Emergency Department Observation of Medical Records

In the past few days, Zhao Bin talked with the department the most about clinical professional issues.Which department is better? In the emergency department, there was a heated discussion. Even the director of the department, Zhou Qinjin, participated in the discussion.

"Orthopedics is good," Director Zhou himself used to be in orthopedics. "Our orthopedics department is divided into so many details now. Those who study the spine and joints are all very new and sophisticated disciplines. There are many new developments, and new technologies are also developing. Soon. People now have high requirements for quality of life and high requirements for limb functions, and these joint disciplines have great prospects in the future.”

"We also have a lot of new technologies in internal medicine." The second line below is not to be outdone and wants to compete, "There are many new technologies, new treatment options and new drugs on the tumor side. How fast are targeted drugs now! And Many chronic diseases can only be controlled by medical drugs, which is a big research prospect.”

"Indeed," Director Zhou nodded, "The development has been rapid in recent years. There are many new treatments in medicine and surgery, and the guideline is updated every year with new content. Have you read the new gout guideline this year? Or we will publish it tomorrow. Let Zhou Lu organize everyone to study?"

Zhou Lu sighed in pain: "Director, how can you come in time tomorrow?"

Zhou Qinjin said resolutely: "If you have time, you can download the guide and make a PPT. You don't need to make it look good. It's too late tomorrow."

"It's impossible!" Zhou Lu argued, "There are still patients and consultations in the ward during the day..."

Seeing that Zhou Lu's eyes were shooting death rays at him, Zhao Bin hurried out of the office to sit in the consulting room.

I finished half a day in the morning, took a break in the afternoon, and then started the night shift at six o'clock.

Around eight o'clock, a couple walked into the consultation room. The two looked like they were in their 50s. The wife looked numb and supported her husband.The husband covered his head and kept moaning.

"Uncle, what's wrong with that?" Zhao Bin showed his standard professional smile.

"Look for a woman to piss me off at night!" the husband said. "When I get angry, my head is dizzy and painful! I keep retching and vomiting!"

"Which part is the main headache?" Zhao Bin asked.

"The whole head hurts! It's dizzy and dizzy! I feel like I can't walk steadily!" The husband shook his head, "When I shake my head, it's like my brain is bumping back and forth!"

"Is the pain constant, or intermittent?" Zhao Bin continued to ask.

"It hurts all the time, but it's like a blood vessel is throbbing inside. The throbbing hurts so badly!" The husband pressed his head, "Hurry up, old woman! I'm going to vomit, I want to vomit... vomit..."

His wife opened the prepared plastic bag in front of him, and he spat a little into it.

"I vomited at home! I can't vomit anything now!" said the husband.

"Did you have high blood pressure before?" Zhao Bin asked while already reaching for the blood pressure monitor.

"Yes, I have had high blood pressure for more than ten years, and I usually take medicine!" said the husband. Seeing Zhao Bin's movements, he skillfully rolled up his sleeves. Had to pull out the whole sleeve to measure blood pressure.

Zhao Bin tied a blood pressure belt on him and measured his blood pressure: "204/112mmHg." He quickly took back the blood pressure monitor and said, "Stay in the emergency department, don't run around the patient, your blood pressure is too high now, you Blood pressure is so high, headache and vomiting are called hypertensive encephalopathy, you should go to the observation ward and lie down, and I will check you carefully in the ward to see if there is any problem with the blood vessels in your head."

"Did you hear that! Hurry up and do something!" The husband yelled at his wife.

"And don't get emotional!" Zhao Bin annoyed him yelling and talking to his wife in the consulting room, but this kind of person has a bad temper, and he couldn't irritate him too much, "Speak softly, this Our nurses and doctors will explain to my aunt what procedures to do, you go to the ward, just lie down and inhale oxygen to rest. Don’t talk, and don’t worry about how she will do things, okay? You are sick now, you just need to relax Rest, understand?" While talking, he arranged a bed in the ward for him.

Zhao Bin took people over to observe. There were many people in the ward. He asked the nurse to draw up the curtains all around to make the space smaller and more private.Oxygen inhalation, ECG monitoring, emergency blood test, antihypertensive drug pump, emergency head CT scan, a series of arrangements were made, and Zhao Bin checked his body more carefully and confirmed that there was no hemiplegia or other nervous system damage. He just came out of the ward and confessed a few words to the patient's wife.

"His blood pressure is very high now, so he must stay in bed peacefully until his blood pressure drops. Later, we will have a nurse pushing a wheelchair to take him for an emergency CT examination. You have to accompany him and help him out. Procedures Those can only trouble you to run away."

There was no expression on the wife's face, she didn't say a word, she just nodded and ran around to go through the procedures according to the hospital's instructions.There are quite a lot of people in the hospital at this point, and this wife is also a bit dull, so she ran back and forth several times.Finally, after ten o'clock, I took the patient back from the head CT scan. I heard the patient swearing and cursing along the way. The nurse couldn't help but persuade him twice. One was to tell him not to worry and keep calm; Too big, affecting other waiting and resting patients.Zhao Bin called to ask about the results of the CT room examination. The oral report showed that there was no hemorrhage and obvious infarction, and there was no obvious edema in the sulci. The basal ganglia had more lacunes.Zhao Bin breathed a sigh of relief, making sure that the patient's life was not in great danger tonight.But just in case something unexpected happened, he thought to himself, he should ask a neurologist for consultation.

At this moment, there was a sudden "boom" outside, and the people in the waiting area were all talking: "Hey, why did it fall down?" "What's going on?" "Oh, it's here all of a sudden!"

Zhao Bin hurried out to look, but saw the patient's wife lying on the ground just now.

"What's going on?" Zhao Bin ran over to look at the woman. The woman was lying on the ground with a pale face. Zhao Bin called her name a few times, but there was no response.

There was also movement at the nurse's station. All the on-duty nurses who were fine at the moment came over, and several of them carried the man to the emergency room together.Zhao Bin commanded: "The consciousness is probably already in a coma. Go to her husband personally, ask for the phone number of the child, and notify the child immediately. Has anyone seen how she fell down?" He yelled towards the waiting room.

"I saw! I saw!" Immediately, a kind person came over and said, "She was fetching water, and I watched her walk by, because my old woman told me to let me see, and I had to count where to fetch water. I just kept looking at her. There is really nothing wrong. At most, she might be a little weak. When she walked over, she suddenly fell down, and nothing else happened. As soon as she fell to the ground, you came over! The Affiliated Hospital of C University is Amazing, the doctor came to see me so soon. You are very kind! You are very responsible!"

Zhao Bin returned a polite smile, and hurriedly asked someone to take him away: "Forget about the formalities, monitoring, oxygen inhalation, blood pressure, and blood sugar are all tested first."

As he spoke, he put a stethoscope in to listen to his heart. "The heart sound is a bit weak..." He listened for a while, then raised his head.

The nurse was about to install the ECG monitor, when the clothes were pulled off, several women in the emergency room gasped. "Bastard!" Someone couldn't help but cursed out.

The patient's body was covered in large and small bruises.

Cold sweat broke out on Zhao Bin's body all of a sudden, and his heart beat faster.Almost immediately he noticed a fresh, red, swollen mark on his upper left abdomen.

"Don't worry about the clothes, just cut them all off! Look at the injuries all over the body, except for the bruises, and pay attention to whether there are any external injuries!" Zhao Bin began to pull down the patient's pants, exposing the entire abdomen. It looks a little bulging, which doesn't match the patient's thin appearance. "Take a blood pressure test quickly! It may be that the abdominal organs are ruptured and bleeding! Hurry up!"

The blood pressure belt was strapped on, and the button on the ECG monitor was pressed, and the sound of inflation began. It didn't take long, and everyone in the emergency room felt that it was too slow.

During this gap, Zhao Bin gave another instruction: "Go and call the boss, the second line, and the second line of medicine and surgery. You should notify the head nurse and the color Doppler ultrasound room to come over and do an emergency color Doppler ultrasound at the bedside. The patient is too dangerous. Someone is going to inform the family members that this patient may die, and the family members must arrive tonight, the sooner the better!"

The sphygmomanometer stopped, deflated, and waited for the data to appear. Everyone was so nervous that they dared not breathe. The young intern nurse's hands were shaking and she couldn't get the needle. Qiu Ting had to get her out to spread the word. A nurse who stayed longer gave the patient IV access.

Blood pressure cannot be measured.Zhao Bin shook his head: "Shock! Hurry up, one dopamine is pushed directly into the vein, and the four with 250 saline are released at full speed."

During this time, the second line of surgery came, and Zhou Lu also came in. I heard about the situation on the way, but everyone still clenched their fists in pain when they entered the door and saw the new and old injuries on the patient.Zhou Lu didn't ask any more questions, and urged the color ultrasound room to do bedside color ultrasound, urged the patient to call other family members, call the director, and continue to do the same thing.

The second-line surgery staff touched the stomach, and called for someone to turn the patient over together, and put the patient in a side-lying position so that they could look at it both before and after: "It's probably because the spleen has ruptured. But these things are also on the back, so I'm not sure." There are other organs inside, such as kidneys and other ruptures and bleeding. And it has been like this for many times for a long time, and the patient may have hemorrhagic anemia...Hurry up and get ready for blood transfusion. How long have they been since then? ?”

"I came here at eight o'clock," Zhao Bin recalled. "When I wrote the medical records, I remembered that it took more than two hours. Now it is four hours."

"There's still hope, there's still hope..." the second line of surgery said, before the blood comes, they will use the expansion one first, "Is the dextran department ready, come up first."

There was a tense atmosphere in the department. All the onlookers and nurses at the door were asked to leave the scene. The patients waiting for treatment were discussing the matter in whispers. Some patients even came out holding an infusion stand to watch the excitement.There was a roar from the observation ward: "She is just pretending to be sick! She pretends to faint and doesn't want to do anything! She has been like this many times! She just needs to be cleaned up!"

Zhou Lu ran over panting, and let go of the string of curses: "I called the patient's son and daughter, and they will come right away, but it will take more than an hour. The old man said...you all heard it. I Call the director right away...but it will take more than an hour for the director to come over."

"Children must come first. The old man is suffering from hypertensive encephalopathy. We don't regard his words as effective communication." The second line of surgery received Zhao Bin's command, "When will the color Doppler ultrasound come?"

"Just now, they said they would come right away." Zhou Lu replied.

"I'll call the operating room later, and prepare the table for emergency surgery," said the second line of surgery, "The family members better hurry up! Zhou Lu, please ask the director for instructions. If the family members don't call for approval after too long Can it be confirmed? Or if they disagree with the operation, can we ignore the opinions of the family members in order to save lives?"

"Okay, I'll ask right away." Zhou Lu went out to make a phone call after speaking.

The people in the color Doppler ultrasound room haven’t come yet. The blood pressure of the patient in the emergency room has just been measured at 40/15mmHg, and the heart rate has also slowed down, from about 105 beats/min at the beginning to 60 beats/min. This is not very good, everyone They all sullenly dared not speak.The nurse was busy drawing blood, and the second line hurried to fill in the blood form.The patient's life is already in danger.

The head nurse came first, and she didn't have time to change her clothes, and her hair was still messed up, so she went to the emergency room to see the patient.While cursing a few old bastards, he still went to the observation ward to see her husband with hypertensive encephalopathy, and comforted him for a while with nice words.The first thing I did when I came back was to call and report to the hospital’s general on duty. I first reported the matter to the hospital’s dispute office, and asked the legal department whether such an accident should call the police and notify the police station.While talking on the phone, I also arranged for someone to apply for a green channel number to enter the system, so that it is convenient for the doctor to issue medical orders and write medical records.After Zhao Bin received the instructions, he hurried out to make up the doctor's order and medical records, and completed all the paperwork.

"Blood pressure is still low," the surgical second line shook his head, "Let's push another dopamine."

As soon as the words were finished, the monitor alarmed, and there was no heartbeat on the screen, only trembling equipotential lines remained.