even if he does it perfectly and follows the guidelines and guiding principles at every step, he will be criticized if something goes wrong.

As for the institutions that issue the guidelines, they will not pay attention to the petty "petty intrigues" in clinical practice.

"What Lao Meng does is meaningful." Luo Hao said seriously, "The focus of medical care is to cure diseases, and the focus of doctors is to make money, not to avoid accidents."

"So vulgar."

"We are all laymen. Doesn't your master also buy stocks?"

Chen Yong curled his lips, and it was obvious that he was somewhat dissatisfied with the master who had money to cover his position but no money to fix his teeth.

"It's best if nothing happens. Old Meng has put all his energy into this. Even if there is emotional value, it is for the patients and their families. Think about it, if nothing happens, who would want to cause trouble for the doctors and nurses? Those who want to cause trouble were screened out by Director Shen at the beginning."

"It's no use talking too much, it's all nonsense. You're accusing me of instilling values..."

[As the saying goes, a man is a boy until he dies~~~]

"Hello, Professor Li."

"Okay, I'm going out right now."

Luo Hao hung up the phone, turned around and took a look at the patient's vital signs on the ECG monitor and the urine in the urine bag. After making an estimate, he put on his clothes and went out.

"Professor Li, what's the matter?" Luo Hao asked as he went out.

"Xiao Luo, this way." Professor Li pulled Luo Hao's clothes and wanted to go to the fire escape.

Luo Hao smiled and said, "It's okay, just speak softly."

"Emmmm." Professor Li hesitated, but when he saw that the fire escape was also filled with patients' families sleeping on the floor and it was inconvenient to talk there, he nodded.

"Doctor in the ICU, I want to give you a red envelope. What do you think is a convenient way, Xiao Luo?"

"Red envelope? No thanks." Luo Hao said calmly.

The sound was not loud, and only he, Professor Li, and Chen Yong behind him could hear it.

"I know... I know..." Professor Li said helplessly, rubbing his hands.

As for what he knew, Professor Li did not say.

"It's like this. The hospital isn't the kind of place where they forget who gave and who didn't. They remember everything clearly." Luo Hao smiled.

"Really?"

"Let me put it this way, Professor Li, do you know what kind of red envelope is the easiest to give out?"

Professor Li shook his head.

"I have never treated a patient with paraquat poisoning. I'll give you a phone number and help you contact a certain professor or expert at the hospital next door. When you go there, you can give them a big red envelope. This kind of thing can usually be delivered."

"Favor?"

"Yes, I will accept this kind of thing calmly. After all, I am still here. Accepting a red envelope is a recognition of me, not a recognition of you, the patient's family member."

What Luo Hao said was a bit confusing, but Professor Li understood it immediately.

"Now, first of all, I'm watching from inside, so they can't intervene. Secondly, if you send them off, you won't have a chance either." Luo Hao smiled, "Forget it, don't worry, I'm here."

Looking at Professor Li's expression, Luo Hao raised his eyebrows and said, "Well, next time I need a supercomputer, you can help me again."

"Okay!" Professor Li agreed without hesitation.

Although it is not difficult to apply for supercomputing at the University of Science and Technology, you still have to queue up. If you want to jump the queue, you need to scan your face, which is a big favor.

"Then you should rest early if you are fine. Go home and sleep. Don't stay at the door. Leave someone here for emergencies." Luo Hao advised, "The acute period lasts for 2 weeks. A lot of people are here every day. They can't bear it."

Professor Li nodded and didn't say anything polite.

Luo Hao has made a request, so we should resolve it as quickly as possible in the future. There is no need to waste time on it.

Back at the ICU, Chen Yong asked, "Luo Hao, you don't accept red envelopes at Union Hospital? That's impossible. I heard from my master that when he went to the capital for further studies, the teacher sometimes asked them to accept red envelopes as subsidies."

“It’s not that the doctor doesn’t want to accept the patient, but he just doesn’t have the opportunity.

Our hospital has very standardized management procedures in this regard.

First of all, once hospitalized, patients cannot leave the ward. The attending physician can only see them during morning and evening rounds. A large group of people appear together. The doctor's office in the inpatient area is a large room with a large group of doctors busy inside. There are too many people and it is difficult to send them away."

That’s right, Chen Yong nodded.

"The ward is a three-person room. The doctor's preoperative talk is usually done by the assistant, just like in my family, it's Lao Meng who does the preoperative instructions. I basically don't do it.

The surgeon in charge, the patient should not be able to see it.

The interview room is outside the ward, a large room with many patients and their families, like waiting chairs at a train station, and several cameras on the roof. Generally, the experts are a team, and to be honest, you don’t know who will perform the surgery on you after you make an appointment with the expert. ”

“So, I can’t send it even if I want to.”

"Besides, who among the experts at Union Medical College can live on that little red envelope money, don't you think?"

"Wen Youren will take it, did you know that?" Chen Yong suddenly put on a mysterious and gossipy attitude, "Our hospital charges 2000 yuan, and ordinary patients charge 3 to 5000 yuan. If you don't give a red envelope, we won't schedule the surgery."

"I know, so I've always wanted to deal with him." Luo Hao said frankly, "Too many people complained about him, which made me very annoyed at the time."

"Have you always been using public resources for personal gain?"

"Can you change the wording to something like 'carrying justice on behalf of heaven'?"

"Hahaha, you are busy, I'm going to see Lao Liu." Chen Yong turned around, changed his clothes and left, waving his hand before leaving.

Luo Hao really didn't expect that Chen Yong would be so obsessed with a relationship that he would rather give up the entire forest for a tree.

Back in the ICU, Luo Hao continued to sit next to the patient, holding his mobile phone in his hand, browsing the paper journals, and occasionally looking up at the ECG monitor and urine bag.

Urine volume is the best indicator of kidney function.

Blood was drawn for testing at 5 a.m., and the patient's indicators all collapsed.

Although there are factors such as prior vomiting induction, and the fact that paraquat has expired and is ineffective, it is still paraquat after all.

What is coming will always come.

Luo Hao was not in a hurry, as this was all within his expectations.

Early in the morning, Luo Hao and Senior Brother Che from Qilu "reported" the results of the emergency tests. Senior Brother Che gave treatment advice and told Luo Hao about the corresponding responses.

Luo Hao was naturally talented, and he understood immediately what Senior Brother Che meant.

Whether it is liver failure or kidney failure, corresponding symptomatic treatment has been given, and medication is given for pulmonary fibrosis.

Time passes day by day.

three days later.

"Is Xiao Luo still busy?" Shen Zizai asked as he stood at the door of the office.

"It's said that the patient will be fine soon. The acute stage of organ failure is almost over and he should be able to survive." Chen Yong stood up, bent his waist slightly, took off his mask, and carefully "reported" the situation on Luo Hao's side.

Shen Zizai glanced at Chen Yong.

He clearly remembered how unruly Chen Yong was when he first came.

Unexpectedly, before a year had passed, he had already learned to provide emotional value for himself.

But the emotional value was too heavy, and Shen Zizai said he couldn't bear it.

(End of this chapter)