My medical skills add experience

Chapter 475 One sentence untie the patient's knot, and take the patient away

It happens that I have to go to the cardiothoracic surgery department every day to help, and I will see Director Xueyan later, and I can ask her about the postgraduate entrance examination.

After the rounds in the emergency department, Zhou Can hurried to the cardiothoracic surgery department after eating in the hospital cafeteria.

Recently, he has always felt that someone seems to be following him secretly. For Su Qianqian's safety, Zhou Can told her not to come to the hospital to deliver meals.If time permits, he will go home and have dinner with her.

When I came to the cardiothoracic surgery room, there was a busy scene here.

Zhou Can's high-profile proposal to publicize the achievements of diagnosis and treatment has played a very good publicity effect.Even better than he expected.

Since a large number of experts and main nurses in cardiothoracic surgery were poached away, people in the department were in panic, and everyone was worried that the business of the department would plummet.As a result, in the past half month, the number of outpatient and emergency departments has not decreased but increased.And it continues to rise. Among the cardiothoracic surgery cases received every day, some difficult cases are gradually increasing.

There are even patients transferred from other hospitals.

"Dr. Zhou is here, that's great! There is a patient over there who complains of chest pain and dyspnea. Can you help me?"

When a female nurse at the nurse's desk saw Zhou Can's arrival, she was as happy as seeing a savior.

"A hospital patient or just here?"

Zhou Can asked.

It's past off-duty time now, and it's either a wild patient or a transfer from the emergency department.

For outpatients, as long as there are beds available, they will usually be hospitalized after the examination.

"The emergency department just notified the patient brought in by our department. After the intern Xiao Wang brought the patient, his superior doctor was still in the operating room following Director Xue to perform the operation. I heard that there was something wrong with the operation. I don't know when The two doctors on duty in Corey were afraid to pick up this patient."

The female nurse's surname is Luo, and I heard that she will be promoted to supervisor nurse this year.

She has a slight status in cardiothoracic surgery, especially after three chief nurses were poached away, her status has risen significantly.

You can see that she is very confident in her status when she directly calls the intern doctor Xiao Wang.

"Where is the patient?"

Zhou Can heard that it was rescued from the emergency department, so he judged that he might not have been checked yet.

After the off-duty time in the emergency department, patients with chest pain usually directly notify the doctors in the specialist department to take them away.Because the emergency department is not equipped to handle such patients.

If something happens, it will be another big trouble.

The fact that the patient was brought to the cardiothoracic surgery department indicated that after a preliminary understanding of the patient's condition, the emergency doctor determined that the patient probably needed surgical treatment.

There are also novice doctors trying to save trouble, as long as patients with chest pain who feel similar, they will be referred to cardiothoracic surgery.

Because internal medicine has two sub-departments of chest and heart.

"That's the gentleman!"

Nurse Luo took Zhou Can to a flat bed not far away.The patient clutched his chest, lying on a flat bed, staring at the ceiling with empty eyes.His breathing was very heavy, like a bellows.

Standing by the cart were two women, one old and one young.

The older woman was tear-stained and looked at the patient sadly.

The young woman is 21 and [-] years old, dressed very purely, like a college student who has just graduated from school, or is studying.Judging from her appearance, she should be the daughter of the older woman.

Face shape and facial features, the mother and daughter are quite similar.

"Where is your chest pain?"

Zhou Can asked the patient directly.

Because the person's eyes were empty and a little indifferent, it was quite scary to look at.Sometimes there is too much blood loss, and you are about to go into shock. This kind of eyes is most likely to appear.

The patient simply ignored him.

The mother and daughter next to her were worried about offending the doctor, and the older woman hurriedly said, "Son, where does it hurt, tell me quickly! Do you want to kill me?"

The patient's mother was really anxious and tears kept flowing.

"My brother only said that his chest hurts, and he seemed to have difficulty breathing, which was very scary. I was working in the company, and my mother called, so I hurried over and took him to the hospital with my mother."

The young woman told all she knew.

"How did you get sick?"

While examining the patient, Zhou Can asked the family members.

"He is my son. He is 28 years old. Not long ago, I was having dinner at home. I saw other people's children married early at this age, but he has never found a girlfriend. I also sleep at home during the day and go out at night at work. I don't care. I knew he was working, so I said a few words to him. Then he roared twice, and suddenly fell to the ground clutching his chest and screaming. Not long ago, he was coughing up blood, which scared me. Just such a son, if If something happens, how can I live?"

The patient's mother blamed herself more and more, and looked at her son with tears in her eyes.

Chest pain, dyspnea, and coughing up blood, these are the symptoms that Zhou Can has learned so far.

When examining the patient, Zhou Can tested the tenderness response.

Pressing the patient's left chest with a little force, the patient's face clearly showed a painful expression, and accompanied by coughing, blood was still coughed up.

There was no obvious tenderness response in the right chest.

Moreover, the patient did not say a word from the beginning to the end, and was indifferent to the doctor's treatment and the mother's crying.

"Has Mr. Luo measured his blood pressure?"

Zhou Can asked the nurse.

I usually call this kind of older nurses, especially those who work longer hours and have older qualifications, and can be called Teacher XX.Calling Nurse Luo directly in front of the patient will make people unhappy.

There is also suspicion of stepping down others and raising oneself.

When dealing with the relationship between doctors and nurses, doctors should be as humble as possible.Because the status, income, and prospects of doctors are superior to those of nurses, if they feel discriminated against in face, it will seriously affect their enthusiasm for work.

Many diagnosis and treatment tasks require the close cooperation of doctors and nurses to complete, and the importance of nurses is self-evident.

Patients and their families can look down on nurses and discriminate against this profession, but doctors absolutely cannot.

Not only can't discriminate against nurses, but also love them everywhere.

"Blood pressure 115/79mmhg!"

Normal blood pressure for adults is between 90mmHg and 140mmHg systolic and between 60mmHg and 90mmHg diastolic.This patient's blood pressure is normal.

Zhou Can breathed a sigh of relief.

Normal blood pressure can generally rule out acute and critical diseases of cardiovascular and cerebrovascular diseases.

Chest pain, chest tightness, dyspnea, and coughing up blood are very dangerous symptoms.

"Is the blood pressure in both arms the same?"

Out of caution, Zhou Can still needs to rule out high-risk factors such as aortic dissection and heart disease through some preliminary simple examinations.

"The blood pressure on both sides of the body is basically the same!"

Nurse Luo's ability is indeed good, as can be seen from these details.

When ordinary novice nurses measure blood pressure of patients, they often only measure one side.If the patient is a common disease, naturally there is no problem.But when the patient has symptoms of chest pain, an experienced nurse will measure the patient's blood pressure on both sides of the body.

Zhou Can checked the patient's forehead temperature with his hand, and it was normal.

When he checked the patient for tenderness just now, he was already silently counting the patient's pulse and respiration.

The pulse is about 100 beats per minute, there may be some error, but not too much.

The patient's heart rate is normal.

Once again ruled out the suspicion of heart disease.

The patient's breathing is about 40 breaths per minute.

The normal breathing rate of an adult is about 16-20 times per minute in a quiet state.Anything over 24 breaths per minute is considered tachypnea.Clearly, the patient had breathing problems.

When Zhou Can observed the patient just now, he found no obvious yellowing of the skin or bleeding, no swelling of superficial lymph nodes all over the body, normal facial features, and only slight cyanosis of the lips.

This is probably related to the patient's dyspnea, but judging from the degree of cyanosis, hypoxia is not serious.

Seeing this, Zhou Can felt a little calmer in his heart.

This patient cannot die temporarily, and the possibility of death if not rescued immediately can be basically ruled out.

He further checked the patient's pupils, the bilateral pupils were equal in size and had good light reflexes.It further explains that the patient's life is not in danger for the time being.

Be especially careful if your pupils are constricted, your light reflex is poor, and you have chest pains.

Such patients are extremely prone to death.

If a novice trainee sees such a patient, it is best to ask the superior doctor to make a judgment immediately.However, for ordinary chest pain patients, the superior doctors will not be so big-hearted that they will be completely handed over to the interns.

Usually, it will be checked first, and it is considered that it is not a high-risk fatal emergency, and then it will be handed over to the interns for exercise.

"Come on, let me see your neck!"

Although the patient's face was indifferent, he did not respond to Zhou Can's examination.

Zhou Can still tries his best to establish a preliminary relationship of trust with patients.A person's neck, head, waist, armpits, and private parts all belong to specific areas, and when touched by outsiders, they will instinctively generate repulsive emotions.

Men and women who have been in love will know that if they have a deep relationship with their boyfriend, the woman will enjoy the man's caress.Whether it's hugging, touching the waist, or ordinary private parts, they generally don't reject them.

But if she is patted on the butt, or hugged, or even just patted on the shoulder by a strange man, she will be particularly vigilant and may be disgusted.

After examination, the patient's neck was soft, without resistance, and there was no neck stiffness.

The jugular superficial veins were not distended, and the thyroid gland was also normal without swelling.

Out of caution, Zhou Can checked the heart area of ​​the patient again. There was no obvious bulge in the precordial area, and the heart circle was not large.

"Mr. Luo, borrow your stethoscope!"

"Give!"

Nurse Luo readily took off the stethoscope and gave it to Zhou Can.

After receiving it, he focused on listening to the patient's heart area. The heart rhythm was regular, the heart sounds were strong, and no murmur was heard.

It seems that there is no major problem with the heart.

This is strange, the patient's left chest pain was not caused by heart disease, so what could be the reason?
Associated with the patient's dyspnea, the lips were slightly cyanotic.

At that time, the patient had the above symptoms after being yelled at by his mother.

At this time, Zhou Can had already seriously suspected that something was wrong with the patient's lungs.

He pressed the patient's abdomen, flat, soft, no tenderness response.No rebound pain either.No hard lumps or tumors were touched in the liver and spleen area, indicating that there was basically no enlargement of the liver and spleen.

After examination of the patient's limbs, muscle strength was normal, and joint movement was also normal.

Originally, it was possible to test the patient's physiological reaction, but due to the patient's non-cooperation, Zhou Can tried not to do anything to stimulate the patient.

"Doctor, is my son's illness serious?"

"Everyone vomits blood, so it must be important. Young people are under a lot of pressure now, and you should try to give them some understanding in the future. When I was diagnosed just now, I saw thick calluses on the palms of your son, which means that he is not As you can see, he doesn't do his job properly and doesn't work well. On the contrary, he should work very hard at ordinary times, and he should work very hard."

Zhou Can said to the patient's mother.

Sometimes, children report good news to their parents but not bad news.Parents only make assumptions based on appearances, and it is easy to mistakenly think that what is wrong with the child.

In reality, kids work harder than they think possible.

"It was my fault, and I will correct it in the future." After hearing this, the patient's mother blamed herself even more. "Wow, my son, it's all about my mother's fault. I shouldn't blame you. Get well soon, and when you get home, my mother will cook something delicious for you."

She took her son's hand and rubbed the thick calluses on his hand.

After Zhou Can's reminder, she realized that her son had suffered a lot outside.It's not what she thought, sleeping during the day, hanging out at night, fooling around.

"mom……"

The patient was whimpering, with red eye circles, calling for his mother for the first time since his illness.

This also means that his hatred for his mother has disappeared, and the mother and son have opened their hearts.

"Hey! My good son, it's my mother who wronged you. Get well soon! I won't talk about you anymore." The patient's mother was very pleasantly surprised, and tightly held her son's hand.

The younger sister next to her was quietly wiping her tears.

Zhou Can has long been used to various touching scenes of relatives interacting, so he didn't fluctuate much in his expression.

"The patient's chest was symmetrical, no subcutaneous emphysema was found, the left chest was slightly raised, and the respiratory movement of the left lung was obviously weakened. There was a drum sound on percussion of the left chest, and the breath sounds of the left lung disappeared on auscultation. No dry or wet rales were heard. Breath sounds are normal. I recommend a chest CT scan immediately."

Considering that it is already off-duty time, there is usually only one doctor on duty in the CT examination room.

And it is shared by multiple departments.

Coupled with the shabby clothes of the patient's family, it can be seen that the family's financial situation is not very good.

In addition, the CT examination takes a long time.

Now what is the reason for the patient to cough up blood, it must be found out as soon as possible.

In order to save the examination cost for the patient and to shorten the examination time, Zhou Can thought for a while and changed his words, "Let's do a chest X-ray examination first! Don't do a CT scan yet."

The patient was given an application for blood routine and chest X-ray examination.

All that is left is to wait for the results of the inspection.

Zhou Can entered the office, logged into his personal department account, and then began to check some difficult cases pushed to him by Director Xueyan, Director Le and others.

Usually, the diagnosis of difficult cases is often consulted by multiple doctors.

Mainly to reduce misdiagnosis and missed diagnosis.

"Another patient with serious postoperative complications transferred from another hospital was admitted, and the operation was performed at Xinxiang Hospital. It seems that after a period of recruitment, Xinxiang Hospital has become very strong!"

Zhou Can found that the first difficult case that he asked for consultation was a postoperative patient transferred from Xinxiang Hospital.

This kind of patient is generally called a rotten patient.

Tuya is trying to improve its reputation by diagnosing and treating some difficult cases and rotten patients, so the threshold for admitting and treating such patients is much lower than usual.

This is also the high-profile suggestion made by director Xueyan and others in response to Zhou Can.

Xinxiang Hospital should not be able to perform this kind of thoracic surgery before, but now it is able to complete the sternotomy and reconstruct the chest wall, which shows that the surgical ability has improved very quickly.

It indicates that Xinxiang Hospital already has the surgical capability of a large hospital.

"Dean Tian is a pragmatic person. After experiencing ups and downs, she was reborn from Nirvana, which is obviously much different from the third hospital with a foreign signboard."

Zhou Can has dealt with Dean Tian of Xinxiang Hospital twice.

I was more impressed with this woman.

To be honest, when he was poached by Dean Tian two years ago, he never thought that Xinxiang Hospital would develop like it is today.

At that time, the Xinxiang Hospital was half dead, and it was already dying.

Even though many experts from the hospital were sent abroad for further study, in Zhou Can's view, that was the case.Can't change the overall situation.

No one could have imagined that that woman didn't play her cards according to the routine, and frantically poached people from other compounds.

Moreover, the digging of the entire department and the entire department was too ruthless.

This simple and crude approach has worked.

No wonder even the Third Hospital is following suit.

(End of this chapter)