I'm really an intern

Chapter 148 Live to the Left, Die to the Right

The patient fell into a coma and the family members were not present, which is actually a very tricky situation.

If the patient is awake, treatment can be given with the consent of the patient.

If the family members are present, treatment can also be carried out after seeking the consent of the family members.

If the patient is in a coma and the family members are away, and the patient wakes up after the treatment, well, that's great.

Just be afraid, the patient is in a coma, his family members are away, he went to the treatment, but he still didn’t wake up in the end.

In this case, if the belated family members choose to make a fuss, no matter whether the hospital is responsible or not, they will definitely not be able to escape with dirty water.

After all, the patient died here!

I can't speak clearly all over my mouth.

This is not the indifference of being a doctor, but the experience gained by countless predecessors with blood lessons.

Sympathy is sympathy, isn't your own life worthy of sympathy?

"How to do?"

Zhang Tianyang looked at Professor Yang, waiting for instructions.

Even if he wanted to treat the patient again, he didn't have that right.

As an intern, even if all the diagnoses and doctor's orders he gave would be carried out for the patients in the end, they still needed to be reviewed by a regular doctor.

This is also the reason why Zheng Hualiang, no matter how salty the fish was, had to stand in the consulting room during the dermatology clinic.

It is also the reason why even though Zhang Tianyang has proven his ability in the emergency internal medicine clinic, the patients he handles still need to see the doctor twice.

The patient is now in the emergency room.

The person responsible is Professor Yang.

That's why Zhang Tianyang asked her specifically whether she could be saved or not.

If the patient is saved, the patient may or may not live, and the doctor is at risk of being held accountable.

If it is not saved, the patient will definitely die, but the doctor does not have to bear the responsibility.

But as soon as Zhang Tianyang finished speaking, Professor Yang made a decision.

"Get treatment! Get it now! Xiao Deng, you go to contact the medical officer on duty, we will rescue him first."

"it is good!"

The two little white coats responded, and then quickly dispersed, each performing its duties.

Brother Deng rushed to the landline and began to contact the medical staff who had a high attendance rate recently.

Professor Yang has already begun to give oral medical orders in front of the hospital bed.

Zhang Tianyang rushed to the computer and began to enter Professor Yang's oral doctor's order into the computer.

Then a series of examinations such as bleeding routine, liver and kidney function, infection indicators, myocardial enzyme spectrum were quickly prescribed, and a bedside B-ultrasound was also called.

By the way, I also completed the chief complaint, medical history, and physical examination of the little brother that I just didn't finish.

Fingers danced on the keyboard, and soon, the information was entered.

Zhang Tianyang walked to Professor Yang's side to observe the patient's condition.

Brother Li Yueban was lying on the flatbed cart, his spacious body covered the entire flatbed cart, his fleshy face was still dripping with cold sweat, even in a coma, he still showed a painful look.

At the foot of the bed, wearing two white coats, his eyes kept scanning back and forth between the beeping monitor and the patient.

Beside the bed, Nurse Ouyang led an intern nurse from left to right, dispensing and injecting medicines according to the oral doctor's orders in white coats.

The atmosphere in the emergency room was very solemn, except for Brother Deng who was on call to contact the medical staff on duty, no one spoke.

Time is lost every minute and every second, and all operations are carried out step by step.

Venous blood is pumped through thin, flexible tubes into tubes with red, yellow, and blue caps.

Arterial blood also flows out quickly through the puncture needle and is collected for arterial blood gas analysis.

The low-flow oxygen is delivered through the tube connected to the nose, so that the little brother can inhale effortlessly.

A sufficient amount of saline was quickly replenished into the little brother's body through the venous channel to rapidly expand the blood volume.

Soon, half a bag of liquid had entered the blood vessel, and then nurse Ouyang followed the doctor's order to insert the venous pump prepared earlier.

Sodium nitroprusside with adjusted concentration and pumping speed slowly entered, starting from the smallest amount, while closely observing Li Yueban's blood pressure.

In view of Zhang Tianyang's timely discovery of the little brother's condition, it was not too late to send in, and the PH value of the arterial blood gas was not too far off the mark, so there was no need to correct the acidosis for the time being.

Rehydration, vasoactive drugs, and correction of acidosis if necessary.

So far, the symptomatic treatment of shock has been used.

The rest is to treat the cause.

Only when the cause of the shock is removed, can Li Yueban's condition not deteriorate further.

But what is the cause?

do not know.

Doctors are not gods. Before the test results come out, they can only "guess" based on their own experience which cause is the most likely.

As for this guess, both Zhang Tianyang and Professor Yang looked a little unhappy.

Urinary system stones generally do not cause shock.

After all, stones are extremely painful, and few people can hold back the pain without going to the doctor.

In fact, those who can carry it, or those who are not sensitive to pain, may block the ureter due to stones, causing the urine that should be excreted to accumulate in the renal pelvis, eventually causing hydronephrosis.

Therefore, once it develops to the point of shock, the patient is very dangerous.

Like this little brother Li Yueban, Zhang Tianyang has two main considerations about his shock.

"Ms. Yang, I have two thoughts about this patient's shock."

Zhang Tianyang spoke very fast.

"The first, severe pain, causes a drop in blood pressure, which in turn causes painful shock."

If that's really the case, then it's easy to handle.

Pain relief is the treatment of the cause. After the pain is relieved, my brother's condition will gradually improve.

"Secondly, the kidney stones lead to obstruction of the ureter, which in turn leads to infection, which eventually leads to septic shock."

If this is the case, bad luck!

The mortality rate of general infection shock is 20%, which is already close to one-fifth.

The septic shock caused by this kidney stone is more violent and rapid.

Because the entire kidney is composed of blood vessels, the infected bacteria will be quickly absorbed into the blood, causing the physical condition to deteriorate rapidly.

Even with antibiotics, it is not always possible to control the infection before the patient's body is finished.

After Zhang Tianyang finished his guess, he turned his head and looked at Professor Yang. Both of them saw the solemnity in each other's eyes.

The situation is urgent, don't worry about it.

No matter what the situation is, first take the medicine and then talk.

"Supu is deeply anti-infective!

Indomethacin 100mg anal administration!

Atropine 0.5mg intramuscular injection!

Furosemide 20mg intramuscular injection! "

Anti-infection, pain relief, diuretic three-pronged approach.

In addition, it is also necessary to get the results of various inspections and tests as soon as possible.

Professor Yang looked serious and quickly gave orders.

"Go, call the laboratory and urge the blood test results to come out quickly!

Is the B-ultrasound at the bedside here?Urge!quick! "

"I'm urging!"

As soon as Zhang Tianyang finished speaking, someone knocked on the door of the emergency room from outside.

Opening the sensor door, the white coat of the clinical laboratory pushed the B-ultrasound machine beside the bed and was outside.

"Quick, come and see!"

Zhang Tianyang slipped and ran out, helping to move the machine to the bed.

Then he quickly opened the little brother's clothes, applied the gel, and adjusted the machine.

Just when the white coat in the clinical laboratory reacted and was about to reprimand Zhang Tianyang, "Don't mess with the machine, it's very expensive", Zhang Tianyang had already grabbed the probe and pressed the little brother's stomach.

"That's too late!"

We must quickly find out the condition of my brother's kidneys. If the accumulation of water is serious, it may be the most terrifying septic shock!

If this is the case, bedside renal pelvic puncture will not be possible!

A blurry black and white picture was displayed on the screen. At the same time, Brother Deng had just hung up the call with the laboratory.

"Hurry up, the inspection department has jumped in the line, and the results of the two items of infection have come out!"

Zhang Tianyang didn't turn his head back, "Say!"

　Thank you Nian Yishi Hongchen, Xiao Xiang Yeyu, and RTX440 for the rewards and popularity~ I love you all

　　

　

(End of this chapter)