Chapter 552: Level 6 Pharmacological Differentiation, the Trouble Caused by Pediatric Heat-Relief Patch
"It seems that his voice is hoarse when he cries. The throat cannot be dehydrated for a long time."
Zhou Can frowned slightly and turned to the nurse.
"Do you have a clean straw? The kind with a balloon?"
"have!"
"Please bring one here. I'll give this baby some water first. It's so heartbreaking to see."
He patted the baby's back gently to comfort it.
After the nurse brought a straw, he asked the nurse to help him open the bottle of water, then sucked a few drops of water from it and squeezed it into the baby's mouth.
The whole process was very gentle and careful.
The baby stuck out his tongue to lick the water stains on his lips, and his crying stopped. He looked at Zhou Can with longing eyes.
It seems to be saying, Uncle, give me some more to drink.
"It turns out that you can feed water this way. Why didn't we think of it? I tried to feed him water with a small spoon before, but he choked and cried loudly, so I didn't dare to feed him again."
The mother watched Zhou Can feed water to her child easily. Not only did the baby not choke, but he also seemed to enjoy it.
I immediately had great confidence in Zhou Can's abilities.
The family members' eyes when they looked at Zhou Can also changed.
Respect and trust.
"Feeding water with a spoon is suitable for older children. At around six months old, it is not so easy for them to choke when feeding water with a spoon. Also, if they choke frequently when feeding water, it is easy to cause problems such as pneumonia, so you must pay attention to this."
Zhou Can didn't mean to scare the family members.
When babies are born, their lungs are not fully developed because they have been breathing through the umbilical cord in their mother's womb.
In addition, it is not a bad thing for babies to cry. It helps exercise the lung function and help the lungs adapt to the outside world.
Especially for newborn babies, if they don’t cry or make a fuss, the midwife will be very anxious.
Will try every possible way to make the baby cry.
For example, patting the soles of the baby's feet, etc. Of course, this scene should not be seen by family members as much as possible to avoid unnecessary misunderstandings.
"Did you have a natural birth or a cesarean section?"
"Normal delivery!"
"Since the child can drink water, you should also try this method with breast milk. Breast milk is rich in nutrients and contains many special elements that can enhance the baby's immunity. If he doesn't want to suck, you can squeeze it out, put it in a bottle, and then feed him a little bit with a straw. When feeding with a straw, be careful not to suck too much at a time to avoid choking the baby. If he chokes twice, he will reject this way of eating because he is uncomfortable."
Zhou Can explained the key points of feeding to the mother.
Now we must find a way to let the baby eat some milk to maintain the body's immunity and nutrient absorption.
"Okay, I'll do that later."
With so many people around, it was naturally impossible for the mother to express milk. She learned the method and would be able to do it herself after the doctors left.
Zhou Can continued to feed the baby some water.
The child's facial expression was much more relaxed and natural, and his originally frowned brows had relaxed a lot.
The family members and the mother saw all this and were very happy.
The child had not eaten for so many days after birth, which made them increasingly anxious. Now they feel a little relieved.
"I need to do some checkups on the baby and put him in his crib."
Zhou Can greets the family members.
"OK."
The family and the mother readily agreed.
Now, in their hearts and eyes, Zhou Can is an absolute expert. They are very happy to let Zhou Can help their children with diagnosis and treatment.
Zhou Can first felt the child's neck pulse and felt it was very weak.
Patients with heart failure often have a very weak pulse.
Next, he performed a detailed examination of the child's entire body, including auscultation of heart and lung sounds.
On auscultation, he found a bruit in the child's left chest.
After careful identification, it was found that the noise came from the upper middle left edge of the sternum.
Moreover, this murmur is very regular and is only produced when the heart contracts.
Ordinary doctors may not be able to distinguish whether the heart sounds are in contraction or diastole, but doctors at Zhou Can's level can make the distinction very accurately.
"The patient's X-ray examination showed that the heart was enlarged, the pulmonary vascular shadows increased, and some even showed pulmonary venous congestion. In addition, the patient's electrocardiogram also showed right axis deviation and right ventricular hypertrophy. So I highly suspected that there was something wrong with the aorta."
Many chief physicians were present on site, including Director Le of the cardiothoracic surgery department.
Zhou Can now has some diagnostic results, so there is no need to hide it. He can just speak it out and discuss it together.
The only thing you need to pay attention to when discussing in the ward is to respect your senior doctors.
You can’t hit them in the face.
For example, if your senior doctor just said in front of everyone that there might be a problem with the left ventricle, and you immediately responded by saying that the problem is with the right ventricle, this is basically playing against your senior doctor.
It will make it difficult for senior doctors to step down.
"Director Le, what do you think?"
Director Tang Fei is not very good at treating diseases related to cardiac surgery, so she can only ask Director Le for his advice.
"Zhou Can's suspicion has some basis. We can do an echocardiogram to clarify it."
Director Le's diagnostic skills were not low, but he was already far behind Zhou Can in many aspects. He rarely refuted Zhou Can's diagnostic opinions. Because of the few times he refuted, only once did he fail to get slapped in the face.
That was a long time ago.
Zhou Can was now far superior to him in both diagnosis and surgical skills, so he didn't dare to refute Zhou Can's diagnosis easily.
Doing an echocardiogram can really help a lot in diagnosing the aorta.
Considering that the child's condition was very dangerous, an echocardiogram was arranged for the child on the spot.
After examination, it was found that the child's aortic valve was narrowed for a considerable section, and the blood signal in this section was very poor.
"It's probably aortic canyon lesions."
Zhou Can said so after reading it.
"It has basically been confirmed that there is a section of the aorta that has narrowed, causing the blood flow in the aorta to be severely weakened." Director Le also agreed with Zhou Can's diagnosis.
"The baby is only three days old. If surgery can be avoided, I think it should be avoided. You can try medical treatment to control heart failure first, and then elective surgery depending on the situation."
After Zhou Can's diagnosis was supported, further treatment advice was given.
Director Le is the type of doctor who appears gentle and elegant, but is as fierce as thunder when it comes to deciding on treatment plans.
It would be better for Zhou Can to decide on the treatment plan for the newborn.
"What kind of internal medicine treatment is Doctor Zhou going to use?" Director Tang Fei also felt that it was safer to use internal medicine treatment for newborns as much as possible.
"Prostaglandin E1 is a good choice for opening the ductus arteriosus. It can effectively alleviate the hypoxia condition of children."
Zhou Can gave the answer after careful consideration.
[Pharmacological differentiation experience +1, bonus experience +10. ]
[Congratulations on your advancement to level 6 in pharmacological differentiation. Current experience value is 1/1000000, junior level of chief physician.]
His pharmacological diagnosis had already reached the critical point of upgrading.
This medical skill is extremely important, but the upgrade speed cannot be compared with other medical skills. It is even slower than the upgrade speed of pathological diagnosis. Now that he has been promoted to the level of chief physician as he wished, Zhou Can has finally made up for a huge shortcoming.
The situation where he was beaten by his nurse Jiang Wei was also changed.
Now both pharmacology and pathology have reached level six, and his clinical level has reached the level of a real director.
Whether it is seeing patients, performing surgery, making ward rounds, or rescuing critically ill patients, it can provide great help to Zhou Can.
He carefully felt the changes brought about by the upgraded pharmacological differentiation.
It is obvious that the clinical use of various drugs is more flexible and accurate, and the subtle differences can be well controlled and grasped. What surprised Zhou Can the most is that now he can naturally form a prediction in his mind about the specific effects of the drugs after use and how much they can be absorbed by the patients.
For example, when giving medication to the child in front of him, when using Prostate E1, he can make a comprehensive assessment based on the child's examination reports and form a map in his mind. Which drugs cannot be used, which drugs can be tried in an emergency, which drugs cannot be used within how long after using Prostate E1, whether it will hinder the child's subsequent emergency surgery, etc.
He can form a map of drugs in his mind.
This ability was not possessed at level five.
He vaguely felt the state of medicinal efficacy that is often mentioned by Chinese medicine experts.
When he was promoted to the injection technique last time, when injecting drugs into the corresponding skin, muscles and other parts of the patient, he could judge whether the drug absorption in that area of the patient had reached saturation. This ability actually touched the realm of drug efficacy.
If the injection technique level can be further improved to reach the intermediate level of chief physician or even the advanced level, this ability is likely to be further improved.
For example, we can only determine which area of skin and muscle has reached saturation point for drug absorption.
Going a step further, it may be possible to determine whether a particular organ has reached saturation with drug absorption.
Now that pharmacological differentiation has been promoted to level six, it is basically equivalent to having one foot directly stepped into the door of drug efficacy and meridians.
"Director Tang, Director Le, and Director Zhuang, I suggest that we wait until the child's condition is slightly stable before giving him a cardiac catheterization and retrograde aortic root angiography. In the case of a long aortic isthmus, surgery is often required in the end. It is very necessary to identify the location of the lesion and the corresponding conditions in advance to eliminate potential hidden dangers before surgery. It can also provide a good basis for the formulation of surgical plans."
Zhou Can felt that the examination of the child was not complete enough.
According to his surgical experience, medical treatment for this child can only alleviate the condition but cannot cure it.
The best way is to wait until the child's physical condition allows for surgery.
"Sure! If the family members agree, I will choose the most appropriate time to arrange it."
Director Tang Fei nodded in agreement.
"It is indeed necessary to do an aortic root angiography."
Director Le also strongly supported Zhou Can's proposal.
Pediatrics does not have the ability to perform cardiac surgery, so the child must eventually be sent to the cardiothoracic surgery department for surgery. Having the child undergo a complete preoperative examination can greatly reduce the risk of surgery and allow the doctor to be fully prepared before the operation.
Basically all major surgeries have preoperative preparation requirements.
To perform aortic surgery on a newborn, the preoperative preparation will be even more.
"We have absolutely no objection. With so many directors and experts helping to treat my child, our family members are grateful to the hospital and we trust it. We are willing to fully cooperate with the hospital's treatment and examination plans."
The person who spoke should be the child's grandfather.
Although he is a grandfather, he is not particularly old, probably less than 50 years old.
As for the child's parents, they are both young people in their early twenties and are still quite immature.
Major matters are basically handled and hosted by the children's grandparents.
"Okay, thank you for your trust and cooperation. Our hospital will do its best. We all have the same goal. We all hope that this smart and cute baby will recover as soon as possible."
Director Tang Fei made a summary speech, and the consultation basically came to a temporary end here.
…
At lunchtime, Zhou Can checked his phone and saw Director Tang Fei sending him a voice message on WeChat, telling him that the child's symptoms had improved significantly after receiving intravenous prostaglandin treatment.
The main symptoms of heart failure are chest tightness and difficulty breathing.
She also told Zhou Can that the child's mother had specifically sent him a message to thank him for helping her come up with the idea of using a dropper to feed the child.
Although this method is a bit time-consuming, after feeding the baby with breast milk, the baby has been sleeping peacefully for more than two hours without waking up. This was almost unimaginable in the first two days.
The child cries almost all the time, day and night.
Since babies cannot speak, they cannot tell their parents when they feel pain or itchiness, and crying is the only natural way to express themselves.
Even as adults, we cry when we feel physically uncomfortable.
If you encounter a particularly fussy child, especially one who is newborn, you must be alert to whether the child is sick or in pain.
When Zhou Can was working in the pediatric department, he once saw a child who was only four months old. The child's mother was about to collapse and told Zhou Can that she didn't know why the child had been crying non-stop in recent days.
She hardly slept a wink during the night.
After examination, Zhou Can found a plaster on the child's belly button.
After asking, we found out that the child's grandmother saw that the weather was hot and the child was sweating all the time. She was worried that the child would have heat stroke, so she took the child to the small clinic downstairs to apply a pediatric heat relief patch.
Some of my child’s colleagues have said that the pediatric cooling patch is very effective.
It can prevent children from heatstroke, prickly heat, etc.
Then, in order to sell the plaster, the "doctor" in the clinic also advertised that the plaster was pure Chinese medicine, had no side effects, etc.
The child's grandmother naturally had extraordinary trust.
The child slept very soundly in the first two days after applying the plaster, especially at noon, when it was usually too hot and the child would always make a fuss and not fall asleep.
After applying the pediatric heat-relief patch, the child slept soundly for two days in a row.
On the third day, the child started crying.
It was already the morning of the fifth day when the child was taken to the hospital for a doctor's visit. Zhou Can, based on his experience, immediately concluded that the child's problem was most likely caused by the plaster.
When I carefully removed the plaster from the child, I found that the child's tender skin was already red and swollen.
Moreover, the belly button seemed to be festering and emitted a faint stench of rotting corpse.
If we had come a day or two later, the consequences would have been disastrous.
The weather was hot at the time, and the child's resistance to bacteria and viruses was already weak. The navel is equivalent to the "eye" of the abdominal cavity. It is responsible for the baby's absorption of nutrients and oxygen from the mother during the fetal period.
The tissue has already begun to rot and fester, and continues to invade the abdominal cavity. Sepsis can easily take the child's life.
