My medical skills are a billion points

Since the amount of bleeding is not too large, only conservative treatment with drugs is required.

At that time, the family members also agreed. Why did they ask to reduce the dosage after only two days?

It's really confusing.

Soon Xiao Chu and Gao Yingjun came to the patient's bedside.

After two days of treatment, the old lady has obviously improved mentally.

She has a broken rib on her left side, which doesn't hurt too much when she's inactive.

There was also no increase in subdural hemorrhage.

So in a situation like hers, if you continue conservative treatment, you can be cured.

However, if the dosage is reduced, it will definitely affect the therapeutic effect.

So Xiao Chu asked the patient softly: "Old lady, your current condition is not completely stable, and you need to continue medication. Although surgery is not needed for the time being, the dose of medication cannot be reduced.

If the drug is reduced, it will directly affect your treatment effect.Why do you insist on cutting down on your medication? "

The old lady's wife, also in his 70s, sat in front of the hospital bed without saying a word.

The old lady was silent for a while, and then said: "Doctor, it's not that I don't want to take medicine, it's because we have no money."

Xiao Chu was stunned for a moment, and asked: "Didn't you say you had medical insurance when you came here? This is an accidental injury, and the medical insurance can reimburse you!"

The old lady took a long sigh and said, "Doctor, you don't understand our situation. I am 72 this year, and now I have to go out to do odd jobs to earn money for the family. My wife also works all day long, so I don't have any idle time." .”

"Our family's money was taken away by my daughter-in-law. My son is a little lame, and he only married a daughter-in-law when he was in his 40s.

And he married this daughter-in-law and brought a child with him.All the money my son earned from working outside the home was taken away by his daughter-in-law, and nothing was left to us. "

"Once we asked her for money, she yelled at us.

So even if I have medical insurance, the money is not enough for medical treatment, doctor, I beg you.Take my medication and reduce it if you can.Otherwise, I will have to leave the hospital. "

It was so!

It's really hard to recite every family's scriptures!

Gao Yingjun also remained silent after hearing what the old lady said.

This kind of family reason caused the patient to request to reduce the dosage of medicine, and he had no way to do it.

I can only express sympathy in my heart, but the medicine really cannot reduce it.

And Xiao Chu and Gao Yingjun were in the same mood.

He thought for a while and said, "Old lady, I will try my best to reduce the cost for you, but the medicine still has to be used. Otherwise, it will be very difficult for you to recover."

Xiao Chu can only do this.

Try to minimize her medical expenses, but he has no right to exempt her.

Finally, the two walked out of the ward and returned to the office. Gao Yingjun sighed.

"It's really distressing to meet this kind of patients. The treatment is limited, but I have to sympathize with them. It's really helpless."

Xiao Chu said: "This kind of thing is probably not uncommon in our emergency department, so we can only try our best to help.

If there is really no other way, let her go back to the primary hospital for treatment, which can minimize the cost. "

Gao Yingjun nodded.

"we can only do this."

……

On Friday morning, after everyone had handed over their shifts, Xiao Chu led Gao Yingjun and others to make a ward round.

When he found ten beds, an 80-year-old lady.

Xiao Chu found that something was wrong with this patient, he was obviously short of breath and not in a good mood.

After Gao Yingjun explained the medical history, Xiao Chu knew that this patient was a patient with chronic heart failure.

When I came, I found bilateral pleural effusion.

Effusion is mainly caused by heart failure.

But there was not much pleural effusion at that time.

She was not drained of pleural effusion.

But now Xiao Chu looked, the patient was obviously short of breath and tight in chest.

He wondered if the pleural effusion had increased.

So he said to Gao Yingjun: "Push over our critically ill color Doppler ultrasound machine, and give her a thoracic color Doppler ultrasound to see if the pleural effusion has increased. Otherwise, why is the old lady's shortness of breath getting worse?"

Gao Yingjun nodded, and asked an intern to bring a color ultrasound machine to the intensive care unit.

He personally performed the bilateral chest color Doppler ultrasound for the old lady.

Surprised to find out.The old lady's bilateral pleural effusion really increased.

No wonder the old lady was obviously short of breath and chest tight when she spoke.

The accompanying family members also said that the condition of the old lady was obviously not as good as when she was admitted to the hospital.

Seeing that there were more bilateral pleural effusions on the color Doppler ultrasound, Xiao Chu said: "Handsome, this old lady has too much pleural effusion. Simply correcting heart failure and diuresis may not work. I think pleural effusion must be performed. Fluid drainage."

Chapter 265

Of course Gao Yingjun knew about this old lady's situation.

When I came here, the symptoms were relatively mild, and there was not much bilateral pleural effusion.

But after two or three days of treatment, the effusion not only did not decrease, but increased.

This also means that the treatment effect is not very good.

Simple diuresis certainly cannot remove all pleural effusion.

The best way at present is to perform pleural effusion drainage.

After Xiao Chu took a few people and checked their patients.

Gao Yingjun brought an intern, prepared the puncture equipment and came to the old lady again.

She's going to be drained for a pleural effusion.

The pleural effusion of this old lady is relatively more on the right side than on the left side.

If drainage of pleural effusion is performed, only the right side can be done.

The pleural effusion on the left side is slightly more than when it came.

However, if you continue to correct heart failure and diuretic treatment, it is still possible to clear it up.

You just need to increase the volume of furosemide.

As for small operations of this level, of course Xiao Chu would not participate.

Instead, Gao Yingjun led the interns to do it directly.

Before performing the operation, Gao Yingjun asked about the patient's condition, and only when he felt that he could tolerate the operation could he really proceed.

It was found that the old lady's asthma was indeed worse than when she came here, and her blood oxygen saturation was also showing a downward trend.

This shows that it is necessary to perform puncture and drainage of pleural effusion as soon as possible.

Pleural effusion drainage is a simple, basic operation that cannot be simpler.

If Gao Yingjun came to operate it, he would basically be considered overqualified.

But the interns under him were not capable of performing this operation, so he did it himself.

Although this is a simple minor operation that cannot be simpler, Gao Yingjun will still take it seriously.

He first did a good job of disinfecting the drape, and then punctured the upper edge of the next rib with 2% lidocaine to form a skin mound, and then entered it layer by layer, gradually injecting lidocaine.

Then, Gao Yingjun fixed the right midaxillary line and the sixth and seventh intercostal skin with his left hand, and inserted the needle with his right hand.

On the upper edge of the next rib, a needle is inserted at the site of local anesthesia until the sense of resistance disappears, that is to say, there is a sense of emptiness, and the needle is stopped.

Secure the puncture needle to prevent puncturing viscera and preventing air from entering the pleural cavity.

Then the drainage tube left outside was connected to the drainage device, and the pleural fluid began to be released.

Soon I saw pale yellow pleural fluid flowing out.

After putting about 700ml of pleural fluid, Gao Yingjun stopped.

Because the first time you put pleural fluid, it should not be too much, generally not more than 700 ml.

If the pleural effusion exceeds 700 for the first time, it is prone to hemodynamic instability or pulmonary edema.

For the second time, the pleural fluid can reach 2 ml.

After Gao Yingjun drained the pleural fluid, he pulled out the needle, covered it with sterile gauze, and stuck it with adhesive tape.

Soon the monitoring instrument showed that the old lady's blood oxygen saturation had risen.

And her shortness of breath has improved significantly.

Of course, since it is the first time to put pleural fluid, you can't put too much.

The effusion in the old lady's chest was not drained.

In her case, another drainage is needed the next day.

While Gao Yingjun was operating, he also taught the interns beside him from time to time.

This intern is a man named Ma Zhen.

He is an intern who just rotated over in September.

The previous batch of interns, including Wang Li and Liu Qing, were all transferred to the Department of Neurology.

Because the interns and regular training doctors of the Provincial Medical Center all rotate to one department for three months.

And Liu Qing and Wang Li have been in the emergency department for three months.

At the end of August, he was transferred to the Department of Neurology.

When the two left, they were reluctant to part with Xiao Chu.

He didn't even want to go to the neurology department, and always wanted to stay in the emergency department to study with Xiao Chu.

However, according to provincial medical regulations, interns must rotate departments for three months.

They couldn't resist, so they could only report to the neurology department resentfully.

Even if the two of them have already gone to the neurology department for rotation, it has been almost a week.

But every time the two of them are off duty, they will come to the emergency department.

Whether it's an intern or a training doctor, some people will develop feelings after staying in a department for a long time.

Even after the rotation, I will go back to the original department to have a look.

After Gao Yingjun performed pleural effusion drainage on the old lady, he asked Ma Zhen to observe the old lady for a period of time to see if there were any uncomfortable symptoms.

As soon as Xiao Chu finished seeing a patient, he heard a siren whistling.

He hurried out of the emergency department and found a very ordinary Santana parked at the entrance of the emergency department.

Soon, two strong men lifted a [-]-year-old crew-cut man from the car.

Seeing Xiao Chu hurriedly shouted: "Doctor, we are the police, my colleague was shot, hurry up and rescue him."

While one of the strong men shouted, he also showed his ID card.

gunshot wound?

It was the first time Xiao Chu encountered this kind of injury.

He hurriedly led the three of them to the emergency room, put the crew-cut man on the gurney, and began to rescue him.

Knowing that there was an urgent need to rescue patients, Gao Yingjun and others rushed over to help.

"What's the condition of the patient?"

Gao Yingjun asked.