Chapter 294 The Doctor's Helplessness, Dr. Pang Survived a Crisis
"Well, very good! In addition to controlling blood sugar, what other treatment measures do you think this patient should take?" Zhang Bihua was very satisfied with Zhou Can's answer.
Then test him.
"Although the patient's condition has improved, there is still a possibility of rebound. We should continue to replenish fluids, correct dehydration, and continue to supplement with small doses of insulin intravenously to try to correct the patient's electrolyte disorder. If the patient's pituitary lesions insist on refusing chemotherapy, surgery may be the only solution."
After thinking for a long time, Zhou Can felt that if the patient's pituitary disease was not treated effectively and only diabetes was treated, it would definitely not be cured.
Diabetes insipidus and amenorrhea are both caused by pituitary diseases.
If these two issues are left unchecked, the patient's treatment will be half-hearted.
Because actively controlling the patient's diabetic hyperosmolar coma and ketoacidosis can only save the patient's life.
"I will try to persuade the family members when the time comes." Director Zhang Bihua probably won't be able to persuade the family members, so they have to consider the worst possible outcome.
…
When it was almost time to get off work, Zhou Can received news that the results of the patient's thalamus-pituitary axis function tests were out, with ACTH at 18.1pg/ml, significantly lower than the normal value of 46pg/ml.
Hemoglobin F16.12ug/ml, which is within the normal range.
E2 167.59pmol/L, T1.0nmol/L……
After reviewing the patient's series of evaluation results, it has been confirmed that central amenorrhea is caused by pituitary lesions.
Now we hope that Director Zhang Bihua can persuade the family to accept radiotherapy.
When I got off work in the evening, the family still refused to accept radiotherapy and their attitude was firm.
Zhou Can was helpless about this.
The cause of the disease has been found out, but the family members refuse to treat it, which makes the doctor feel frustrated.
Xinxiang Maternity and Child Health Hospital also seemed to want to publicize this case as a typical example, and specially sent people to do ideological work for the family members and patients.
The pregnant woman in the emergency room finally survived the most dangerous first six hours.
After get off work, Director Zhang rushed to the emergency room to check on the pregnant woman's condition.
After checking it out, she was very satisfied with the work of the crisis management team.
"It was not easy to save this pregnant woman from death. Thank you for your hard work."
Director Zhang affirmed their work.
"Director Zhang, I want to stay on duty tonight."
Some of the medical staff at Xinxiang Maternity and Child Health Hospital neglected their duties, which made it difficult for Zhou Can to feel at ease.
He volunteered to stay in the hospital's duty room at night so that any emergencies could be easily rescued.
Director Zhang was stunned for a moment, then glanced at the medical staff of Xinxiang Women and Children's Hospital with a look of realization. Whether it was the doctors or nurses in the emergency room, they were laughing and joking at work, which made her frown.
However, she only came here temporarily to see patients for a few days, so she was just a guest.
It’s naturally difficult to meddle in other people’s family affairs.
This pregnant woman was finally rescued and handed over to the medical staff of Xinxiang Maternity and Child Health Hospital for care. There are indeed many unstable factors.
However, Zhou Can was a general, and staying on night shift at night, even though he only had to take care of one patient, was still very tiring. If he didn't get enough rest at night, his work status tomorrow would certainly be greatly affected.
"Although Dr. Zhou is the deputy leader of our crisis management team, he actually takes on the work of the leader. If he is left alone on the night shift, it will definitely affect his work the next day. I am willing to stay and take turns on duty with Dr. Zhou."
Ji You took the initiative to step forward at this time.
Doctors and nurses working together is the most efficient solution.
"Okay! If there are two people on night duty, the situation will be much better. I'll talk to Chief Tang and get you a special duty room. I guess other doctors in our hospital will be able to use it in the future."
Director Zhang said this, obviously knowing that the medical staff of Xinxiang Maternity and Child Health Hospital are unreliable.
It's easy to talk to such an "old hand".
After talking to Section Chief Tang, they temporarily vacated a small room for them not far from the emergency room. This was a small room for bedding and sheets. After a little cleaning, they put in a simple folding bed, a small wooden table, and a chair.
A simple temporary duty room was set up.
"Doctor Zhou, the conditions are a little shabby. Please forgive me and make do with it."
Section Chief Tang said to Zhou Can apologetically with a smile.
"It's already very good to have a place to lie down and sleep at night. We are the ones who have caused trouble to your hospital."
Although Zhou Can is a rich second-generation, he is not arrogant.
He is not particular about food, clothing and housing.
He can eat a high-end meal that costs 10,000 yuan, or a box lunch that costs 10 yuan. As for the living environment, as long as it is not noisy and has a bed, that is enough.
"Thank you for your understanding, Dr. Zhou! If you need anything, you can always tell me." Director Tang pulled out a business card like a magic trick. "This is my business card. If you need anything, you can call me directly."
Anyone can see that Section Chief Tang's attitude towards Zhou Can is very unusual.
Not only polite, but also extremely enthusiastic.
Director Zhang and others saw this, but they didn't think much about it. Because Zhou Can did perform very well, and he had a high hidden status in Section Chief Tang's mind, which was normal.
Whether it was rescuing the sick child or the pregnant woman, Zhou Can was the main force and the most important contributor.
Although the top management of Xinxiang Maternal and Child Health Hospital didn't say it, they must have looked up to Zhou Can in their hearts.
…
After dinner, Zhou Can prepared to go back to the hotel to take a shower and pick up a medical book.
When on duty at night, you must stay by the pregnant woman's bed.
You don't have to stare at the monitoring equipment all the time, just take a look at it occasionally, because as long as the monitoring equipment detects a major change in the patient's vital signs, it will sound an alarm.
In addition, Zhou Can needs to personally perform intravenous drip dressing changes, ventilator parameter adjustments, etc.
As a result, his cell phone rang before he even walked out of the hospital.
I saw that the number was an unfamiliar mobile phone number.
"Hello, who are you?"
Zhou Can answered the call.
"Doctor Zhou, Doctor Zhou, this is Doctor Pang! The patient's blood oxygen level has suddenly dropped, please come over quickly."
There was a hint of nervousness and panic in Doctor Pang's voice.
After all, he is an attending physician and has experience working in the intensive care unit. How could he be so scared by the sudden drop in blood oxygen?
Zhou Can quickly turned around and rushed to the emergency room, but he was secretly thinking in his heart.
Doctor Pang's professional level is not bad. There are only two possibilities for her to be so scared. Either she neglected her duty and something went wrong, or she took measures after the patient's blood oxygen level dropped, but they were ineffective.
Rushing into the emergency room, Zhou Can saw Dr. Pang and nurse Chen Qingling rescuing the patient.
Three doctors and nurses from Xinxiang Maternity and Child Health Hospital were standing nearby and watching.
"Wasn't he fine when I went to eat? Why did the patient's blood oxygen suddenly drop so much?"
Zhou Can calmly observed the patient's vital signs and found that his blood pressure had not dropped significantly.
This shows that the situation is not as bad as imagined.
The patient's breathing was short and heavy, and his face was cyanotic.
Diffuse infiltration shadows were detected in both of her lungs after fat embolism, and her lung function was definitely not as good as that of normal people.
But after being put on a ventilator, his condition has stabilized.
It suddenly got worse, what happened?
In order to save the pregnant woman, Zhou Can has been guarding her with his men for a whole day.
Never want to fail at the last moment.
"I went out to the toilet, and when I came back I found that the patient's blood oxygen index was dropping." Chen Qingling replied.
Patient care in the intensive care unit is often provided by one nurse on a one-to-one basis and one doctor on a three-to-one basis.
What does it mean?
That means there is at least one nurse providing one-on-one care for each bed. A doctor can be in charge of up to three beds at a time.
In fact, it would be most appropriate for this pregnant woman to be sent to the intensive care unit. However, out of consideration for the patient's family's financial conditions and the fact that the pregnant woman has not yet passed the critical period, Zhou Can worked so hard to provide high-quality four-to-one service.
There are five medical staff in the crisis management team, and Deputy Director Shi is just a sign holder.
The only people who actually worked were Zhou Can, Doctor Pang, and two nurses.
Because Zhou Can and Ji You have to work the night shift tonight, Dr. Pang and Chen Qingling will be on duty temporarily.
People have urgent needs. Chen Qingling went to the toilet while on duty, and no one could say anything to her.
Doctor Pang was the only one present when the incident happened.
Zhou Can looked at Doctor Pang.
"I was at the bedside the whole time. The patient's blood oxygen index dropped. I immediately took a series of emergency measures after I noticed it."
Her eyes were somewhat evasive.
Obviously not telling the truth.
Doctor Pang was dissatisfied with Zhou Can being the deputy team leader, but now he was so lazy at work. Zhou Can was immediately a little angry.
"You called me as soon as you noticed the blood oxygen index was dropping. How could the patient's blood oxygen saturation drop below 70%?" Zhou Can's voice was filled with anger.
A nurse from Xinxiang Women's and Children's Hospital nearby whispered, "I see she seems to be on the phone all the time!"
Seeing that he could not argue any further, Doctor Pang had to tell the truth.
"Just now I was guarding the bedside when my family called. My mother had been bedridden, and I was a little worried, so I chatted with her for a while. At that time, I was probably focused on chatting with my mother, and the pregnant woman had not been in any danger all day, so I did let my guard down. When nurse Chen Qingling came back from the toilet, she found that the patient's blood oxygen saturation had dropped to 85%, and the instrument was alarming, so she quickly called me."
Doctor Pang knew he was in the wrong, but his attitude was still pretty good.
Now is not the time to blame anyone. The most important thing is to find out the problem and rescue the patient.
"How long did it take from the time you discovered the patient's blood oxygen alarm to the time you called me?"
"It was probably less than five minutes later. Doctor Pang took some emergency measures but there was no improvement. Instead, the blood oxygen level dropped even faster, so she called you immediately."
Chen Qingling said from the side.
"In just a few minutes, the blood oxygen level dropped so much. What emergency measures did you take?"
While Zhou Can was looking for the cause, he asked Dr. Pang.
"I increased the oxygen concentration and the oxygen flow rate..."
Doctor Pang repeated his rescue measures.
Zhou Can had already suspected that there was something wrong with Dr. Pang's rescue measures. After listening to him, he carefully checked the ventilator parameters and suddenly realized what was going on.
Quickly try to reduce nebulization and adjust several parameters of the ventilator.
Then I checked again to see if there was any problem with the patient's intubation.
The blood oxygen saturation, which had been dropping rapidly, slowly stabilized and then began to rise again little by little.
About twenty minutes later, the patient's blood oxygen saturation rose to over 95% and the alarm was lifted.
The pregnant woman's originally cyanotic complexion also returned to normal.
There was just a little bit of cyanosis on the fingertips.
Doctor Pang seemed to have survived a life-or-death crisis. She heaved a long sigh of relief, and her originally gloomy and tense face finally regained color. A hint of joy at surviving a disaster appeared on her face, and the fear in her eyes disappeared.
If something had happened to the pregnant woman just now, Dr. Pang would probably have to bear some responsibility.
Given the strict approach of Tuya Hospital to medical safety, her future was basically ruined. If she could continue to stay in Tuya Hospital and work as a chief physician until retirement, she would be very lucky.
"Doctor Zhou, why can the patient's blood oxygen saturation be stabilized and then rise again just by adjusting the ventilator parameters?"
Dr. Pang, an attending physician, used a respectful title for the first time to address Zhou Can, a resident intern.
It was both out of gratitude and heartfelt admiration for Zhou Can's abilities.
"From the beginning, your rush to increase the oxygen concentration and flow was not right. More haste, less speed, have you heard of that? In the future, when Dr. Pang treats such patients, it is best to consider the patient's condition. Then, you saw that increasing the oxygen concentration and flow did not work, and blindly gave the patient nebulization inhalation, which made the situation even worse for the patient."
"The specific principle is that her respiratory tract is already flooded, and if you create a wave of artificial heavy rain, won't it block her respiratory tract?"
Zhou Can did not hide his knowledge, but patiently explained the principles to Dr. Pang.
She may understand these principles, or she may only have a vague understanding of them.
Because she was busy making the phone call at the time, she didn't notice until the patient's blood oxygen level dropped to 85%. Instinctively, she must have been extremely panicked.
When people are anxious or panicky, they can easily lose their sense of proportion and make wrong decisions.
When one is seriously ill, one will try any possible means. This applies not only to patients, but also to doctors.
After listening to Zhou Can's explanation, Dr. Pang carefully comprehended and deduced the pathological and physiological mechanisms. After seven or eight minutes, he suddenly realized it.
"I see... Oh my, it's all my fault for being so anxious! I almost made a big mistake."
After she understood the pathological mechanism, she slapped her forehead repeatedly.
"Thank you Dr. Zhou for your advice, thank you!"
This time, she thanked Zhou Can with submission and gratitude from the bottom of her heart.
This made Zhou Can feel a little embarrassed to punish her. He had originally considered reporting the matter to Director Zhang and giving her a severe lesson. She was not young anymore, middle-aged, and had a bedridden mother at home.
It would seem a bit cruel if her job was really taken away from her.
"You don't have to thank me. Safety is the most important thing in medical work. Just because we were able to save the patient this time doesn't mean we'll be so lucky the next time an accident happens. I sincerely hope that Dr. Pang can cherish his job as a doctor. Patients entrust their lives to us. What kind of trust is this? Don't you think so?"
Zhou Can didn't say anything harsh, he just criticized her a few times.
