Chapter 475: One sentence to untie the patient's knot, and take the dead patient
It just so happens that I have to help out in the cardiothoracic surgery department every day. When I meet Director Xueyan later, I can ask her about the postgraduate entrance examination.
After finishing his rounds in the emergency room, Zhou Can went to the hospital cafeteria to eat and then hurried to the cardiothoracic surgery department.
Recently, he always felt that someone seemed to be following him secretly. For Su Qianqian's safety, Zhou Can asked her not to come to the hospital to deliver meals. If time permits, he will go home and eat with her.
When we arrived at the cardiothoracic surgery department, we saw a busy scene.
Zhou Can's suggestion to publicize the diagnosis and treatment achievements has achieved a good publicity effect, even better than he expected.
Since a large number of experts and key nurses were poached from the Department of Cardiothoracic Surgery, people in the department have been in a state of panic, and everyone is worried that the department's business will plummet. As a result, in the past half month, the number of outpatient and emergency cases has increased instead of decreased. And it continues to rise. Among the cases of cardiothoracic surgery that are received every day, some difficult cases are gradually increasing.
There are even patients transferred from other hospitals.
"Doctor Zhou is here, that's great! There's a patient over there who says he has chest pain and difficulty breathing. Can you help take a look?"
A female nurse at the nurses' station was so happy to see Zhou Can coming that she felt like she had seen a savior.
"Inpatient or newcomer?"
Zhou Can asked.
It is now past closing time, and the patients are either outpatients or transferred from the emergency room.
Patients admitted to the outpatient clinic will generally be admitted to the hospital after examination as long as there are beds available.
"The emergency department just notified our department of the patient who was brought in. After the intern Xiao Wang brought the patient in, his superior doctor was still in the operating room with Director Xue performing the operation. I heard that something went wrong during the operation and it was not known when he would be able to be released. The two doctors on duty in the department did not dare to take this patient."
The female nurse's surname is Luo. I heard that she will be promoted to head nurse this year.
She has a certain status in the cardiothoracic surgery department, and her status has obviously risen a lot, especially after three head nurses were poached.
Just look at the fact that she directly calls the intern "Xiao Wang" and you will understand that she is very confident in her status.
"Where is the patient?"
Zhou Can heard that the body was fished out from the emergency room and judged that it was possible that no examination had been done yet.
After the emergency department closes, if they receive a patient with chest pain, they will usually notify the doctor in the specialist department to take the patient away, because the emergency department does not have the ability to handle such patients.
If something goes wrong, it will be a huge trouble.
The fact that the patient was sent to the cardiothoracic surgery department means that the emergency doctor, after a preliminary understanding of the patient's condition, determined that the patient was likely to require surgical treatment.
Some novice doctors try to save time and push any patient with similar chest pain to the cardiothoracic surgery department.
Because internal medicine has two sub-departments: thoracic medicine and cardiology.
"That's the gentleman!"
Nurse Luo took Zhou Can to a flat bed not far away. The patient was lying on the flat bed, holding his chest, with his eyes staring at the ceiling. His breathing was very heavy, like a bellows.
There were two women standing next to the cart, one old and one young.
The older woman's face was covered with tears as she looked at the patient sadly.
The young woman was about 21 or 22 years old, and she was dressed very innocently, like a fresh graduate or a student. Judging from her appearance, she should be the daughter of the older woman.
In terms of face shape and facial features, the mother and daughter are quite similar.
"Where does your chest hurt?"
Zhou Can asked the patient directly.
Because this person's eyes are hollow and a little indifferent, it looks scary. Sometimes when someone has lost too much blood and is about to go into shock, this kind of look is most likely to appear.
The patient ignored him.
The mother and daughter next to them were worried about offending the doctor, so the older woman quickly said, "Son, where does it hurt? Tell me quickly! Do you want to drive me crazy?"
The patient's mother was really anxious and tears kept flowing.
"My brother just said that his chest hurt a lot and it seemed like he had difficulty breathing, which was really scary. I was at work when my mom called me, so I rushed over and took him to the hospital with her."
The young woman told everything she knew.
"How did it happen?"
Zhou Can examined the patient while questioning the family members.
"He is my son, 28 years old this year. Not long ago, when I was having dinner at home, I saw that other children of this age had already married, but he has never found a girlfriend. He also sleeps at home during the day and goes out at night. I don't know if he is working, so I complained to him. Then he roared twice, and suddenly fell to the ground with his hands on his chest and screamed. Not long ago, he coughed up blood, which scared me. I only have this one son. If something happens to him, how can I live?"
The patient's mother blamed herself more and more as she spoke, and looked at her son with tears in her eyes.
Chest pain, difficulty breathing, and coughing up blood are the symptoms Zhou Can has learned about so far.
When examining the patient, Zhou Can tested the tenderness response.
When pressing the patient's left chest with a little force, the patient's face showed obvious pain, and he coughed and coughed up blood.
There was no obvious tenderness in the right chest.
Moreover, the patient did not say a word from beginning to end, and was indifferent to the doctor's treatment and his mother's crying.
"Has Mr. Luo measured his blood pressure?"
Zhou Can asked the nurse.
Usually, we address such older nurses, especially those who have worked for a long time and have more experience, as Teacher So-and-so. Calling her Nurse Luo directly in front of patients will make them unhappy.
There is also a suspicion of putting others down and elevating oneself.
When dealing with the relationship between doctors and nurses, doctors should be as humble as possible, because doctors have better status, income and prospects than nurses, and if they feel discriminated against, it will seriously affect their work enthusiasm.
Many diagnostic and treatment tasks require close cooperation between medical staff and nurses to complete, and the importance of nurses is self-evident.
Patients and their families can look down on nurses and discriminate against this profession, but they absolutely cannot do so to doctors.
Not only should we not discriminate against nurses, we should also care for them in every way.
"Blood pressure 115/79mmhg!"
Normal blood pressure for adults is 90 mmHg to 140 mmHg for systolic pressure and 60 mmHg to 90 mmHg for diastolic pressure. This patient's blood pressure is normal.
Zhou Can breathed a sigh of relief.
Normal blood pressure can generally rule out critical and severe cardiovascular and cerebrovascular diseases.
Chest pain, chest tightness, difficulty breathing, and coughing up blood are very dangerous symptoms.
“Is the blood pressure the same in both arms?”
Out of caution, Zhou Can still conducts some preliminary simple examinations to rule out high-risk factors such as aortic dissection and heart disease.
"The blood pressure on both sides of the body is basically the same!"
Nurse Luo is indeed very capable, as can be seen from these details.
When a novice nurse measures a patient's blood pressure, they usually only measure one side. If the patient has a common disease, there is no problem. However, if the patient has chest pain, an experienced nurse will measure the patient's blood pressure on both sides of the body.
Zhou Can checked the patient's forehead temperature with his hand and found it was normal.
When he was checking the patient's tenderness just now, he was already silently calculating the patient's pulse and respiration.
The pulse rate is about 100 beats per minute. There may be some error, but it will not be too large.
This indicates that the patient's heart rate is normal.
Once again, heart disease was ruled out as a possibility.
The patient's breathing rate is about 40 times per minute.
The normal breathing rate for an adult at rest is about 16-20 times per minute. If it exceeds 24 times per minute, it is considered tachypnea. Obviously, this patient has a breathing problem.
When Zhou Can observed the patient just now, he did not find any obvious yellowing or bleeding of the skin, no enlargement of the superficial lymph nodes throughout the body, and his facial features were regular, with only slight cyanosis of the lips.
This is most likely related to the patient's breathing difficulties, but judging from the degree of cyanosis, the hypoxia is not serious.
Seeing this, Zhou Can felt a little calmer.
This patient will not die for the time being, and the possibility of death without immediate rescue can basically be ruled out.
He further checked the patient's pupils, which were equal in size and round, and reflected light well, which further indicated that the patient was not in danger of death for the time being.
If your pupils are constricted and your light reflex is poor, coupled with chest pain, you should be especially careful.
Such patients are very likely to die.
When a novice intern sees such a patient, it is best to ask a senior doctor to make a judgment immediately. However, for ordinary chest pain patients, senior doctors will not be so careless as to completely let the interns handle it.
Usually they will screen the case first and only hand it over to interns for training if they decide it is not a high-risk, fatal emergency.
"Come, let me see your neck!"
Although the patient looked indifferent and had no reaction to Zhou Can's examination.
Zhou Can still tries his best to establish an initial trusting relationship with the patient. The neck, head, waist, armpits, and private parts of a person are all specific areas, and when they are touched by outsiders, they will instinctively feel repulsive.
Men and women who have been in love will know that if they have a deep relationship with their boyfriend, the woman will enjoy the man's caress. Whether it is a hug, or touching the waist or ordinary private parts, generally they will not reject it.
However, if a strange man pats her on the butt, hugs her, or even just pats her on the shoulder, she will be particularly alert and may even feel disgusted.
After examination, the patient's neck was soft, without resistance, and there was no neck stiffness.
The superficial pulses in the neck were not dilated and the thyroid gland was normal, not enlarged.
Out of caution, Zhou Can checked the patient's heart area again. No obvious bulge was found in the precordial area and the heart border was not large.
"Teacher Luo, can I borrow your stethoscope?"
"Give!"
Nurse Luo happily took off her stethoscope and gave it to Zhou Can.
After taking it, he listened carefully to the patient's heart area. The heart rhythm was regular, the heart sounds were strong, and no murmurs were heard.
It seems that there is no serious problem with the heart.
This is strange. The patient's severe pain in the left chest is not caused by heart disease, so what could be the cause?
Considering the patient's breathing difficulties, his lips were slightly cyanotic.
The patient developed the above symptoms after his mother scolded him for a few words and then yelled at him.
At this time, Zhou Can had begun to seriously suspect that there was something wrong with the patient's lungs.
He pressed the patient's abdomen, which was flat, soft, and non-tender. There was no rebound pain. No lumps or tumors were felt in the liver and spleen area, indicating that the liver and spleen were basically not enlarged.
The patient's limbs were examined and found to have normal muscle strength and joint movement.
Originally, he could have tested the patient's physiological reaction, but due to the patient's non-cooperation, Zhou Can tried his best not to do anything that would stimulate the patient.
"Doctor, is my son's illness serious?"
"He's vomiting blood, so it must be serious. Young people today are under a lot of pressure, so try to be more understanding of your child in the future. When I was diagnosing your son just now, I saw thick calluses on his palms, which means he's not lazy and doesn't work hard as you think. On the contrary, he must be working very hard and it's very hard."
Zhou Can said to the patient's mother.
Sometimes, children only report good news to their parents, but not bad news. Parents can easily make assumptions based on appearances and mistakenly think that something is wrong with their children.
In fact, children may work harder than they think.
"It's my fault, I will correct it in the future." After hearing this, the patient's mother blamed herself even more. "Son, it's all my fault. I shouldn't have said that to you. Get well soon. I'll make you something delicious when you get home."
She held her son's hand and rubbed the thick calluses on his hands.
After Zhou Can's reminder, she realized that her son suffered a lot outside. It was not like what she thought, sleeping during the day and hanging out at night.
"mom……"
The patient gasped, his eyes red, and called for his mother for the first time since he fell ill.
This also meant that his hatred for his mother disappeared, and the mother and son resolved their misunderstanding.
"Hey! My dear son, I have wronged you. Get well soon! I will never nag you again." The patient's mother was very surprised and held her son's hand tightly.
The younger sister next to her was quietly wiping away her tears.
Zhou Can was used to seeing all kinds of touching scenes of family interactions, so his expression did not fluctuate much.
"The patient's chest is symmetrical, no subcutaneous emphysema is found, the left chest is slightly bulging, and the respiratory movement of the left lung is significantly weakened. There is a tympanic sound when percussing the left chest, and the breath sounds of the left lung disappear when auscultating. No dry or wet rales are heard, and the breath sounds of the right lung are normal. I suggest a chest CT scan immediately."
Considering that it is now after get off work, there is usually only one doctor on duty in the CT examination room.
And it is shared by multiple departments.
In addition, the patient's family was dressed rather poorly, and it was obvious that their family was not well off financially.
Another thing is that CT examination takes a long time.
Now we must find out as soon as possible why the patient is coughing up blood.
In order to save the cost of the examination for the patient and shorten the examination time, Zhou Can thought about it and changed words, "Let's do a chest X-ray first! Don't do the CT scan yet."
The patient was prescribed a routine blood test and chest X-ray.
All that remains is to wait for the test results.
Zhou Can entered the office, logged into his personal department account, and then began to look through some difficult cases that Director Xueyan, Director Le and others had pushed to him.
Usually, the diagnosis of difficult cases is often jointly discussed by multiple doctors.
The main purpose is to reduce misdiagnosis and missed diagnosis.
"We have admitted another patient with severe postoperative complications who was transferred from another hospital. The surgery was performed at Xinxiang Hospital. It seems that Xinxiang Hospital has become very strong after a period of recruitment!"
Zhou Can found that the first difficult case that required his consultation was a postoperative patient transferred from Xinxiang Hospital.
This kind of patient is generally called a bad patient.
Tuya is trying to increase its visibility by treating some difficult cases and bad patients, so the threshold for treating such patients is much lower than usual.
This is also the response of Director Xueyan and others to Zhou Can’s high-profile suggestion.
Xinxiang Hospital probably wouldn’t have been able to perform this type of thoracic surgery before, but now it can actually complete sternotomy and reconstruct the chest wall, which shows that its surgical capabilities have improved very rapidly.
This indicates that Xinxiang Hospital already has the surgical capabilities of a large hospital.
"Director Tian is a pragmatic person. After experiencing ups and downs, she was reborn from the ashes. This is obviously much different from the Third Hospital hanging a foreign sign."
Zhou Can has dealt with Director Tian of Xinxiang Hospital twice.
I have a deep impression of this woman.
To be honest, when he was poached by Dean Tian two years ago, he never thought that Xinxiang Hospital would develop to what it is today.
At that time, Xinxiang Hospital was half-dead and was barely surviving.
Although many hospital experts were sent abroad for further studies, Zhou Can thought that was just the way it was. It could not change the overall situation.
No one could have imagined that the woman did not play by the rules and frantically poached people from other compounds.
Moreover, the poaching throughout the department was really ruthless.
This simple and crude approach actually worked.
No wonder even the Third Hospital started to follow suit.
