Chapter 517: Madman Zhou Can, the disaster caused by venous puncture
"Sir, the patient you want to visit is in that bed!"
When the nurse saw Zhou Can enter the ward and look around, she thought he was looking for patients to visit.
Because all patients who come in here have to have their hair and nails trimmed.
They all became bald, and some patients were even wrapped in bandages all over their bodies, like mummies, making it really hard to tell them apart.
"Oh well!"
Zhou Can had actually guessed long ago that the bed farther away was most likely occupied by Deputy Director Lu, because there were several doctors and nurses busy around the bed, and various rescue measures were being used.
Director Xiang Fei, who is known as the 'King of Hell's Nemesis', is acting as the commander-in-chief.
He himself is also participating in the technically difficult rescue work.
"You can only stand by and watch. Don't interfere with the medical staff 's rescue efforts."
The nurse was worried that Zhou Can might get into trouble, so she gave him a shot in advance.
"clear."
Zhou Can walked over there.
Because he was wearing disposable sterile protective clothing, the medical staff could tell at a glance that he was a family member entering the ward to visit.
Everyone was busy with their own work, so naturally no one paid any attention to him.
Only the nurse who accompanied him was there. When family members visit, they must also be accompanied by medical staff one-on-one. If some family members are careless and accidentally use other patients' ventilators, blood perfusion machines, hemodialysis machines, monitoring equipment, etc., some actions are enough to cause fatal harm to those patients whose lives are already fragile.
This is also one of the reasons why medical staff do not like to allow family members to visit in the ICU.
A stranger coming in means there are many unknown risks.
Everyone is already busy enough at work, and having to spend energy and time to receive visiting family members is equivalent to adding burden to their work. Naturally, no one is willing to do it.
When Zhou Can was about to approach bed 13, the nurse quickly stopped him and told him not to go any further.
On the hospital bed, Deputy Director Lu's hair had been shaved off, and there was an obvious traumatic hematoma on the back of his head. His face looked very gray and lifeless.
In addition, his right hand fell at his side at an unnatural angle. With Zhou Can's experience in diagnosis and treatment, he could tell at a glance that the hand bones must have been fractured.
His legs also had severe hematomas, and both legs were probably fractured to some degree.
From the fracture and the hematoma on the back of the head, we can basically infer the posture of Deputy Director Lu when he landed.
His legs probably landed first, and then his body lost balance. The huge impact caused his body to fall to the ground. His right hand instinctively tried to support himself, causing a fracture. When he fell to the ground, the back of his head hit the hard ground.
But the ground should be flat concrete or something like that.
If the ground is rocky, or there are sharp edges where the head hits, it is easy to form a wound and bleed.
This kind of large-area hematoma injury will only be formed if the impact point is on flat ground .
Blood stasis accumulates in the skin.
After learning about how Deputy Director Lu fell from the building and was injured, Zhou Can felt that the hope of rescuing him was much greater.
Anatomically, the back of the head is closer to important brain tissue.
Even in fighting, it is generally forbidden to hit the back of the head and the perineum, which are vital areas.
A severe blow to the back of the head can easily cause a person to faint or even die.
The injured part of Deputy Director Lu was probably located at the occipital bone.
The parietal bones were also affected.
It is estimated that the impact of falling to the ground was very great.
It is hard to say whether the legs touched the ground first. Only the person involved knows.
The cerebellum, cerebrum, and even the pineal gland may have been severely impacted and damaged. As for where in the brain the bleeding is and what kind of bleeding it is, it is impossible to tell with the naked eye.
Diffuse bleeding is more likely.
Of course, there is also the possibility of intracranial artery rupture and single or multiple sources of bleeding.
Zhou Can looked at the screen and dial of the monitoring equipment. Alarms sounded one after another. Deputy Director Lu's blood oxygen, heart rate, blood pressure, breathing, and brain waves were all abnormal.
The situation is far more serious than imagined.
Central venous pressure monitoring has been done and the patient is on a ventilator.
Deputy Director Lu seemed to have a lot of questions, but as long as the real cause of the coma was found, most of the problems could be solved. If we only start from one of the problems of blood pressure, breathing, or blood oxygen, we will only fall into the situation of being blinded by one leaf and being confused by a plethora of flowers.
This is the most common mistake made by attending physicians and below.
Because of the limited ability to apply clinical knowledge and the inability to see the overall situation when making a diagnosis, it is very easy to limit one's thinking to a very narrow range.
Director Xiang Fei is the head of the critical care medicine department of the Provincial People's Hospital and an absolute boss.
His diagnostic thinking is definitely far beyond the attending physician level.
The clinical experience is extremely rich.
At present, the idea of directing everyone to rescue is mainly symptomatic treatment, striving to increase the patient's blood oxygen saturation, stabilize the patient's heart rate, increase blood pressure, assist breathing, etc.
This is also the most commonly used rescue idea in Western medicine in clinical practice.
I will help you correct any sign that is not good.
This is also the most effective rescue method for emergency rescue of critically ill patients.
If there is enough time, there are more advanced rescue methods.
That is to unravel the mystery, find the real cause of the patient's illness, and then treat it.
For example, if Deputy Director Lu has found intracranial hemorrhage, he must find a way to stop the bleeding, reduce intracranial pressure, etc. If you just help the patient raise blood pressure or increase the auxiliary strength of the ventilator, it is a bit like looking for fish in a tree.
Zhou Can stood not far away, about five or six meters away, and his diagnostic thinking had already focused on the fact that Deputy Director Lu was in a coma.
With his rescue experience and unique reverse diagnostic thinking, he instinctively felt that the cause of the coma was the key to solving all problems.
There are three main mechanisms that cause coma.
The first is the disturbance of normal consciousness caused by pathological physiology. The second is the changes in microstructure and neurotransmitters of normal consciousness. The third is the main neural structure of normal consciousness.
The most likely cause of Deputy Director Lu's coma is the main neural structure of the consciousness state.
For example, the brain suffers traumatic damage, the brain stem is severely affected by intracranial hemorrhage, etc.
Even problems with blood supply to important tissues within the brain can cause coma.
The main neural structures are divided into three parts: the cerebral cortex, the thalamic diffuse projection system, and the brainstem ascending reticular activating system.
Among them, the cerebral cortex was damaged in the impact, which was the first suspected diagnostic direction.
The cerebral cortex is divided into more than a dozen gyri or five lobes by fissures and sulci.
They are connected by white matter nerve fibers, and the corpus callosum connects the two cerebral hemispheres.
If the lesion is diffuse, it is very easy to cause varying degrees of consciousness disorders.
Therefore, Zhou Can felt that the first thing to check was the cerebral cortex.
Unfortunately, he is only here as a visiting relative, and it is impossible for him to view the patient's examination reports and auxiliary examination results.
You can only see these superficial data.
For example, blood oxygen index, heart rate, blood pressure, central venous pressure, etc.
Even ordinary family members here can't understand the instrument screens and dials. Zhou Can is a professional, so he can see it clearly.
"Sir, your visiting hours are over, please leave! According to regulations, family members cannot visit for too long. This is because the ward is sterile, and if you stay too long, it will easily increase the risk of bacterial contamination. Please understand."
The nurse was very polite to him.
Through her contact with Zhou Can, she could definitely feel that Zhou Can was not an ordinary person.
"Director Xiang, when did the patient undergo central venous blood pressure monitoring?"
Zhou Can saw that he was about to die. At this time, after a quick comprehensive diagnosis based on some fluctuations in Deputy Director Lu's vital signs and the most intuitive visual inspection results, he came to a surprising conclusion.
Deputy Director Lu’s coma was likely caused by a variety of reasons.
Emergency rescue is needed now, which may be related to some minor negligence or mistakes made by the doctor during the operation.
The nurse didn't expect Zhou Can to be so bold as to ask questions directly to Director Xiang, who has the highest status here.
She was so scared that her face turned pale.
She didn't know why Zhou Can knew Director Xiang, and the questions he asked were quite professional.
At this moment, what she wanted to do most was to quickly ask this "master" to leave.
"Sir, please go out immediately and don't interfere with the medical staff's rescue of the patient."
There was a slight hint of anger in the nurse's voice.
I guess they are angry but dare not speak out.
Everything was explained to the family member beforehand, why is he so ignorant?
Wouldn't this cause trouble for her?
Director Xiang Fei, who was directing the rescue work, was a little annoyed at the moment because he found that the usual rescue methods seemed to fail on this patient. He secretly guessed that the patient's injuries might be too serious.
Rescuing victims of falls from heights is already difficult.
There were all kinds of internal bleeding and damage to internal organs, and it was impossible to diagnose the cause in a short period of time.
Not to mention the series of complications caused by internal bleeding and damage to internal organs.
The rescue was in trouble, and at this time, the family member who came to visit him actually asked him a question openly, interrupting his ongoing thinking. He suddenly felt angry.
But he is a veteran after all.
After years of clinical work, he knew that he should not easily come into conflict with family members.
He just looked up and glanced at Zhou Can calmly, then replied in a cold tone, "If you have any questions, you can ask the nurse directly. The visiting hours are over, please get out!"
Obviously, he didn't take Zhou Can seriously.
In clinical diagnosis and treatment, he often encounters some "Baidu warriors" and "popular science emperors" who question doctors' operations based on the little medical knowledge they have seen on the Internet and in medical books.
No medical staff would not have a headache when it comes to this type of family members.
In many cases, when encountering such family members, everyone will basically push the patient away if they can. If they really can't afford to push the patient away, they will most likely initiate defensive medical treatment to protect themselves.
Of course, when dealing with such family members, the attitude of medical staff will most likely become increasingly cold.
"Director Xiang, I'm not trying to cause trouble. I'm just providing a diagnostic idea. Will the patient's overall physical signs decline due to venous thrombosis? In particular, central vein thrombosis can be checked in detail."
Zhou Can had no choice but to bite the bullet and offer advice again.
People who don’t understand him think he is a psychopath.
You, a visiting family member, are actually here directing Director Xiang Fei on how to perform the rescue?
"Please go out! If you have any questions, you can talk to our nurse."
The young male doctor under Director Xiang Fei, who was quite tall, walked over and asked Zhou Can to leave.
There was even more hostility in his eyes.
If he wasn't in the intensive care unit, he would have called security directly.
The young female doctor under Director Xiang also looked at Zhou Can with the same look as if he was crazy. She must have sneered in her heart, wondering where this "great god" came from? He actually taught Director Xiang how to rescue patients.
These days, the world is so big that there are all kinds of birds.
"etc!"
Xiang Fei called out to Zhou Can.
His disciple obeyed his master's orders very well and immediately stopped driving Zhou Can away.
However, the look he gave Zhou Can was still unfriendly.
"Why do you think the patient's central vein has developed a thrombosis?"
After Zhou Can's reminder, Director Xiang Fei seemed to have come to his senses. No wonder all kinds of rescue efforts were ineffective. If central vein thrombosis really formed, it would be extremely harmful.
"I'm not sure, I just suspect it. As for the most common cause of central vein thrombosis, it may be that the air was not completely expelled during puncture, or that air was accidentally brought in. I'm just making a hypothesis, and I don't mean to question the doctor's operation."
After Zhou Can finished speaking, he quickly explained again.
He didn't want to arouse everyone's hostility by questioning the doctor's improper operation.
Having worked in the hospital system for a long time, Zhou Can knows very well that when conflicts between doctors and patients occur, everyone will stick together and become comrades on the same front.
Just like when corruption or other problems occur in official circles, it is easy for people to form groups to resist the scrutiny of their superiors.
To put it bluntly, this is a form of self-protection for people.
The establishment of venous access is very common in clinical rescue, mainly used for circulatory support, central venous pressure monitoring, hemodialysis, etc.
"Are you a doctor too?"
Director Xiang Fei looked at Zhou Can for the first time.
"yes!"
Zhou Can did not deny it.
"Who is this patient to you?"
“He is my colleague.”
Upon hearing that Zhou Can and the patient were just colleagues, Director Xiang Fei's expression softened a lot and his vigilance also faded a little.
"Tell me why you suspect venous thrombosis."
There was an obvious change in the tone of Director Xiang Fei's speech to Zhou Can.
People who are familiar with Director Xiang can hear that he has a little more respect when talking to Zhou Can.
"When rescuing critically ill patients, it is often necessary to open at least two peripheral venous accesses. If conditions permit, it is better to directly establish a central venous line. Whether it is to administer a large amount of medication in a short period of time or to monitor central venous pressure, it can be used. You can see that both the monitoring of central venous pressure and the administration of medication seem to be abnormal now. Combined with the changes in the patient's various vital signs and data, it can basically be concluded that there is a high possibility of thrombosis in the venous access. As for the cause of thrombosis, there is no need to delve into it."
After Zhou Can analyzed the reasons, he deliberately released some goodwill.
Doctors understand the hardships of doctors best.
It is very common that there are some negligence and mistakes in the operation.
Everyone makes mistakes sometimes.
If Zhou Can now investigates which doctor's improper operation caused the central vein thrombosis, he will be standing on the enemy side of these medical staff.
Deputy Director Lu’s rescue efforts were unable to make a quick breakthrough.
