Do nothing

According to the teaching syllabus, interns need to work night shifts with teachers.Ling Lu was put on the night shift the next day, and Yu Cheng was with him.However, Yu Cheng had an outpatient clinic this afternoon and did not come back until 05:30.

Everyone else has gone home from get off work, and today it's Yan Ke's turn to stay behind, and he can't leave until he finishes his shift with Yu Cheng.After the work was almost done, Yan Ke chatted with Ling Lu casually.

"Is Teacher Yu's outpatient clinic always so busy?" Ling Lu asked.

Yan Ke played with his mobile phone: "Well, he doesn't limit the number of general outpatient clinics, and he can only mix with experts. Do you have any taboos? I'll order takeaway first."

Ling Lu smiled and said: "I eat everything. By the way, I heard that Mr. Yu has just been promoted to deputy director, so can he go to the specialist clinic?"

"Yeah. But even if his number is limited, he will give people unlimited plus numbers. He is a workaholic, and the food is never delicious." Yan Ke ordered dinner for five people, and fruit, and then handed the phone to Ling Deer, said, "Look what drink."

Seeing that it was Starbucks, Ling Lu exclaimed, "Our department treats you so well."

Yan Ke said with a smile: "No, our group 1 is treated better."

Takeaway is here in no time.Yan Ke asked Ling Lu to call two nurses to show the classroom to eat first, while he was still sitting in the office playing with his mobile phone.Ling Lu saw that there were two portions of rice left, and asked again: "Teacher, don't you want to eat?"

Yan Ke said without raising his head, "I'll eat with Teacher Yu."

Ling Lu then returned to the demonstration classroom, and opened the takeaway with the two nurse sisters.Seeing that it was a high-end Japanese-style set meal, the two young ladies exclaimed in amazement, "As expected of Mr. Yan!"

Ling Lu also said with emotion: "Teacher Yan and Teacher Yu have such a good relationship."

The two young ladies looked at each other and laughed."They're a model couple," one quipped.

Ling Lu opened his eyes wide: "Ah?"

The other nurse smiled and said, "Don't fool the kid." Then she turned to Ling Lu and said, "They have known each other for many years. Isn't Yu Cheng the apprentice of Mr. Yan."

"I know this, but aren't the other teachers also students of Mr. Yan? I think Mr. Yan has a good relationship with Mr. Yu."

"Yu Cheng is Yan Lao's closed disciple. He is the youngest and has the best temper." The young lady came up and said in a low voice, "You will know after staying for a long time. Although Yan Ke is Yan Lao's grandson, his level is really not good. What's the matter. Mr. Yan left early, and he didn't learn much. He has a bad temper, and when he first came, Director Wang didn't dare to let him take patients. Fortunately, it's good to take him for the rest of the two years Clicked."

Ling Lu felt that eating other people's food and talking behind his back like this was not very nice, so he smiled awkwardly, broke apart the disposable chopsticks and handed them to the two nurses.The nurses also smiled and changed the subject.

The nurses ate quickly, packed up and went back to the nurse's station.Before Yu Cheng went to the clinic, Ling Lu touched the takeaway that was getting colder, and couldn't help feeling a little emotional.

Yu Cheng didn't come back until seven o'clock, and Yan Ke waited for him without complaint.Ling Lu found that their relationship was really good.

Yu Cheng is really a workaholic.After Yan Ke left, Yu Cheng sat in the office and began to read the medical records.Ling Lu suddenly remembered what Zhu Yunting had said before leaving.

"By the way, Mr. Yu, Mr. Zhu said that the patients in their 45 beds with respiratory failure are not doing well. Let us go and see more."

"Well, I know. Let's go to the ward rounds." Yu Cheng got up and took some medical records, "I just came back to tell you about respiratory failure."

This is Linglu's first night rounds.Doctors on duty need to go through hundreds of beds, especially for critically ill patients.Therefore, ordinary patients can be checked very quickly, just simply ask, after all, most of them are not in their first group.

Unexpectedly, just after finding more than [-] beds, the nurse suddenly ran to find Yu Cheng.

"Doctor Yu! 45 is manic!"

Manic?Mental symptoms? Isn't 45 the one with respiratory failure?

Unexpectedly, Ling Lu was a little excited that he would be able to experience rescue on the first night shift.Immediately followed Yu Cheng and ran to bed 45.

This is a fat elderly male.Ling Lu noticed that the hospital bed was raised very high, and the patient was sitting almost upright.He was breathing hard, fidgeting about, coughing now and then.Nurses and family members are putting him in restraints.

Yu Cheng put the medical records aside, immediately leaned over to confirm the patient's state of consciousness, and at the same time asked the bedside family members.

"When did it start? Have you eaten?"

The family members said they didn't know. They went to the toilet just now and saw the old man like this when they came back.

Yu Cheng asked a few more questions, but the family members could not speak clearly.Without much hesitation, Yu Cheng ordered the nurse to immediately adjust the oxygen intake to 8L/min, then pointed to the patient's collarbone and said, "Three concave signs."

This is for Ling Lu to hear.

The three-concave sign refers to the obvious depression of the suprasternal fossa, supraclavicular fossa, and intercostal space during inhalation, which is caused by inspiratory dyspnea due to partial obstruction of the upper airway.

Ling Lu was a little excited.It turned out to be exactly as written in the book!Three concave signs, so concave!

But...how to deal with it?

The most common cause of upper airway obstruction is foreign objects blocking the trachea, but now there is no food next to the bed, and the family members can't explain clearly, and it is not certain that the food is blocking the airway.

Could it be caused by primary disease?

Ashamed to say, Ling Lu only knew that 45 was critically ill, but forgot to read his medical records.And what Yu Cheng put next to the bed happened to be 45's medical records. He was overjoyed for a while, and immediately picked it up to look through it.It turned out that this was a patient with pulmonary heart disease,

Pulmonary heart disease is the abbreviation of pulmonary heart disease. Ling Lu hasn't reviewed this chapter yet, but only remembers that it is heart disease caused by pulmonary hypertension.Therefore, I don't know anything about first aid measures, so I can only watch Yu Cheng's operation with my eyes wide open.

At this time, Yu Cheng had already picked up the stethoscope, and after listening to the patient's heart and lungs, he said, "There are moist rales in both lungs, which is acute pulmonary edema." He handed the stethoscope to Ling Lu, and said to the nurse, " Furosemide 20, Dimi 20—did he take cedilan today? It’s the kind of medicine that the doctor gives you every day after measuring your heartbeat.” Having said this, his eyes turned to his family members.

Cedilan is a digitalis cardiotonic drug, but it can only be used when the heart rate is higher than 60 beats per minute.Zhu Yunting said when she entered the department for missionary education: The medicines in the ward are usually dispensed by the nurses, and only digitalis is dispensed by the doctors.

The family members were still bewildered.Ling Lu immediately turned the medical record to the page of the doctor's order, and handed it to Yu Cheng.Yu Cheng flipped through it quickly and said decisively: "I haven't used it today, so add GS0.4 to Cedilan 20, and push it slowly."

Ling Lu suddenly remembered that overdose of digitalis would lead to poisoning, if the patient had used cedilan today, he would not be able to use it now.

In fact, he also thought about taking cardiotonic drugs, but he completely forgot about digitalis poisoning.If you don't confirm it like Yu Cheng did, maybe it will aggravate the patient's heart failure.

After all, I have no experience...

Ling Lu looked at the calm Yu Cheng, and couldn't help but admire him.

The nurse was standing by the ambulance and had prepared all the medicines while he was talking.Yu Cheng suddenly reached out to untie the restraint belt, and shouted: "Little deer!"

Ling Lu understood, and quickly went around to the other side of the bed to take off the restraint belt as well.Yu Cheng pulled down the guardrail, picked up the patient's legs and moved them vigorously, letting the patient's lower limbs hang over the bed.

"This is?" Ling Lu was a little puzzled.

Yu Cheng signaled the family members to support the patient: "Dropping the legs can reduce venous return."

Sure enough, after the legs were put down, the patient's irritability was slightly relieved, but he still had obvious difficulty in breathing.The patient struggled uncomfortably, and the family members struggled to support him.

"Shouldn't you be given a sedative?" Ling Lu asked.

"Sedatives have a respiratory depressant effect, so the elderly and delirious people should use them with caution." Although Yu Cheng dismissed his opinion, he still showed approval, "But sedatives can indeed correct hypoxia. For example, morphine can Dilation of veins and arterioles also reduces return to the heart and relieves dyspnea."

Ling Lu suddenly realized, and quickly jotted it down in a small notebook.

At this time, the nurse has already pushed the first three medicines.The humming sound in the patient's throat became lighter, but it still sounded like phlegm.

Could it be pink frothy phlegm?Ling Lu recalled the typical signs of pulmonary edema mentioned in the book, but it was a pity that the patient only coughed, but did not spit out the sputum.

Yu Cheng observed for a while, and asked the nurse to apply some medicine.The patient seemed much better, and finally he stopped struggling and became more conscious.Ling Lu finally breathed a sigh of relief.

Yu Cheng was very calm.After transferring the patient to the ICU, he quickly finished writing the emergency medical records, with a calm expression throughout the process.

"Teacher Yu is so calm." Ling Lu couldn't help sighing, "As expected of the director."

"The more you see, the more you will be sure." Yu Cheng smiled and shook his head, "I really can't talk about the night shift. We are still talking about 45, and 45 will show you right away."

Ling Lu couldn't help laughing: "I was wrong."

"It's okay, you can go to the rescue." Yu Cheng looked at the time, "Oh, it's almost ten o'clock. Go to bed quickly."

Ling Lu blinked in surprise: "Hey, can the night shift go to bed so early?"

"If you have time to sleep, hurry up and sleep—" Yu Cheng smiled, and stopped talking for the rest of the sentence: Maybe he will wake up in the middle of the night.

Ling Lu smiled knowingly, but felt that his brain was in a state of excitement, and he couldn't fall asleep even if he lay down.Seeing that Yu Cheng didn't intend to rest, he said, "Teacher, why don't you explain it to me? I didn't understand the rescue just now. I know furosemide and misidilan. What is GS?"

"Come on, come over and read the rescue records." Yu Cheng moved the chair a little so that Xiao Lu could sit on it.Then he pointed to the course of disease he had just recorded, "GS is glucose water. For normal saline, it is NS. These are all abbreviations. They are used for dispensing medicine."

"Oh!" Ling Lu said pleasantly, "I've never heard of this in school!"

"How did you feel when you saw this patient at first?" Yu Cheng pulled up the medical records and asked Ling Lu to look at his admission records.

"Hmm..." Ling Lu recalled the scene when he first entered the ward, "First of all, he had difficulty breathing, and he had orthopnea, which shows that his heart is not functioning properly."

"Yes, what else?"

"Cyanosis and three concave signs are also symptoms of hypoxia, so the teacher immediately let him breathe oxygen."

Yu Cheng corrected: "He was already inhaling oxygen. Because of respiratory failure, his blood oxygen saturation has been low. I just asked the nurse to increase the oxygen intake. Do you know how to distinguish type 1 and type 2 of respiratory failure?"

Ling Lu chuckled: "I just read this. Type 1 is hypoxia without carbon dioxide retention, and type 2 is hypoxia plus carbon dioxide retention. Arterial blood gas analysis can identify it."

Yu Cheng just pulled the medical records to the patient's latest arterial blood gas results.Ling Lu excitedly pointed to the test results and said, "Oxygen is less than 60, carbon dioxide is greater than 50! Type 2 respiratory failure!"

"That's right." Yu Cheng nodded approvingly, "But you have to pay attention to the units. Our hospital uses millimeters of mercury, which is the same as blood pressure. You may see Kpa in other hospitals in the future, which uses kilopascals as the unit. , the diagnostic criteria are different, 80 corresponds to 8.0, and 50 corresponds to 6.7. This patient was first admitted to the hospital with pulmonary heart disease..."

Yu Cheng began to explain the diagnosis ideas in detail.Ling Lu listened carefully, trying hard to engrave his words in his mind.

I couldn't help but chuckle in my heart, as if being taken special care of by the teacher.

Xiaozao is delicious.

The rest of the night shift was very smooth, and both of them got a good night's sleep.You can only leave the night shift after checking the room.Yu Cheng asked Ling Lu to go first, and he explained to Yan Ke alone before returning to the dormitory.

I had a good rest last night, so after returning home, Yu Cheng started to look up the literature in high spirits.He has two papers on hand and plans to publish them together under Yan Ke's name this year.

The doctor's promotion route is inpatient, attending, deputy director, and director.There are requirements for the promotion of professional titles, but there are lengths according to academic qualifications.For example, if he graduated with a Ph.D., he can participate in the deputy director review as long as he has worked as an attending physician for more than two years; while Yan Ke has a master's degree, it will take four years.

When he thought of Yan Ke, his train of thought was interrupted.

Yu Cheng glanced at the time, it was a quarter past twelve.He suddenly remembered that he hadn't eaten lunch yet.Hungry is not hungry, but a little backache.He pressed the Yaoyangguan (Note) with his backhand, and the tenderness was obvious, indicating that his lumbar muscle strain had aggravated again.

This is not good.

He took his meal card and walked towards the hospital cafeteria, planning to find time to go to the acupuncture department or massage department, and ask his colleagues to do it for him.

The hospital's lunch break is from 11:1 to [-]:[-], and he has nothing to eat in the cafeteria at this time.In desperation, I had to go to the convenience store next door and buy some bread to deal with it.

While queuing up to check out, he unconsciously rubbed his waist, and suddenly someone laughed in his ear, "Director Yu, do you have kidney deficiency?"

Yu Cheng smelled a sweet scent of medicine and thought it was a colleague from the traditional Chinese medicine pharmacy, but when he looked back, it was Zhang Xingduan, so he joked, "You're right, kidney-deficiency lumbar muscle strain. Can I report a work-related injury?"

"I can't report this, I can only register and jump in the queue for you." Zhang Xingduan glanced at the cash register with a smile, "Hey, is this your lunch?"

Yu Cheng smiled and said, "It's late to the cafeteria, there's nothing I can do."

Zhang Xingduan slapped the chewing gum in his hand on the cashier counter, and said briskly, "Let's settle it together. I'll treat you to this meal. Director Yu, please don't be polite to me."

Yu Cheng feigned surprise and said, "My God, I'm so embarrassed that Mr. Zhang is so generous."

The two looked at each other and smiled.

When Yu Cheng returned to the dormitory, he caught a cold and dealt with the bread for nothing.Suddenly, I received a WeChat message from Zhang Xingduan, asking him if he would go hiking outdoors on weekends.

"Just the two of us."

Yu Cheng glanced at the schedule, Yan Ke was on duty on weekends, so he replied: "Okay."

Note: Yaoyangguan, the name of the acupoint.Published "Su Wen · Bone Empty Theory".Also known as Jiyang Pass, Beiyang Pass.It belongs to the governor vessel.In the waist, on the posterior midline, in the depression under the spinous process of the fourth lumbar vertebra.