My medical skills add experience

Chapter 590 Hospital version of the forensic doctor, the truth of the cause of death emerges
Now that everyone is dead, if you want to find out the cause of death without an autopsy, this will undoubtedly greatly increase the difficulty of diagnosis.

Zhou Can often finds it difficult to diagnose a living person, but this is the first time to treat a dead person.

Facing Qin Yuanzhu's hopeful gaze, Zhou Can finally chose to try.

"Let me try! It's just that you also know that after the death of the patient, it is no longer possible to provide a lot of meaningful diagnostic data, so please don't have too much hope."

Zhou Can took on this difficult task.

After a person dies, all symptoms disappear, and key references such as blood pressure, respiration, heart rate, and body temperature all disappear.

This is very detrimental to the diagnosis.

It can only be comprehensively inferred based on some nursing records left by the patient during his lifetime, films taken, and symptoms described, combined with symptoms at the time of death and some manifestations after death.

"I understand this! Let's do our best. If it doesn't work, if the family members don't accept our opinion, then we can only suggest that they go through the judicial process, autopsy!"

Assistant Qin nodded.

Director Shi from the Infection Office looked at Zhou Can meaningfully.

"Our first group encountered this kind of death before, and we were able to quickly find out the cause of death almost every time. After Lao Song left, this ability of the first group was interrupted. Now you have taken Lao Song's seat, I hope you can Let’s develop more in this direction.”

Zhou Can was full of curiosity about the old Song mentioned by Director Shi.

"Who is Lao Song?"

he asked casually.

"A bed doctor with rich clinical experience, later joined our quality control department. He started as an ordinary member of the fifth group and finally entered the first group."

When director Shi mentioned Lao Song's past experience, he showed admiration.

From his words, it is not difficult to hear that the five teams in the quality control department actually have a level difference.The highest status should be the first group, and the lowest status should be the fifth group.

Zhong Hui, the team leader who once dealt with Zhou Can, which team it is?

Being able to be the group leader, and Xin Wanshan, the chief of the medical department at that time, was very respectful to him, so his status must not be low.

Zhou Can and Zhong Hui are colleagues in the same department now, and if they meet each other, will the other party feel embarrassed?

But the events of those years have long passed, and Zhou Can is not the kind of person with a small stomach.

Definitely not holding on to it.

He has just joined the quality control department, and there must be many hospital leaders staring at him.If he took revenge on those who suppressed him as soon as he took office, it would only cut off his bright future.

"After Lao Song entered the quality control department, considering the needs of his work, he studied forensic medicine by himself, and later went to the criminal police team for a period of further study. After returning, he showed a very high talent in forensic medicine. Moreover, his forensic research direction and criminal investigation Different, he specializes in the study of the cause of death of patients who died in clinical treatment. As long as a patient dies in the hospital, ask him to go and have a look, and the cause of death can often be found out very quickly.”

"At the beginning, the family members didn't trust his deduction results. After applying for an autopsy, it was almost exactly the same as Lao Song's deduction. Later, Lao Song became the hospital's version of the forensic doctor. Not only did the patients in our hospital die, but Ask him to analyze the cause of death, and when the need arises in other hospitals, he will also be hired at a high price. Your clinical talent is very enchanting, and you can learn from Lao Song and study forensic medicine. After joining the quality control department, naturally you must do this job wholeheartedly Work."

Director Shi tried his best to let Zhou Can follow the development path of forensic medicine.

And it's a hospital version.

Whether the intention is good or bad is hard to judge.

Zhou Can has his own dream, and it is impossible for him to give up chasing his dream for a job in the quality control department.

What people fear most is half-heartedness.

And he thinks that being a clinician is more promising than being a hospital version of a forensic doctor.

Forensic medicine is the identification of the cause of death of a patient.

Clinicians save living patients, save fresh lives, and relieve patients' pain.This must be much more meaningful than being a forensic doctor.

"Thank you Director Shi for your suggestion, I will consider it carefully."

Zhou Can replied with a panacea-style formula.

He stopped wasting time and began to pick up the patient's diagnosis and treatment records and examination reports to check carefully one by one.

In fact, I've seen it once when I was outside.

Only this time, look more closely.

And the focus is different.

When checking in the ward, it is mainly to find out whether there are irregularities in the diagnosis and treatment process of the doctors and nurses in the Department of Gastroenterology.Now it is time to find the cause of death of the patient.

The patient's stool routine was checked before hospitalization, and occult blood in the stool was negative.

It shows that gastrointestinal bleeding can basically be ruled out.

But before the patient died, he suddenly vomited a lot of blood, and his abdomen was distended like a drum. All the signs indicated that the patient was likely to have gastrointestinal bleeding.

And the high probability is upper gastrointestinal bleeding.

"Did the patient defecate before death?"

"No! It's already difficult for him to defecate. After he needs to use Kiselu, let the nurse help him dig it out with his hands."

The attending doctor replied.

Nurses are an absolutely respectable job, and they are more like unsung heroes who pay silently.When the patient's disease is cured, the credit belongs to the doctor, and few people mention the nurse.

However, all kinds of nursing and medication during the patient's hospitalization are performed by nurses.

Only a small number of medications are operated by doctors in charge of the bed.

A nurse is more like a virtuous minister, while a doctor is a king.

Picking up stool for patients, if there is a male nurse, is usually performed by a male nurse.However, male nurses are scarce talents, and many departments have no male nurses at all.

All kinds of arduous nursing tasks fell on female nurses.

One by one, they eventually turned into female men.

In the inpatient ward, they help bed doctors or interns lift patients onto flat beds and send them to the operating room or for some important examinations. In the ICU, they help patients feed liquid food, turn over, and deal with feces and urine... As for ordinary injections and dressing changes, these are just their most basic daily operations.

Now that the patient died, the nurse in charge was called to be investigated together.

Zhou Can looked at the young female nurse opposite with teary eyes and a frightened expression, and couldn't help but feel sorry for her.

Especially when I heard the attending doctor say that the patient's stool was picked out with her hands.

This is a worthy heroine.

"Have you been caring for the patient who died?"

Zhou Can cast his eyes on the female nurse.

"Ok!"

She bit her lip and nodded heavily.

The tears in the eyes seemed to be squeezed out at any time.

When she looked at Zhou Can, there was a hint of deep gratitude in her eyes.

Because at the beginning, Director Ju Shiman of the Nursing Department and Director Shi of the Infection Office of the hospital thought that the urinary catheter was not inserted correctly, which caused the patient's urine to be unable to be discharged, which caused the death.

Indeed, if you can't urinate all the time, it will really kill you.

But with the current medical level, this kind of thing rarely happens.

If it is really impossible to urinate, basically as long as it lasts for more than a day, the patient will rush to the hospital for treatment.Once a doctor has identified the cause, there are several ways to help the person pass urine.

It is not just a method of inserting a urinary catheter, such as creating a fistula from the waist and hanging a urine bag on the body.

If the male urinary catheter collapses and is blocked due to inflammation, dilators can also be considered.

There are various specifications.

Dilated catheters are sour, but they work.

Zhou Can deduced that the patient's death had nothing to do with the placement of the catheter, which helped her clarify her grievances.She was full of gratitude to Zhou Can in her heart.

"Don't be afraid, Ni has done a great job in clinical care, especially the behavior of picking up stool for patients. He is very brave and dedicated."

Zhou Can first fully affirmed and praised her work.

After hearing this, she was very pleased.

Nodding vigorously again.

"Thank you! Thank you for judging me like this!"

"Excuse me, what's your name?"

"Luo Xiao!"

"Mr. Luo, when was the patient's last bowel movement?"

A doctor is called a nurse. If you have a professional title, the deputy chief nurse, or the chief nurse, or the head nurse, you can directly call a certain director.Those who do not have a senior professional title or position are generally respected by a certain teacher.

However, in recent years, the term "teacher XX" seems a bit unfriendly to non-educational female practitioners.

Because many AV actresses in the island country are called so-and-so teachers by the male compatriots.

The job of a nurse is quite special, and it is also easy to cause misunderstandings.

In the hospital, many directors don't like others to call themselves teachers, and this is also the reason.

Of course, this reason is only part of the story.

The main reason is human vanity. Everyone generally thinks that the director is more advanced and better-sounding than the teacher.

"Uh... it should be two days before the patient's death. On the evening of the 19th, the patient kept saying that his chest was a little tight and his stomach was bloated and painful. I helped him defecate once."

Nurse Luo Xiao replied.

After Zhou Can heard this, his heart moved slightly.

As a cardiothoracic surgeon, he is extremely sensitive to the symptoms of many diseases in the field of cardiothoracic surgery.Hearing that the patient has chest tightness, other medical staff may ignore it.

Zhou Can thought that the patient vomited a lot of blood before he died, and the medical staff had no time to rescue him, so the patient died directly.

Make a bold inference, does the patient have cardiovascular disease?
For example, aortic dissection, especially ascending aortic dissection is the most dangerous.Or an aortic aneurysm.

It's just that even if the aortic dissection ruptures, the bleeding will accumulate in the chest and abdominal cavity, and it is impossible to vomit directly from the mouth.

Most patients with ruptured aortic dissection present with an acute onset of severe chest pain.

The nature of the pain is mostly knife-like, needle-like, or tear-like. It is usually persistent and unbearable, and treatment with opioid painkillers is often ineffective.

However, she mentioned that the patient had experienced chest tightness, which is an important clue.

"Before the patient died, was Teacher Luo present?"

"I was there, I happened to be on the night shift today! After the family member rang the bell, I immediately ran to the ward to check. The patient's blood pressure was very low at the time, and I realized something was wrong, so I immediately called the doctor on duty and called the person in charge Doctor Wang in charge."

When she mentioned the scene at that time, she still seemed to have lingering fears.

Watching a life disappear with their own eyes, even for medical staff who are used to seeing death, every time they see it, it will still bring great spiritual pain.

Female medical staff are generally more fragile than men.

Seeing patients die in person often has a greater impact on them.

"The patient's blood pressure was very low at that time?" Zhou Can couldn't help but suspect that the patient might have aortic rupture and bleeding. "Did you notice the physical characteristics of the patient at that time? Did the patient show symptoms similar to shock, such as pale face, sweating, and clammy skin on the limbs?"

Zhou Can asked.

If it is really ruptured aortic dissection, patients generally only have symptoms similar to shock, but rarely true shock.

Most die within a very short time.

It can also be understood as death before shock.

"Hmm... At that time, his face was indeed frighteningly pale. I didn't pay attention to whether he was sweating. When I took his blood pressure, the skin on his arm seemed to be a little clammy. At that time, I saw that the patient's condition was not good, and I was very nervous. These details Didn't pay much attention."

She said with some embarrassment.

For most young medical staff, when they see a patient's critical condition, they often behave like this.

Nervous, anxious, and only thinking about saving people quickly.

Fear that the patient will die by his own hands.

Zhou Can has also been trained in the Department of Critical Care Medicine for several months, so he can deal with all kinds of emergencies calmly.

When he was in the critical care medicine department, Vice President Ye personally arranged for him to train for a period of time.It has brought great benefits to his whole life of practicing medicine.

Among the school-level leaders, although Zhou Can has certain connections with Dean Zhu and Vice President Bai, deep down in his heart, he is closest to Vice President Ye.

It's hard to say, but from many details, it can be found that Vice President Ye is really good for him and considers him in every way.

"The patient had an abdominal CT at that time, and the film should be archived. Can you call it all now?"

"No problem, I will contact the medical technology department immediately."

Director Shang highly cooperated with Zhou Can's request.

In the past, Zhou Can studied with him and was regarded as his student.Also his subordinates.

But now Zhou Can has grown beyond him.

After having an administrative position, Zhou Can is already a leader.

Of course, this leader has water.

Because he is still just an ordinary member of the quality control department, and has not held any leading cadre positions.

"Dr. Zhou has made a major discovery?"

Deputy Chief Xiong of the medical department asked aloud.

"That's right! I suspect that the patient's death was caused by aortic rupture and massive hemorrhage."

Zhou Can doesn't dare to be too sure now.

Because there are still many doubts that have not been solved.

"Aortic rupture and massive bleeding? It should be ruled out, because the patient vomited a lot of blood before dying, which is more like death from upper gastrointestinal bleeding." Director Shi retorted from the side.

"Under normal circumstances, this is indeed the case. But everyone's body is different. For example, the heart of a normal person grows on the left side, but there are also people with heterocentric positions whose heart grows on the right chest cavity. Even in clinical practice, I encountered a case In a very special case, the heart grows in the abdominal cavity. Therefore, everything is possible."

Zhou Can talked eloquently.

The gradually enriched clinical experience made him more confident when dealing with such things.

Only by being well-informed can we break the conventional solidified thinking.

　I am very grateful to all the readers for their support all the way, to speed up the progress of the plot, to finish writing a few climaxes, and strive to finish the book this month.I was criticized...

　　
　
(End of this chapter)