My medical skills add experience

Chapter 490 Completely Different Fate, Touching the Threshold of Top Diagnosis

Under normal circumstances, nine out of ten people who are over 45 years old and have not been rated as a sub-high school are stuck in academics.

In this era of increasing emphasis on academic qualifications, even nurses now start with a bachelor's degree.

Most powerful nurses have postgraduate degrees.

Until now, many people look down on nurses, thinking that they can only give injections, change medicines, and do some waiting work.That's because most people's impressions are still in the past, and the nurses in the past were basically graduates from technical schools.

But so what?
Self-motivated nurses have already completed their undergraduate studies and postgraduate entrance examinations, and have become the best among nurses.Those who are not self-motivated and dawdling have retired or changed careers.

In today's large hospitals, the quality of nurses is already very high.

Ai Li is quite a different kind of existence in Tuya Hospital.

Tuya Hospital wants to build a general practice department, but it has been stuck in the ideal stage and has never really been implemented.

As a result, there are very few general practitioners in Tuya Hospital.

There are only two general practitioners who can reach the attending level or above in the emergency department, Ai Li and Director Lou.

Director Lou is currently a deputy senior professional title, and has become the department director of the emergency department.Compared with Ellie, she is a winner in life.

I heard that Director Lou also encountered the same embarrassing situation as Ellie.

You can't chew too much!

Engaging in general subjects sounds awesome, but the end result is that you can master a little bit in every subject.

Really just a little bit.

It is almost impossible to achieve a high level of medical skills.

Director Lou realizes that if he takes the route of general practitioner, it will be difficult to be awarded the title of deputy senior professional in his lifetime.He was eliminated by Zhongquan Keshi back then and entered the emergency department, and his own conditions were not particularly good.

But he was much smarter and more visionary than Ellie.

Not only after working for 11 years, he worked hard to obtain a postgraduate master's degree, but also specialized in respiratory medicine in order to evaluate the associate senior professional title.In the field of respiratory medicine, it should be the easiest to achieve results in many disciplines.

Director Lou works in the emergency department, and the rescue of all kinds of acute and severe patients and ensuring the smooth breathing of patients is the top priority.

Therefore, his specialization in respiratory medicine matches the nature of his work.

Needless to say later, Director Lou was successfully appraised as a deputy senior professional title, and even after the previous director of the emergency department was transferred, he succeeded like a dark horse.

It was said that deputy director Han and another retired deputy director were the most promising candidates for the head of the emergency department.

No one expected that Director Lou, a humble junior, jumped out to pick the peaches.

After Director Lou became the director of the emergency department, the deputy director surnamed He fell ill not long after I heard.It must be angry.

Deputy Director Han is a bit more firm, but he is definitely hostile to Director Lou.

It's just that how Director Lou cleverly resolved it and the two became close comrades-in-arms is unknown.

Director Lou is not a very good-looking person, but he is capable and resourceful.Even more, he has a long-term vision and great ambition. It is a good thing for him to be the director of the emergency department.

If Deputy Director Han Changqing had really been made the department director back then, it would be impossible for the emergency department to have the current situation.

It has to be said that sometimes a person's fate may be changed just because of a single choice.

Ai Li didn't have the courage and foresight of Director Lou back then, and in the end she was still an attending physician at the age of 50.

If nothing else, she will retire at the level of attending at the age of 55.

In terms of diagnosis and treatment experience, Dr. Ai Li is extremely rich.

What kind of patient could make her helpless?
Zhou Can followed the nurse to the emergency room.

From a long distance away, I saw a female family member lying on the bedside of the patient crying, and several other family members also looked sad and anxious.

Dr. Allie is doing various examinations on the patient.

At present, it should not be clear what caused the shock, so no emergency measures were taken rashly.

In the emergency department, the patient's death can be roughly divided into three processes.

Severe illness, shock, death.

Ordinary doctors will feel extremely flustered when encountering patients with shock, but for Dr. Ellie, this kind of scene can be encountered every day.It can even be encountered many times a day.

Tuya's emergency treatment volume is astonishing. Even if only one percent of the patients are in shock, several shock patients can be treated in one day.

"Doctor Ai, what's the matter with this patient?"

Zhou Can squeezed away the family members gathered in front of the portable emergency bed, and while greeting Ellie, he had already started to look at the patients on the bed.

"According to the family members, the patient had black stools for nearly a month. This morning, he suddenly had a nosebleed when he was having breakfast, and then lost his mind and fell to the ground. The family members worried that calling an ambulance would delay the condition, so they took the patient directly by their own car. Let's go to the hospital."

Ellie briefly introduced the patient's medical history.

Black stool means gastrointestinal bleeding.

The patient suddenly had a nosebleed while eating breakfast. Could it be upper gastrointestinal bleeding?

Zhou Can secretly observed the patient's appearance, his face and lips were pale and bloodless, he was still conscious, and the expression on his face was slightly painful.No rash or ecchymosis was seen on the neck, arms, etc.Sclera without jaundice.

He reached out and touched the patient's neck, and there was no obvious swelling of the superficial lymph nodes.

Thyroid is also normal.

Try to press the patient's chest, the patient has no obvious tenderness.

"The patient's body temperature is 36.7 degrees, pulse rate is 100 beats/min, respiration is 21 beats/min, and blood pressure is 90/70mmHg."

After Ellie checked the patient's basic signs, she informed Zhou Can.

The level of a doctor really doesn't mean whoever is older is better.

After Zhou Can came, she obviously regarded Zhou Can as the backbone.

"His blood pressure is obviously low. Have you taken a blood test? After you know your blood type, you have to ask the blood bank to prepare plasma. I think he will definitely need a blood transfusion." While Zhou Can was speaking, he was still doing a physical examination for the patient .

The level of doctors is sometimes mainly reflected in the details.

Also do physical examination for patients, some people may just go through the procedure according to the book.

A clever doctor can make a comprehensive diagnosis and judgment based on the patient's skin color, spirit, demeanor, body shape, chest and lung percussion, etc.

Normal blood pressure is generally around 120/80mmHg.

The patient's systolic blood pressure dropped to 90, which is already very dangerous.

If a blood test is done, Zhou Can can even deduce the approximate blood loss of the patient based on the hemoglobin.

The most urgent task is to find out the source of the patient's bleeding and find a way to stop the bleeding.

Otherwise, the bleeding cannot be stopped, and no amount of blood transfusion will help.

"Blood has been drawn and sent for examination!"

As expected of an old doctor, Ai Li is much more stable than the young Dr. Xie.

Zhou Can nodded and tried to press the patient's abdomen.

For digestive organ bleeding, the abdomen is the key object of investigation.

Because the human intestines and stomach are almost all in the abdominal cavity.

The patient's abdomen was still soft, and the patient didn't respond when pressed.

No obvious mass was palpable on the patient's abdomen.

But I heard bowel sounds and was quite active.

When Zhou Can pressed under the patient's xiphoid process, the patient immediately groaned in pain.

"Mr. Lu, give me a disposable finger-checking glove."

While speaking, Zhou Can picked up the patient's hands and checked them carefully.

"Doctor Zhou, what items are you checking the patient's hands?" The young female doctor standing next to Ellie was only 23 or [-] years old, quite young.

This is a newly recruited intern in the emergency department.

Because interns change majors frequently, Zhou Can sometimes doesn't bother to remember their names.

This female doctor was quite courageous, and dared to ask him questions on this occasion.

"Mainly check whether the patient has liver palms, spider nevus, and clubbed fingers, and whether there is redness and swelling in the knuckles and wrist joints. If you don't know which symptoms correspond to these characteristics, you can read the book after work and keep them in mind. In my heart. Because when encountering clinical first aid, there is no time to look up information and read books."

With a gentle tone, Zhou Can roughly explained the purpose of checking the patient's hands.

Right now, patients are waiting for help, so there is definitely no way to explain them in detail.

For some knowledge, novice doctors can only read more books and recite more.

There are too many knowledge points for medical students to memorize. If you can memorize a little more when you are young, you can memorize a little more.Then after work, continue to use it in practice, and gradually you can remember it very firmly.

The nurse handed Zhou Can a thin glove for finger examination.

After putting it on, Zhou Can took off the patient's pants and did a digital rectal examination directly.

If it is a female patient, the patient's privacy may be considered and the digital examination may be done in another place.Male patients have basically no preferential treatment in this regard.

In fact, when it came time to save lives, there was nothing to be hypocritical about.

Everything a doctor does is to save the patient's life.

After a digital examination, Zhou Can found that the patient's sphincter was tense, there were no internal or external hemorrhoids, and there was a little dark red blood on the fingertips.

The possibility of rectal bleeding can basically be ruled out.

Because if the rectum is bleeding, the blood on the fingertip will be bright red.

"Doctor Ai, would you like to give the patient an urgent chest X-ray and an abdominal ultrasound?"

"Strongly Agree!"

Ai Li has always been highly cooperative with Zhou Can in front of her family.

"I suspect that the patient is likely to have upper gastrointestinal bleeding. First, the chest and abdominal cavity should be excluded before considering emergency gastroscopy. Although he is basically in a state of shock now, judging from some of his symptoms, the bleeding should have become smaller. As long as you are prepared Good plasma should be safer."

Zhou Can definitely won't say anything about guarantees.

His hemostasis is now level six, giving him a huge benefit in the diagnosis.

Through various manifestations of the patient, we can basically grasp the actual situation of the patient's internal bleeding.

He just did a number of physical examinations on the patient in order to determine the approximate location of the bleeding, the current bleeding speed and the amount of bleeding.There is no way to make an exact estimate, only a rough estimate.

The patient was quickly sent for examination.

Accompanied by the intern female doctor who asked Zhou Can questions for the examination.

People are already in shock, and patients must not be allowed to queue up slowly.Such critically ill patients have priority in various examinations and treatments.

Because the purpose of setting up the emergency department is to save the lives of patients.

Dr. Ai Li pulled Zhou Can aside, and said in a low voice, "Dr. Zhou, I don't know anything about this patient. I'll delay you for a while. You can go to the operating room when the patient's condition is stable."

She knew that when Zhou Can entered the operating room, he often had to stay until after twelve o'clock before coming out for lunch.

Sometimes if you are too busy, you don't even leave the operating room for a whole day.

"Row."

Zhou Can readily nodded in agreement.

The old comrade opened his mouth, it must not be good to refute the other party's face.

Soon, the blood test results came out.

血红蛋白只有56g/L，白细胞计数是7.3*10的9次方每升。中性粒细胞0.87，淋巴细胞0.15，血小板132*10的9次方每升。

Fecal occult blood test, positive, three plus, white blood cells, positive.No insect eggs or amoeba trophozoites were found.

Urinalysis was negative.

It appears that the patient's bleeding was already heavy because his hemoglobin was low.

However, considering that the patient has had black stools for more than a month, the amount of bleeding this time may not be as large as expected.

how to say!

This bleeding was more like the straw that broke the camel's back.

Long-term continuous blood in the stool, has been dragged on, even if the body is a blood bank, it can't resist it!

"Doctor, is my son critical?"

The patient's mother is in her 40s and has been crying, with fear and tension in her eyes.

It was the patient's father who asked Zhou Can the question.

The dress of this family is no different from that of ordinary citizens.Should be a permanent resident of the city.

The family's financial situation may not be particularly rich, but it is not too bad either.

"At present, the blood loss is quite serious. Why didn't you send him to the hospital earlier? It took more than a month to come, and the heart is too big."

Zhou Can slightly blamed him.

But to scold family members, he generally doesn't.

"Oh, this kid didn't tell us either. After the child grew up, he seldom communicated with us. After the winter vacation, he knew to hide in the room and play games all day long, or go out with his classmates."

The patient's father shook his head and sighed again and again.

The 20-year-old son, who is sensible, can already take advantage of the holidays to work part-time to earn living expenses and reduce the burden on his parents.

If you are more willful, you will basically play games crazily with your classmates every day.

Maybe the patient has some slight physical discomfort and is too lazy to tell his parents.

As for the black stool, some people don't even know the color of their stool, and flush the toilet directly after going to the toilet.

Even if you see black stool and lack medical knowledge, you won't take it seriously.

"Isn't it because you beat and scolded your son at every turn, making him dare not tell the family anything! My son is like this, and you are still scolding him, woo woo woo..."

The patient's mother wept.

When the husband saw his wife crying like this, he didn't say anything.

Soon, the results of the chest X-ray came out.

There is no obvious abnormality.

It shows that the heart and lungs are basically normal.These two organs are the core organs for the maintenance of human life.One controls breathing and the other controls blood circulation.

Abdominal B-ultrasound results came out later.

B-ultrasound showed that the spleen was slightly enlarged, and no abnormalities were found in the liver, gallbladder, and pancreas.

Sure enough, it was similar to Zhou Can's diagnosis, and the bleeding location was probably in the upper gastrointestinal tract.

It seems that after his hemostasis technique is promoted to level six, it can indeed play a certain role in auxiliary diagnosis when encountering this kind of internal bleeding patients.

As long as he gradually accumulates richer diagnostic experience, he can also reach the diagnostic level of those top experts in the future.

Just by looking at the patient and looking at the medical history, you can basically deduce the focus of the disease.

He used to think that surgical skills could only be used for operations, but now that he was promoted to the director level, he was pleasantly surprised to find that surgical skills can be used in conjunction with pathological diagnostic skills.So as to achieve the role of auxiliary diagnosis.

He couldn't help feeling that the medical skill experience point system is really a good thing.

Without this system, it would be impossible for his medical skills to advance so quickly.

It is even more impossible to get the appreciation of chief physicians everywhere.

"Give him an emergency gastroscopy! The source of the bleeding can basically be located in the upper gastrointestinal tract."

Zhou Can said to Ellie.

(End of this chapter)