Emergency Department Observation of Medical Records

There is a full day off after the night shift.Zhao Bin slept the whole morning to replenish his energy.The morning is not the time for the biological clock to rest. He didn't sleep well. Even after two years in the emergency room, he still couldn't adapt to such an upside-down routine.He closed his eyes and rested in the bed in a daze, endured all kinds of noises outside the door, finally got up exhausted, and ordered some noodles for lunch.

Zhao Bin, who had not had a good rest, was in a bad mood. He lit a cigarette and sat in front of the computer, reading what he wrote last night.Only the background part was written, less than ten lines, too little, he read it several times, wanted to write but couldn’t hold back anything, finally heaved a sigh of relief, closed the computer in boredom, put out the cigarette, and went out Relaxed.

Zhao Bin went to a coffee shop in the city called "gettogether", a famous gay hangout.The boss told Zhao Bin that he actually meant "gaytogether".

Zhao Bin discovered that his sexuality problem was in college. He had a relationship with a college student of an art school. Later, the art student said that he wanted to pursue his dream, and the two separated.He is as gentle and gentle as his name to his patients, but he easily reveals his inner irritability to people he is familiar with. He knows that this is the reason for their breakup.When he fell in love, he explained his situation to his family, and the family never contacted him again.Even if he works in a top hospital like the Affiliated Hospital of C University after graduation, his family members are ashamed to have any contact with him.

There were not many people in the coffee shop in the afternoon, so he found a familiar seat by the window and sat down, basking in the warm sunshine in early March, feeling that the backlog of irritability in his heart dissipated a lot.Only then did he become a little interested to look at the other people in the coffee shop.

The coffee shop was remodeled from a previous dance hall. The overall design is American pastoral style, with bulky wooden tables and sofas, with half-old and peeled-off paint cabinets, and a few vases of dried flowers are decorated.The boss nodded to him from behind the cash register.Then nunuzui asked him to look at the other side.

There were a few young people sitting over there, looking at him with a smile on their eyes, and whispering something in a low voice, and then the people at the table burst into laughter.Zhao Bin picked up his gentle and elegant demeanor when he was seeing patients, smiled at them, and nodded in greeting.The young man over there was obviously fascinated by his appearance, and all the red faces shrank their heads and got together again.Zhao Bin knows that he looks good. His first love art student once joked that if he was asked to be a mannequin in school, the whole class would be excited.But he has been single for many years, and he has never raised his spirits to start a new relationship.It was too tiring to do projects when I was studying for a Ph. D., and it was even more tiring to work alone when I came out to work. I was too tired to have a relationship.

After an unsuccessful love affair, he felt exhausted all over his heart.

So after adding a few young friends, he threw his phone in his bag.

The March sun was just right. He tapped his fingers on the table and drank his coffee slowly.

"You don't like these students, either?" The shop owner sat opposite him, "It's not like the old love will be forgotten for so many years."

"Never forget the old love." Zhao Bin offered him a cigarette, and after being rejected, he lit one himself, "They are all students, what do they know?"

"Doctor, don't look down on me," the boss laughed. "I started my own business after graduating from high school. Why, don't you look down on me?"

Zhao Bin quickly waved his hands: "How could it mean that..."

The boss put the ashtray in front of him and stopped talking.Whether Zhao Bin looks down on others, they all know it well.

Zhao Bin is not a casual person, because he is not casual, so looking for a boyfriend is basically the criterion for choosing a spouse. He does not look down on anyone, but it is really difficult to chat with other young people with his profession and work.

The day shift was in turmoil early in the morning.An elderly female patient came in in a wheelchair, panting heavily.

"Doctor, doctor," the patient's daughter also panted anxiously, "My mother is an old patient of your cardiology department. She went to the bathroom this morning and suffered from heart failure again. Do you have a bed in your cardiology department? Get her sooner." Let's live in."

"What's the problem with her heart? What did our cardiology department diagnose before?" Zhao Bin didn't care about writing the medical records. He grabbed the stethoscope while asking and went to see the patient.

"Diagnosed by the Cardiology Department...the Cardiology Department said it was myocardial hypertrophy." The family member anxiously flipped through the plastic pocket in his hand and took out a file bag with a large stack of documents in it. "This is the document from the last time I was hospitalized in January. She I was hospitalized here only in January."

There was a rapid heart rate and obvious murmurs from the stethoscope, and there were moist rales in both lungs. The patient should have acute left heart failure induced by a lung infection.At this moment, the patient was so panting that he didn't say a word, his lips were slightly cyanotic, and his lower limbs were edematous, with depressions.Zhao Bin hurriedly pushed the wheelchair into the emergency room.

"Don't go to bed yet!" Zhao Bin yelled at the young intern nurse who came to move the patient, "Patients with heart failure don't go to bed yet! Get oxygen quickly! If you can't handle it, call your teacher right away!"

Nurse Qiu Ting heard him yelling from a long distance, and hurried over to connect the aerobic tube to the patient. She quickly instructed her students to do the simplest ECG monitoring, and she quickly inserted an indwelling needle to establish a venous channel.

"Give her a furosemide first." Zhao Bin put the oxygen saturation clip on the patient. The oxygen saturation will have to wait for a while, and he followed up with a series of instructions, "draw blood, check the blood routine, Coagulation, liver and kidney function, electrolytes, myocardial markers, blood gas, PCT."

At this time, the blood pressure and oxygen saturation came out, the blood pressure was 210/105mmHg, and the oxygen saturation was 91%.Zhao Bin stopped yelling at this time, and spoke in a steady voice: "Drip nitroprusside. Test your fingertip blood sugar." He turned his head and shouted to the door, "Did the patient take the antihypertensive medicine this morning? Where are the family members? "

The family members quickly came up to get the medicine: "I haven't eaten, we'll take it with me and give it to her right away."

"Let's eat." Zhao Bin waved his hand, and the family members hurried out to pour water, and he said to the nurse: "After furosemide is finished, give her morphine, and niprena drip to measure blood pressure every 10 minutes. You and you Learn from the teacher, don't lift the patient to the bed when he comes." After speaking, he touched the phone, found the boss of the cardiology department and called him. "It's me, you old patients in the cardiology department, with lung infection and heart failure, hurry up and see if there is any bed to transfer in."

Li Panqiu, chief executive of the Cardiology Department, sighed: "Pulmonary infection is the cause of heart failure. Can't we take the Respiratory Department? Our department has been an imaging patient recently..."

Zhao Bin interrupted her: "When will your department not be an angiography patient? How can I be admitted to the respiratory department for hypertrophic cardiomyopathy?"

"Okay, okay..." Li Panqiu was afraid that he would start yelling again, so he hurried to steady him, "Come and see right away."

The family members over there brought water and asked the elderly to take the antihypertensive medicine. Zhao Bin saw that the matter was almost handled, so he called the patient's family members aside and started talking.It is very serious, and the patient's condition is indeed serious. At this time, the worst must be explained to the family members for psychological preparation.

While talking, Li Panqiu also came, and checked his body with a stethoscope. After looking at the treatment, he added a few points, asked him to do a "piperacillin-sulbactam" skin test, and then came to ask family members and patients disease process.After thinking about the same as the two of them, the old man had a little cough a few days ago, but it was not severe, and he had no fever or phlegm. The family thought it was a common cold, and felt that he had just returned from the hospital. Special attention.This morning the old man got up to go to the toilet by himself, and he started to pant after he came back.Fortunately, the family members have already had experience in going to the hospital over the years, so they brought good things and came here without delay.

Li Panqiu took the discharge information and looked at it: "The EF value of the heart color ultrasound was 37% when I was discharged from the hospital last time, and the heart function is not bad..."

Zhao Bin glared at her.She sighed again, and said to her family members: "I will inform the head nurse of the cardiology department later, and Dr. Zhao from the emergency department here will issue an admission certificate for you, and will notify you as soon as you have a bed."

At this time, Qiu Ting came to the door of the consulting room and reported: "The blood pressure has come down, and it is now 183/95mmHg. The blood oxygen is still 92%, and the fingertip blood sugar was 4.7 just now. The blood has been pumped. Please hurry up and order me to take it." I got the barcode and sent it to the laboratory.”

"Continue at this speed. First follow the observation process, and the cardiology department will transfer when the bed is notified." Zhao Bin replied.All three people in the consulting room were relieved.

"The situation is like this." Zhao Bin sat back in front of the computer and began to write the observation records of the emergency department and make up the doctor's orders. "Okay, family members, let me ask you more carefully..."

In the morning, I saw 10 patients. Zhao Bin, a patient with heart failure, called the second line on duty in the emergency department to see him. The patient's breathing improved a little, and his blood pressure was more than 150 mmHg.Still unable to lie flat, I had to continue sitting in the wheelchair.Zhao Bin went over and listened, and his heart rate also dropped a little, but the heart rate was still regular.So I explained some things that the family members need to pay attention to. It is finally a busy morning, and I can go to the lounge for lunch with a little peace of mind.

The other three first-line workers in the day shift and the boss of the cardiology department all ate in the lounge.They are all box lunches from the cafeteria. The emergency department is too busy, so they are brought here for the nurses to pay for their travel expenses. There is nothing to choose from in the dishes, and they are all greasy and unpalatable.

"Is the patient with heart failure stable?" Li Panqiu asked, "I just came back, so I didn't have time to see it."

Zhao Bin nodded and said nothing.Enough talking this morning, he doesn't want to move his mouth at all now.

I buried my head in eating for a while, but there was really nothing to whet my appetite, and everyone ate slowly.The nurse outside came to remind that there was a patient, and the doctor who was scheduled to go in at noon today went out first.Others finished eating one after another and went out to get busy.Zhao Bin came in last, and now he is not in a hurry, he is still looking for something to eat.

"Did you go out after the night shift yesterday?" Li Panqiu asked him.

Li Panqiu was in the same class as him, and they had a good relationship since college.Zhao Bin didn't hide his sexuality from her.Li Panqiu doesn't have any colored eyes on him, but he is a bit like the three aunts and six wives at home, who likes to take care of his emotional life.

"Go to that gaytogether?" Li Panqiu knocked on his lunch box, signaling not to pretend not to hear.

Zhao Bin let out a "huh".

"Have you met a suitable one?" Li Panqiu asked.

"No..." Zhao Bin accepted her question as if he was tired and had to be interrogated, "I went in the afternoon, and those who didn't go to work or school were in the coffee shop, just waiting for a cheap partner. I only added WeChat and didn't want to meet."

"What nonsense are you talking about?" Li Panqiu was annoyed by his genius logic, "Just judge people without knowing each other. Why don't you go to the coffee shop and wait for someone to strike up a conversation without going to work or school in the afternoon. Come out, you are arrogant, Zhao Bin." She felt that she sighed a lot today, "Can't you get to know people well?"

Zhao Bin also sighed, was silent for a while, and nodded: "You are right, I think I am a bit arrogant."

Li Panqiu patted him on the shoulder. "Come here, I'll take a handsome photo of you! Send it out later, find a handsome young man for a date!"

Li Panqiu groomed him, took pictures, and used several filters.In the photo, Zhao Bin was wearing a white coat, with his professional smile that was always popular with patients, looking quite refined and handsome.

"I sent it to you." Li Panqiu sent him the photo on WeChat.

"Okay..." Zhao Bin clicked on the message, long pressed the photo, and prepared to forward it to a young man he met yesterday.Looking for someone in a row of conversations, there was only a small avatar displayed, and he chose an unfamiliar avatar that looked pleasing to the eye and sent it over.Then click it to see who it was sent to.

The square profile picture is just dark blue without any pattern, click in, and there is a conversation: Hello, Mr. Zhao, I am Luo Mingyao who helped you bring the barbecue to the emergency room early this morning... There will be a transfer later.

Zhao Bin cursed in a low voice, and quickly withdrew it.After such a fuss, I have no interest in posting photos of myself to flirt.He put away his mobile phone, threw it in his pocket and went out to continue seeing patients.

Luo Mingyao was playing on his mobile phone at noon, when a notification of new news popped up on the top.He clicked in and found that it was a picture sent by Mr. Zhao the day before yesterday. After loading it, it was a charming photo.

His heart was hit all of a sudden, pounding.

After he finished dancing, his intuition came up immediately.Mr. Zhao... like him... is gay...

Soon the photo was withdrawn, and he stared blankly at the phone, neither daring to ask Mr. Zhao why he sent the photo to himself, let alone why it was withdrawn again.He was still repeating the impact of Zhao Bin's photo in his head.

"It's so handsome..." He couldn't help covering his face and laughing.