Chapter 490: Completely Different Fates, Reaching the Threshold of Top-Level Diagnosis
Generally speaking, nine out of ten people who are over 45 and have not been promoted to associate professor are stuck in academics.
In this era where academic qualifications are increasingly valued, even nurses now require a bachelor’s degree as a starting point.
Most of the better nurses have postgraduate degrees.
Even now, many people still look down on nurses, thinking that they can only give injections, change dressings, and do waiter work. That's because most people's impressions are still stuck in the past, when nurses were basically graduates from technical schools.
But so what?
Ambitious nurses have already completed their college education, taken the postgraduate entrance examination, and become the best nurses. The unambitious ones who just want to get by have already retired or changed careers.
The quality of nurses in today's large hospitals is already very high.
Ellie is a rather unique person in Tuya Hospital.
Tuya Hospital wanted to build a general practice department, but it has always remained in the ideal stage and has never been actually implemented.
This has resulted in very few general practitioners in Tuya Hospital.
The only general practitioners who can reach the attending level or above in the entire emergency department are Ellie and Director Lou.
Director Lou is now a deputy senior professional and has become the director of the emergency department. Compared with Ellie, he is a winner in life.
I heard that Director Lou also encountered the same embarrassing situation as Ellie.
You can't digest too much if you bite off more than you can chew!
It sounds cool to master all subjects, but the end result is that you will only know a little bit of each subject.
Just a little bit really.
It is almost impossible to reach a high level of medical skills.
Director Lou realized that if he pursued the path of general practice, he would not be able to obtain the title of associate senior professional in his lifetime. He was eliminated from the powerful departments and entered the emergency department, where his conditions were not particularly good.
But he is much smarter and more far-sighted than Ellie.
Not only did he work hard to get a master's degree after 11 years of work, but he also specialized in respiratory medicine in order to be evaluated for the title of associate senior professional. In the field of respiratory medicine, it should be the easiest to achieve results among many disciplines.
Director Lou works in the emergency department. Rescuing various critically ill patients and ensuring that they can breathe smoothly are top priorities.
Therefore, his specialization in respiratory medicine is very consistent with the nature of his job.
Needless to say, Director Lou was successfully awarded the title of associate senior professional, and he took over like a dark horse after the previous director of the emergency department was transferred.
At that time, when competing for the position of director of the emergency department, it was said that Deputy Director Han and another deputy director who has already retired were the most promising candidates.
No one expected that Director Lou, an unprepossessing junior, would jump out and reap the benefits.
After Director Lou became the director of the emergency department, the deputy director surnamed He fell ill not long after. He must have been angry.
Deputy Director Han is a bit more resolute, but he is definitely hostile to Director Lou.
But how the conflict was cleverly resolved by Director Lou and the two became close comrades-in-arms is unknown.
Director Lou may not look good, but he is very capable and resourceful. He has a long-term vision and great ambitions. It is a good thing for him to be the director of the emergency department.
If Deputy Director Han Changqing had really been made the department director back then, the emergency department would never be what it is today.
It has to be said that sometimes a person's destiny may change just because of a single decision.
Ellie did not have the courage and foresight of Director Lou, and in the end, she was still an attending physician at the age of fifty.
If nothing unexpected happens, she will retire at the attending physician level at the age of 55.
In terms of diagnosis and treatment experience, Dr. Ellie has extremely rich experience.
What kind of patient could leave her helpless?
Zhou Can followed the nurse and walked quickly towards the emergency room.
From a distance, I saw a female family member lying beside the patient's bed crying, and several other family members also looked sad and anxious .
Doctor Ellie is performing various examinations on the patient.
It is probably not clear yet what caused the shock, so no emergency measures were taken rashly.
In the emergency department, the patient's death can be roughly divided into three processes.
Severe illness, shock, death.
When ordinary doctors encounter patients in shock, they will probably feel extremely panicked, but for Dr. Ellie, this kind of scene can be encountered every day. Even many times a day.
Tuya's emergency volume is astonishing. Even if patients with shock only account for one percent, there will be several patients with shock in a day.
"Doctor Ai, what's wrong with this patient?"
Zhou Can squeezed through the family members who were surrounding the portable emergency bed and greeted Ellie while he began to look at the patient on the bed.
"According to the family, the patient had black stools for nearly a month. This morning, he suddenly had a nosebleed while eating breakfast. He then became unconscious and fell to the ground. The family was worried that calling an ambulance would delay the patient's condition, so they directly sent the patient to our hospital in their own car."
Ellie briefly introduced the patient's medical history.
Black stools mean gastrointestinal bleeding.
The patient suddenly had a nosebleed while eating breakfast. Could it be upper gastrointestinal bleeding?
Zhou Can secretly observed the patient's appearance. His face and lips were pale and bloodless, but he was still conscious and had a slightly painful expression on his face. There were no rashes or ecchymosis on his neck and arms. There was no yellowing of the sclera.
He reached out and touched the patient's neck, and found no obvious enlargement of the superficial lymph nodes.
The thyroid gland is also normal.
I tried to compress the patient's chest, but the patient did not experience any obvious tenderness.
"The patient's temperature is 36.7 degrees, pulse is 100 beats per minute, respiration is 21 breaths per minute, and blood pressure is 90/70 mmHg."
After checking the patient's basic vital signs, Ellie informed Zhou Can.
The level of a doctor is not determined by who is older.
After Zhou Can came, she obviously regarded Zhou Can as her backbone.
"His blood pressure is obviously low. Have you drawn blood for test? After we know his blood type, we have to ask the blood bank to prepare plasma. I guess he will need a blood transfusion and fluid replacement." While Zhou Can was speaking, he was still doing a physical examination on the patient.
The level of a doctor is sometimes mainly reflected in the details.
When doing a physical examination on a patient, some people may just follow the process verbatim.
A skilled doctor can make a comprehensive diagnosis and assessment based on the patient's skin color, spirit, demeanor, body shape, chest and lung percussion sounds, etc.
Normal blood pressure is around 120/80 mmHg.
The patient's systolic blood pressure dropped to 90, which is very dangerous.
If a blood test is done, Zhou Can can even infer the patient's approximate blood loss based on the hemoglobin.
The top priority is to find out the source of the patient's bleeding and find a way to stop the bleeding.
Otherwise, the bleeding cannot be stopped and blood transfusions will be useless.
"Blood has been drawn and sent for testing!"
Ai Li is indeed an old doctor, and is obviously much more stable than the young Dr. Xie.
Zhou Can nodded and tried to press the patient's abdomen.
When there is bleeding in the digestive organs, the abdomen is the key area for investigation.
Because human intestines and stomach are almost entirely in the abdominal cavity.
The patient's abdomen was relatively soft and there was no response when pressed.
No palpable mass was felt in the patient's abdomen.
But I heard bowel sounds, and they were quite active.
When Zhou Can pressed under the patient's xiphoid process, the patient immediately groaned in pain.
"Teacher Lu, give me a disposable glove for finger examination."
While speaking, Zhou Can picked up the patient's hands and examined them carefully.
"Doctor Zhou, what items do you check when you examine the patient's hands?" The young female doctor standing next to Ellie was only about twenty-three or twenty-four years old, quite young.
This is a new intern recruited into the emergency department.
Because interns change departments very frequently, Zhou Can sometimes is too lazy to remember their names.
This female doctor was quite brave enough to ask him questions in such an occasion.
"The main thing is to check whether the patient has liver palms, spider nevi, and clubbing, and whether the finger joints and wrist joints are red and swollen. If you don't know which diseases these characteristics correspond to, you can flip through the book after get off work and remember them firmly in your mind. Because when you encounter clinical emergency, you don't have time to look up information or flip through books."
Zhou Can spoke in a gentle tone as he roughly explained the purpose of examining the patient's hands.
The patient is waiting to be saved right now, so it is definitely impossible to explain each one in detail.
For some knowledge, novice doctors can only read more books and memorize more.
Medical students have too many knowledge points to remember. If you can memorize as much as you can when you are young, then you should memorize as much as you can. Then, after you start working, you can keep applying it in practice and gradually you will be able to remember it firmly.
The nurse handed Zhou Can a thin glove for finger examination.
After putting it on, Zhou Can pulled down the patient's pants and performed a digital rectal examination directly.
If the patient is a female, the doctor may consider the patient's privacy and change the location for the digital examination. Male patients basically do not receive any preferential treatment in this regard.
In fact, when it comes to the moment of needing life-saving, there is no need to be pretentious.
Everything a doctor does is to save the patient's life.
After a digital examination, Zhou Can found that the patient's sphincter was tense, and he had no internal or external hemorrhoids. There was a small amount of dark red blood stain on the finger cuff.
The possibility of rectal bleeding can basically be ruled out.
Because if there is rectal bleeding, the blood stain on the fingertip will be bright red.
"Doctor Ai, do you think we should give the patient an emergency chest X-ray and an abdominal ultrasound?"
“I totally agree!”
In front of her family, Ai Li always cooperates highly with Zhou Can.
"I suspect the patient is suffering from upper gastrointestinal bleeding. I will first exclude the chest and abdominal cavities before considering emergency gastroscopy. Although he is basically in shock now, judging from some of his symptoms, the bleeding should have subsided. As long as the plasma is prepared, it should be relatively safe."
Zhou Can would definitely not tell anyone about anything that was guaranteed.
His hemostasis is now level six, giving him a huge advantage in diagnosis.
The actual situation of bleeding in the patient's body can be basically understood through the patient's various manifestations.
He had just performed several physical examinations on the patient in order to determine the approximate location of the bleeding, the current bleeding speed and the amount of bleeding. There was no way to make an accurate assessment, only a rough estimate.
The patient was quickly sent for examination.
The examination was accompanied by the female intern doctor who asked Zhou Can the question.
The patient is already in shock, so we cannot allow him to wait in line any longer. Such critically ill patients have priority in all examinations and treatments.
Because the purpose of setting up an emergency room is to save the patient's life.
Doctor Ai Li pulled Zhou Can aside and whispered, "Doctor Zhou, I have no idea about this patient. I'll delay you for a while. Can you go into the operating room when the patient's condition stabilizes?"
She knew that once Zhou Can entered the operating room, he would often have to stay there until after twelve o'clock before coming out to eat lunch.
Sometimes, if I am too busy, I may not even leave the operating room for the entire day.
"OK."
Zhou Can nodded readily in agreement.
Now that the old comrade has spoken, it would be difficult to offend the other party.
Soon, the blood test results came out.
The hemoglobin was only 56g/L, the white blood cell count was 7.3*109 per liter, the neutrophil count was 0.87, the lymphocyte count was 0.15, and the platelet count was 132*109 per liter.
Fecal occult blood test, positive, three plus, white blood cells, positive. No worm eggs, amoeba trophozoites, etc. were found.
Urinalysis was negative.
It appears that the patient has been bleeding a lot because his hemoglobin is very low.
However, considering that the patient has had black stools for more than a month, the amount of bleeding this time may not be as large as imagined.
How to say it!
This bleeding is more like the last straw that broke the camel's back.
If you keep dragging on with bloody stools for a long time, even if your body is a blood bank it will not be able to withstand it!
"Doctor, is my son okay?"
The patient's mother, who was in her forties, kept crying, her eyes full of fear and tension.
The person who asked Zhou Can the question was the patient's father.
The family's clothing was no different from that of ordinary citizens. They must be permanent residents of the city.
The family's financial situation may not be particularly rich, but it is not too bad either.
"From what I can see, the blood loss is quite serious. Why didn't you send him to the hospital earlier? It's been more than a month since you came. You are too careless."
Zhou Can seemed a little reproachful.
But he usually doesn't scold his family members.
"Alas, this kid never told us. After the child grew up, he rarely communicated with us. After the winter vacation, he just hid in his room playing games all day, or went out to fool around with his classmates."
The patient's father shook his head and sighed repeatedly.
My 20-year-old son is sensible enough to take part-time jobs during holidays to earn a living and reduce the burden on his parents.
Those who are more willful basically play games crazily with their classmates every day.
Maybe the patient is just feeling slightly unwell and is too lazy to tell his parents.
As for black stools, some people don't even look at the color of their stools and just flush the toilet after using it.
Even if you see black stool, if you lack medical knowledge, you will not take it seriously.
"It's all because you always beat and scold our son, so that he dares not tell his family anything! Our son is like this, and you're still scolding him, wuwuwu..."
The patient's mother cried sadly.
When the husband saw his wife crying like this, he didn't say anything.
Soon, the chest X-ray results came out.
There is no obvious abnormality.
This means that the heart and lungs are basically normal. These two organs are the most core organs for maintaining human life. One controls breathing, and the other controls blood circulation.
The results of the abdominal ultrasound came out soon after.
B-ultrasound showed that the spleen was slightly enlarged, and no abnormalities were found in the liver, gallbladder, and pancreas.
Sure enough, it was similar to Zhou Can’s diagnosis, and the bleeding location was most likely in the upper gastrointestinal tract.
It seems that after his hemostasis skills were promoted to level six, they can indeed play a certain auxiliary diagnostic role when encountering patients with internal bleeding.
As long as he slowly accumulates more diagnostic experience, he will be able to reach the diagnostic level of those top experts in the future.
Just by taking a look at the patient and understanding his medical history, you can basically make a pretty accurate guess as to the cause of the disease.
He used to think that surgical skills could only be used for surgery, but now after being promoted to the director level, he was pleasantly surprised to find that surgical skills can be used in conjunction with pathological diagnosis skills to achieve the role of auxiliary diagnosis.
He couldn't help but sigh that the medical experience system was a really good thing.
Without this system, his medical skills would never have been able to improve so quickly.
It is even more impossible to gain the appreciation of chief physicians everywhere.
"Let's give him an emergency gastroscopy! The source of bleeding can basically be identified as the upper digestive tract."
Zhou Can said to Ai Li.
