Chapter 509: The dangers of excessive infusion, the unspoken rules cannot be broken
The more such people there are, the better for any department.
Doctors are also human beings. They need to eat and make money.
When treating patients who have no medical insurance or only have agricultural insurance, doctors try to save money for patients as much as possible. Even if they encounter patients who have purchased employee medical insurance, they still need to control the amount of money.
Only this kind of god-like old cadre does not need to have any worries and will do whatever treatment method is most effective.
Zhou Can came to the intensive care unit and found a thin old man with a slightly cyanotic face lying on the bed.
This type of ward is very expensive and has at most two beds with a private bathroom.
There are dedicated nurses and doctors to manage the hospital and provide the best quality service to patients as much as possible.
Ordinary people generally can’t afford to live there.
"Excuse me, is this Mr. Bai Dongyang?"
"Yes, he is my lover!"
The person taking care of the bedside was an old lady with outstanding temperament. Her hair was completely white, but she looked in very good spirits.
Many veteran cadres and their spouses are senior intellectuals.
"How are you now? Are you still having trouble breathing?"
"Yes, I still have trouble breathing and my chest feels stuffy."
Zhou Can nodded and said to the patient in a gentle voice, "Let me listen to your chest and lung sounds. Do you feel uncomfortable lying on your side like this all the time?"
The patient had just undergone a left lung resection surgery. No matter which side he lay on, the wound inside his body would be affected.
"It's uncomfortable lying flat..."
The patient seemed to have to use all his strength to speak.
You have to push out as hard as you can.
The voice is also quite weak, and the breath is obviously lacking.
He is not on a ventilator at the moment, only receiving concentrated oxygen through one nostril.
It must be said that it is extremely irresponsible to put patients on ventilators without any reason. Invasive ventilators, in particular, are usually only used when life-saving is needed.
For patients who can breathe on their own but have some breathing difficulties but are not in life-threatening condition, sometimes they don't even need oxygen.
Doctors will decide on measures to improve patients' breathing based on actual needs in clinical practice.
Before auscultating the patient's chest and lung sounds, Zhou Can did a little detail: he warmed up the probe of the stethoscope before using it on the patient.
This is to reduce irritation to the patient.
It must be uncomfortable to have the cold metal probe pressed against the weak patient's chest.
He listened carefully to the patient's chest and lung sounds.
There are obvious moist rales and bubbling sounds in the lungs.
The left lung has been completely removed, and now only the right lung is working.
The presence of this bad murmur indicates that there is a serious problem with the right lung. No wonder the patient has difficulty breathing and chest tightness.
This person's condition is already extremely dangerous, and if things go wrong he may suffocate at any time.
Zhou Can looked at the patient's physical measurement record after admission and found that his blood pressure was 162/100mmhg, which is considered high blood pressure. A systolic blood pressure of over 140 is considered high blood pressure.
However, sometimes false hypertension occurs.
For example, if the patient is emotionally excited or has consumed some stimulating food, blood pressure will often return to normal after a period of time.
The ECG showed that the patient had sinus tachycardia.
Now I have high blood pressure and cannot lie flat.
The words "pulmonary edema" immediately popped into Zhou Can's mind.
It is not difficult to find out the cause of the patient's illness.
After receiving the patient, Deputy Director He of Tuya and another doctor jointly consulted with the patient and both determined that it was pulmonary edema.
But the real difficulty lies in clarifying the specific cause of the disease and the pathology.
If the cause of the disease cannot be identified, there can be no treatment.
If we just treat it as a postoperative complication, it would be too rough and superficial, and it is impossible to solve the problem.
After checking the patient's actual physical condition, Zhou Can did not leave.
Instead, he took the patient's examination records and postoperative medications and checked them carefully.
Check each one by one.
The operation was successful.
The preoperative examination was also very thorough.
Since their medical insurance reimbursement rate is close to 100%, they naturally do as much as possible and as safely possible.
No inspection was missed.
This also provided favorable conditions for Zhou Can to find out the cause of the patient's illness.
He himself knows how to perform left lung removal surgery and has performed many such operations.
When investigating the cause of the disease, he can give accurate judgments on every step of the patient's diagnosis and treatment.
The results of the preoperative examinations showed that the patient had a malignant tumor in only the left lung, and the right lung was normal, and there were no other hidden diseases.
The surgical process was also very careful and thorough.
At least judging from the surgical records, the operation was very successful.
It can also be seen that the surgical capabilities of the Provincial People's Hospital are very strong.
Since there were no problems in the preoperative examination and the operation went smoothly, there is only one possibility: the cause of the patient's illness occurred after the operation.
The potential for postoperative complications is high.
It is possible that some parts of the operation were not done properly or some negligence caused the right lung edema.
However, judging from some cases transferred from the Provincial People's Hospital that Zhou Can has treated, the surgical procedures of the Provincial People's Hospital are standardized, each step is very strict, and responsibilities are assigned to individuals.
This patient is a veteran cadre and is considered a special patient.
We will only treat him more attentively.
The possibility of postoperative right lung edema caused by surgical negligence or removal of the left lung is extremely low.
There is only one possibility, something went wrong with the postoperative care.
This has happened more than once.
Some are caused by the carelessness of medical staff, some are caused by the poor professional level of medical staff, or some unexpected incorrect nursing methods.
"Did his breathing difficulties begin after he came out of anesthesia?"
"No! My wife was in good condition when she returned to the ward after the operation. Later, the nurse came in with medicine and gave my wife an infusion. After more than three hours, my wife felt uncomfortable. She reported it to the nurse who came to remove the needle on the spot. She told us that it is normal to have a little adverse reaction after the infusion. The infusion is to improve my wife's ability to resist infection, replenish the body with necessary nutrients, and speed up recovery. I didn't say anything else."
The patient's wife should always be with her husband.
Otherwise I wouldn’t know it so clearly.
Young couples are companions in old age.
It can be seen that the two old people must have a very good relationship.
After learning this important situation from the family, Zhou Can immediately checked the patient's postoperative infusion.
There was nothing wrong with the medications and saline used.
The infusion volume is up to 1200ml.
This is truly a special care from the God of Wealth!
Is it because you see that the medical insurance reimbursement rate is 100% that you are giving patients intravenous drips?
At least in Zhou Can's opinion, the dosage must have exceeded the standard.
However, he did not understand the actual situation at the time, so it was difficult to judge whether the doctor had over-treated the patient.
"How long did the whole infusion process last?"
He asked.
The patient just mentioned an important detail, that the postoperative infusion took about three hours to complete.
"Uh... I didn't check the start time of the infusion. I only know that it was close to four in the afternoon when the infusion was finished. My wife came out of the operating room around one in the afternoon and returned to the ward. The entire infusion process should not take more than three hours."
The family gave the answer.
The Provincial People's Hospital is quite cunning. The postoperative care records only include the drugs and dosage, as well as what kind of care was provided, but the time of infusion was not given.
"Doctor, is there something wrong with the infusion given to my wife at the Provincial People's Hospital?"
The family members seemed to smell something.
Ask Zhou Can directly.
"I was not there at the time, so I cannot comment on this. Your husband's lung edema is probably quite severe now. I have given him medical advice and he needs treatment as soon as possible . Is he able to urinate easily now?"
Zhou Can naturally would not evaluate whether the operation of another hospital was wrong in front of the patient.
He would never do something that could easily cause disputes.
"It's quite convenient. You can use a urinal to collect it."
They are an old couple, so she doesn't feel embarrassed when it comes to taking care of her husband's urination.
"Does he have any medication allergies?"
"Probably not."
"Okay, you may need to give him some diuretics in the next few days, so that the amount of urine he excretes will exceed the normal level. If your husband wants to drink water, you don't have to forbid him, just eat and drink normally."
Zhou Can explained some precautions and directly prescribed medical advice to the patient.
It needs to be approved by Deputy Director He before it can be implemented clinically.
Basically, the medical orders written by Zhou Can now, whether by Deputy Director He, Director Xueyan and others, are all briefly reviewed and approved directly.
[Pharmacological differentiation experience +1, bonus experience +10. ]
The improvement of pharmacological differentiation is really a long way to go. Currently, I am only at level 5, and there is still a long way to go if I want to be promoted to level 6.
He has basically found the cause of the patient's postoperative right lung edema.
Based on his work experience in the critical care department, he believed that the patient's pulmonary edema was most likely caused by too rapid postoperative infusion. It could be that the nurse in charge of giving the patient infusion at the Provincial People's Hospital was not very professional, or that some unexpected circumstances occurred at the time, which accelerated the infusion of the liquid medicine.
For example, family members secretly turned up the infusion switch.
This situation is the most common.
Some family members and patients think the infusion speed is too slow, so they will secretly increase the infusion switch to speed up the infusion.
In their opinion, since it is going to be injected into the body anyway, it makes no difference whether it is done earlier or later.
Sometimes when encountering such patients and their families, nurses feel helpless.
We can only gently tell the family members not to do it again next time.
I don't even dare to say harsh words.
Because if you speak more harshly to the family members, some of them with bad tempers may start arguing with you or even become violent.
In addition to family members who privately speed up the infusion speed, sometimes the patient has certain physical conditions and needs emergency infusion treatment. Medical staff will also speed up the infusion speed after comprehensive consideration.
Compared with some possible side effects, saving lives must be the top priority.
For example, if the patient has internal bleeding, hemostatic drugs are needed to control the patient's bleeding and help them stop bleeding.
If the infusion is given slowly for 24 hours, the patient's blood will be drained out.
Or for anticoagulant and thrombolytic drugs, the drugs also need to take effect quickly.
This is also the reason why Zhou Can did not make any negative comments about the nursing care at the Provincial People's Hospital.
If you are not at the scene, you will never know what situation the medical staff were facing at the time.
He prescribed the patient 10 mg of coffee intramuscularly, mainly for sedation, to relieve the patient's pain and control blood pressure.
If the patient continues to get excited, his blood pressure may continue to rise.
Furosemide 20 mg and digoxin 0.4 mg were injected intravenously.
This is the medical order that needs to be implemented now. There is also a long-term medical order that requires the patient to use diuretics and drugs such as digitalis within the next five days.
The purpose is to quickly relieve the symptoms of pulmonary edema.
The lungs control water, so when edema occurs, the first thing to consider is not water restriction, but diuresis.
If the patient also suffers from renal failure, the situation will be very dangerous.
When a problem occurs in a certain organ of the body, it can actually seek help from other organs of the body, just like a kingdom in ancient times that was attacked and asked for help from its neighboring kingdom.
However, this kind of help requires doctors to use drugs or other methods to achieve it.
Giving this patient a diuretic is like asking the kidneys and other organs for help when there is a problem with the lungs, speeding up the discharge of excess water in the body and alleviating the symptoms of pulmonary edema.
By finding out the cause and pathology of the patient's illness, Zhou Can earned 101 points of pathology diagnosis experience.
100 points of these are system rewards.
By diagnosing such difficult cases, you can basically get at least 100 pathology diagnosis experience points as a reward.
Sometimes he is lucky and has won huge rewards of 1,000.
Pathological diagnosis has also been rising rapidly, leaving pharmacological diagnosis far behind. It is now about to be promoted to level six.
Because of the live broadcast of the surgery yesterday, Zhou Can directly pushed Tuya's cardiothoracic surgery to the throne. With it, there will be a steady stream of difficult cases, and his opportunities to earn large experience value rewards will also be endless.
There is one prerequisite: nothing can go wrong.
If a major medical accident occurs, the entire reputation is likely to be ruined.
After dealing with this old cadre, Zhou Can prepared to return to the office to study another difficult case.
Don't underestimate his contribution.
Every time we successfully treat a difficult patient, the reputation of cardiothoracic surgery will be greatly improved. Over time, this is very significant.
"Doctor Zhou, please come here for a moment!"
Director Bu waved at Zhou Can.
Zhou Can walked quickly into the conversation room used to communicate with patients and their families. Two bodyguards were standing in the corridor. They looked quite professional and vigilantly observed everyone who approached the conversation room.
These two people had already remembered Zhou Can.
After all, their boss came all the way from Shanghai specifically to see Zhou Can for medical treatment.
Inside the room, the patient Chen Zhongzhi sat there with a calm expression.
"Director Bu just had a conversation with me. I also understand the regulations and policies of your medical industry. But I hope that Dr. Zhou can help me with my surgery. As for how to do the superficial work, it's up to you."
Chen Zhongzhi's status is noble, and his life is extremely important.
He was unwilling to undergo aortic vascular replacement surgery in a large hospital in Shanghai because the risk was too great. He was unwilling to take such a big risk.
“I’m just a resident!”
Zhou Can usually performs level 4 surgeries. Even if he is the main surgeon on a patient, he is openly performing the surgery as a participant.
Although some trust had been established with this patient, it was impossible to get him to admit some hidden secrets in person.
Some unspoken rules can only be understood but not expressed in words.
For example, if you give gifts to some important leaders, even if you carry a big box or a bundle of cash, they will not let you in.
Because who knows if you are secretly filming? Is there anyone else secretly filming?
The risk is too great.
It was no secret in the cardiothoracic surgery department of Tuya Hospital that Zhou Can could perform level 4 surgery, but it was never spread outside, and could not be spread outside.
