I'm really an intern
Chapter 5 Critical Illness
Chapter 5 Critical Illness
"Ok."
Zhang Tianyang responded, and opened the past medical records of 40 beds.
Bed 40, male, 36 years old, two years ago found that blood pressure increased, the highest systolic blood pressure can reach 180mmHg, did not pay attention, did not take medicine regularly.
One month ago, when the patient went to the toilet, he suddenly felt dizzy, his limbs were weak, he could not speak, and his back slowly slipped against the wall. One hour later, the family members found him and sent him to the local hospital. The specific treatment process is unknown...
"Only 36 years old, such a high blood pressure at such a young age?"
Continue to look down, there is a 5-year history of kidney failure and dialysis, and the frequency of dialysis is twice a week...
"Suddenly there is a bad feeling."
Zhang Tianyang finished flipping through quickly, pulled a piece of white paper and rushed to see the patient.
"Bed 40, here... eh? ICU?"
The Department of Nephrology has about 72 beds, 4 general beds, 4 VIP beds in a single room, and [-] beds in the intensive care unit.
Only the most critically ill patients are admitted here.
There was a thump in my heart, and the bad premonition magnified again.
The area of the intensive care unit is twice the size of the general ward, and the four beds are separated by special curtains. Zhang Tianyang rushed in sullenly.
"40 beds, Guo xx, I'm here to ask about the medical history, is that you?"
The head of the hospital bed was shaken by 45 degrees, and the elder brother with a dark complexion was half lying and half leaning, and reacted slowly for a long time after hearing the words.
"Ah? Ah...it's me."
I go!
Zhang Tianyang swears in his heart.
Premonition test!
Not only was this big brother slow to react, he even started rolling his eyes!
"Family! How long has he been slow to react like this and rolled his eyes weakly?"
The family member of Bed 40 is an old lady with gray hair, who is said to be the mother of Bed 40.
The old lady didn't realize that her son was dying, and she was still smiling.
"I don't know, he seems to be like this all the time."
I am special!
Opposite was an old lady with a wrinkled face, and Zhang Tianyang didn't want to be aggressive with her, so he could only ask patiently and slowly.
"When was the last time he had dialysis?"
"I don't know for sure. He manages his own affairs."
The little old lady was still cheerful, and Zhang Tianyang complained frantically in his heart, but on the surface he looked calm and spoke in a hurry.
"Brother Guo, when was the last time you had dialysis?"
"Huh? Dialysis... last week, last week... Wednesday?"
"Do you still remember the amount of dialysis you have each time? Do you know the approximate weight gain between dialysis?"
"I'm like, like, low sodium dialysis, amount, amount is..."
It is extremely difficult to ask about medical history, but these are important information closely related to treatment and management, so we have to ask.
"Your blood pressure usually fluctuates from a certain amount to a certain amount. Is there any medicine you have been taking?"
"..."
After finally asking the most critical information briefly, Zhang Tianyang decisively decided to deal with it first, and then asked the rest after the patient's condition stabilized.
"Family, I must tell you that the patient's current condition is not very good and needs to be dealt with immediately."
"I will bring some consent forms later, and you and the patient must sign."
Zhang Tianyang rushed to the nurse's station first, pulling the white paper with handwriting on it.
"Nurse sister, please set up intravenous access for bed 40. The patient came late but was seriously ill. I'm sorry to delay you from get off work."
Zhang Tianyang apologized when he added it with reason and evidence, and the nurse had no complaints about being forced to "work overtime".
"It's okay, I'll go now, have you issued a doctor's order?"
"It's in a hurry, I didn't have time to open it, don't worry, I'll make it up later!
By the way, please also give him the urgent blood test, six ions, liver and kidney function, and four preoperative items. I will make up the doctor's order, thank you! "
Zhang Tianyang's voice fell, and he had already walked quickly to the doctor's office.
"Sister!"
Senior sister Liang, who was about to get off work, was stopped by Zhang Tianyang, with a slight impatience on her face.
"Sister, bed 40 is a patient with kidney failure who has undergone regular dialysis for five years, twice a week. This patient has high blood pressure. The last dialysis was four days ago. Now he is not conscious. I think he needs dialysis immediately. Can I trouble you? Call the professor?"
No matter whether patients in the Department of Nephrology make an appointment for dialysis with a fixed bed downstairs or bedside dialysis, the professor needs to make an appointment in person.
If Zhang Tianyang didn't have Professor Liu's phone number, he really didn't want to trouble this senior sister who was so indifferent to him.
"Regular dialysis twice a week, the last dialysis was four days ago, is it okay? Are you in such a hurry? They are all off work!"
Senior Sister Liang frowned, "Junior Brother, I heard from them that you have only been in the clinic for a week, and there are criteria for judging the patient's state of consciousness. Have you done it?"
"Most of the patients in the Department of Nephrology need dialysis, and their illnesses are quite serious. Junior brother, you don't have to make such a fuss."
"Sister!"
Zhang Tianyang couldn't help raising his voice.
Of course, he could hear the implication of Senior Sister Liang's words. It was nothing more than that he felt that he was short of clinical knowledge when he first graduated, and he would make a fuss about a little ailment.
This is indeed a common problem that intern doctors cannot avoid. Many novice doctors who have just entered the clinic feel that the cases that are startled at first sight are actually trivial matters that do not need urgent treatment and can be relieved by themselves in the eyes of senior doctors.
But this patient is really serious!
"Senior sister, this way, you go to see the patient, if you think you really should do it, let's call the professor, if you don't think it is necessary, then I will buy milk tea for senior sister tomorrow to apologize!"
As soon as these words came out, Senior Sister Liang frowned.
Isn't this a blatant threat?This junior brother is too ignorant!
Senior Sister Liang sentenced Zhang Tianyang to death in her heart, but she turned around and walked towards the intensive care unit.
Of course, Senior Sister Liang did not forget to add, "You don't need to buy milk tea, I don't like greasy ones."
The implication is, junior brother, you must be making a fuss, and senior sister doesn't care about you, but she also refuses your kindness to make an apology. If there are such trivial things in the future, just get out of here and don't delay my mother from getting off work!
Zhang Tianyang was considerate of the patient, and he was not angry. He walked two steps quickly and raised his hand in front of Senior Sister Liang to help her open the curtains around bed 40.
The little nurse had diligently started to place intravenous access on the back of the hand on the 40th bed, which made Senior Sister Liang feel that Zhang Tianyang was making too much fuss.
On the hospital bed, the 40-bed brother's confusion seemed to be a little more serious, he couldn't even roll his eyes, and his eyes were almost narrowed.
Senior Sister Liang casually set her eyes on the hospital bed.
"40 beds, you..."
The last half of the sentence was swallowed in his stomach.
Don't talk about the criteria for judging the state of consciousness, this big brother is simply a problem that is visible to the naked eye!
"Senior sister, call."
Zhang Tianyang reminded her lightly, and Senior Sister Liang woke up instantly.
I saw Senior Sister Liang's aura of "I'm getting off work, I'm so lazy, I don't want to take care of things" all over her body suddenly changed, and she became serious in an instant.
"I'm calling Professor Liu now! Junior brother, hurry up and get the consent form! Remember to get your blood checked!"
(End of this chapter)
"Ok."
Zhang Tianyang responded, and opened the past medical records of 40 beds.
Bed 40, male, 36 years old, two years ago found that blood pressure increased, the highest systolic blood pressure can reach 180mmHg, did not pay attention, did not take medicine regularly.
One month ago, when the patient went to the toilet, he suddenly felt dizzy, his limbs were weak, he could not speak, and his back slowly slipped against the wall. One hour later, the family members found him and sent him to the local hospital. The specific treatment process is unknown...
"Only 36 years old, such a high blood pressure at such a young age?"
Continue to look down, there is a 5-year history of kidney failure and dialysis, and the frequency of dialysis is twice a week...
"Suddenly there is a bad feeling."
Zhang Tianyang finished flipping through quickly, pulled a piece of white paper and rushed to see the patient.
"Bed 40, here... eh? ICU?"
The Department of Nephrology has about 72 beds, 4 general beds, 4 VIP beds in a single room, and [-] beds in the intensive care unit.
Only the most critically ill patients are admitted here.
There was a thump in my heart, and the bad premonition magnified again.
The area of the intensive care unit is twice the size of the general ward, and the four beds are separated by special curtains. Zhang Tianyang rushed in sullenly.
"40 beds, Guo xx, I'm here to ask about the medical history, is that you?"
The head of the hospital bed was shaken by 45 degrees, and the elder brother with a dark complexion was half lying and half leaning, and reacted slowly for a long time after hearing the words.
"Ah? Ah...it's me."
I go!
Zhang Tianyang swears in his heart.
Premonition test!
Not only was this big brother slow to react, he even started rolling his eyes!
"Family! How long has he been slow to react like this and rolled his eyes weakly?"
The family member of Bed 40 is an old lady with gray hair, who is said to be the mother of Bed 40.
The old lady didn't realize that her son was dying, and she was still smiling.
"I don't know, he seems to be like this all the time."
I am special!
Opposite was an old lady with a wrinkled face, and Zhang Tianyang didn't want to be aggressive with her, so he could only ask patiently and slowly.
"When was the last time he had dialysis?"
"I don't know for sure. He manages his own affairs."
The little old lady was still cheerful, and Zhang Tianyang complained frantically in his heart, but on the surface he looked calm and spoke in a hurry.
"Brother Guo, when was the last time you had dialysis?"
"Huh? Dialysis... last week, last week... Wednesday?"
"Do you still remember the amount of dialysis you have each time? Do you know the approximate weight gain between dialysis?"
"I'm like, like, low sodium dialysis, amount, amount is..."
It is extremely difficult to ask about medical history, but these are important information closely related to treatment and management, so we have to ask.
"Your blood pressure usually fluctuates from a certain amount to a certain amount. Is there any medicine you have been taking?"
"..."
After finally asking the most critical information briefly, Zhang Tianyang decisively decided to deal with it first, and then asked the rest after the patient's condition stabilized.
"Family, I must tell you that the patient's current condition is not very good and needs to be dealt with immediately."
"I will bring some consent forms later, and you and the patient must sign."
Zhang Tianyang rushed to the nurse's station first, pulling the white paper with handwriting on it.
"Nurse sister, please set up intravenous access for bed 40. The patient came late but was seriously ill. I'm sorry to delay you from get off work."
Zhang Tianyang apologized when he added it with reason and evidence, and the nurse had no complaints about being forced to "work overtime".
"It's okay, I'll go now, have you issued a doctor's order?"
"It's in a hurry, I didn't have time to open it, don't worry, I'll make it up later!
By the way, please also give him the urgent blood test, six ions, liver and kidney function, and four preoperative items. I will make up the doctor's order, thank you! "
Zhang Tianyang's voice fell, and he had already walked quickly to the doctor's office.
"Sister!"
Senior sister Liang, who was about to get off work, was stopped by Zhang Tianyang, with a slight impatience on her face.
"Sister, bed 40 is a patient with kidney failure who has undergone regular dialysis for five years, twice a week. This patient has high blood pressure. The last dialysis was four days ago. Now he is not conscious. I think he needs dialysis immediately. Can I trouble you? Call the professor?"
No matter whether patients in the Department of Nephrology make an appointment for dialysis with a fixed bed downstairs or bedside dialysis, the professor needs to make an appointment in person.
If Zhang Tianyang didn't have Professor Liu's phone number, he really didn't want to trouble this senior sister who was so indifferent to him.
"Regular dialysis twice a week, the last dialysis was four days ago, is it okay? Are you in such a hurry? They are all off work!"
Senior Sister Liang frowned, "Junior Brother, I heard from them that you have only been in the clinic for a week, and there are criteria for judging the patient's state of consciousness. Have you done it?"
"Most of the patients in the Department of Nephrology need dialysis, and their illnesses are quite serious. Junior brother, you don't have to make such a fuss."
"Sister!"
Zhang Tianyang couldn't help raising his voice.
Of course, he could hear the implication of Senior Sister Liang's words. It was nothing more than that he felt that he was short of clinical knowledge when he first graduated, and he would make a fuss about a little ailment.
This is indeed a common problem that intern doctors cannot avoid. Many novice doctors who have just entered the clinic feel that the cases that are startled at first sight are actually trivial matters that do not need urgent treatment and can be relieved by themselves in the eyes of senior doctors.
But this patient is really serious!
"Senior sister, this way, you go to see the patient, if you think you really should do it, let's call the professor, if you don't think it is necessary, then I will buy milk tea for senior sister tomorrow to apologize!"
As soon as these words came out, Senior Sister Liang frowned.
Isn't this a blatant threat?This junior brother is too ignorant!
Senior Sister Liang sentenced Zhang Tianyang to death in her heart, but she turned around and walked towards the intensive care unit.
Of course, Senior Sister Liang did not forget to add, "You don't need to buy milk tea, I don't like greasy ones."
The implication is, junior brother, you must be making a fuss, and senior sister doesn't care about you, but she also refuses your kindness to make an apology. If there are such trivial things in the future, just get out of here and don't delay my mother from getting off work!
Zhang Tianyang was considerate of the patient, and he was not angry. He walked two steps quickly and raised his hand in front of Senior Sister Liang to help her open the curtains around bed 40.
The little nurse had diligently started to place intravenous access on the back of the hand on the 40th bed, which made Senior Sister Liang feel that Zhang Tianyang was making too much fuss.
On the hospital bed, the 40-bed brother's confusion seemed to be a little more serious, he couldn't even roll his eyes, and his eyes were almost narrowed.
Senior Sister Liang casually set her eyes on the hospital bed.
"40 beds, you..."
The last half of the sentence was swallowed in his stomach.
Don't talk about the criteria for judging the state of consciousness, this big brother is simply a problem that is visible to the naked eye!
"Senior sister, call."
Zhang Tianyang reminded her lightly, and Senior Sister Liang woke up instantly.
I saw Senior Sister Liang's aura of "I'm getting off work, I'm so lazy, I don't want to take care of things" all over her body suddenly changed, and she became serious in an instant.
"I'm calling Professor Liu now! Junior brother, hurry up and get the consent form! Remember to get your blood checked!"
(End of this chapter)
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