Emergency Department Observation of Medical Records

March passed quickly in the alternation of cold and heat. There were a lot of cold patients in this month. The emergency observation room was full of patients with cough and fever, and the respiratory department was also full. The registration office of the Affiliated Hospital of C University began to kindly advise patients to go to the community or lower-level hospitals as much as possible.After March and April, the weather gradually warmed up, and the raging upper respiratory infection finally slowed down.

On Monday morning, during shift time, Zhao Bin saw a familiar figure again.

Luo Mingyao glanced at him, lowered his head and blushed.

Zhao Bin was inexplicably surprised by his look.

"These are the three new students from the internship." After the class was over, the secretary of science and education pulled the three interns out to the whole department, "Introduce yourself."

The tall boy standing at the front took the initiative to introduce himself: "Director Zhou, hello teachers, my name is Huang Baihuai, and I am a five-year student in the medical school of C University. This year, I am in the second semester of my senior year. I hope to greet you in the emergency department. The teacher learns and masters the management of clinical emergencies."

Director Zhou of the emergency department nodded and applauded, and the rest of the department also applauded this young man. Everyone had a good impression of Huang Baihuai.

Then the girl on the other side stood up: "Hello, teachers, my name is Zhu Zhenzhen, I'm in the same class as Huang Baihuai, and I'm also in the five-year school. I will study hard in the emergency department without fear of hardship or tiredness!" The voice of the girl said Lively, also won the favor of department doctors.

Luo Mingyao was the last to stand up, blushing with nervousness: "Hi teachers, my name is Luo Mingyao, and I have been clinical for five years. I hope to study hard with the emergency teachers."

The applause for him was obviously not as enthusiastic as the previous two.

Director Zhou also talked about some requirements for interns, and what should everyone do after the shift is over?

Zhao Bin went to the consulting room and sat down, and began to see patients.

After a while, the secretary of science and education brought Luo Mingyao over and introduced him: "This classmate Luo Mingyao will follow you from now on."

Zhao Bin hurriedly logged into the system and nodded to show that he knew.

The secretary of science and education tapped the folder in his hand again: "I have all the evaluation forms for the interns here, and I will type them for attendance, and finally ask them to hand over the observation records of our emergency department when they leave the department. You need to find the medical records and let him Write. In the end, there will be someone who will give you a grade." Looking at Zhao Bin and nodding seriously, he handed over the document with satisfaction, "Mr. Zhao, I have explained everything to you, sign it."

Zhao Bin grabbed a pen and signed.The science and education secretary over there took care of Luo Mingyao again with a loving voice: "Xiao Luo will study hard with Mr. Zhao in the future. Mr. Zhao is a doctor in our emergency department, very good." After finishing speaking, he patted the student like an old mother shoulders.

Zhao Bin raised his eyes and looked at Luo Mingyao. The young man stood like a primary school student seeing his class teacher, his face was still red.Zhao Bin felt that he hadn't released his aura this morning, so he wouldn't scare the child like this. He was a little surprised, but couldn't help but withdrew his temper, and said with a professional smile like treating patients: "The emergency department is more difficult. How long have you been in our department?"

"One month." Luo Mingyao quickly replied.

"All for internal medicine?" Zhao Bin actually knew the arrangement of the interns, and remembered that he had scolded and cried students before, and now he wanted to restore his reputation, or say a few more words to make a good impression.

"Two weeks for internal medicine and two weeks for surgery." Luo Mingyao replied politely.

Zhao Bin beckoned him to sit in front of the computer: "Start seeing patients later, you operate the computer. Ask me if you don't understand, the emergency system is not much different from the internal medicine department above, and the medical records are simpler..." talking A new patient had already arrived, so Zhao Bin called the number and let the patient come in.

After seeing two or three patients, Zhao Bin could see that Luo Mingyao was not very clever, and his movements were quick, but he would know what to write and do only if you explained each sentence well.It's better than being alone, Zhao Bin thought with a little headache.

"The main complaint is that you are not good enough." Zhao Bin educated Luo Mingyao during the absence of patients, "The main symptoms need to be kept simple and refined. The internal medicine department you transferred to may be less concerned with writing medical records by yourself. We have one patient a day in the emergency department. People may read dozens of them, and you must grasp the main symptoms of the patient in a few sentences. Basically, in a few sentences, you should know what the disease is. Only when you have a prediction of the diagnosis in your heart can you write your main complaint. With a good chief complaint, others will know your initial diagnosis at a glance."

Luo Mingyao nodded obediently.

Zhao Bin glanced at the computer while talking, but no new patients came yet.

Suddenly there was the sound of an outpatient ambulance outside, and a stretcher was pushed down from the 120 car, and pushed into the consulting room with a whimper.

The visiting doctor hurriedly shouted to him: "If you have chest pain for an hour, consider a myocardial infarction."

Zhao Bin immediately stood up and waved his hand to push towards the emergency room.The old man in the car closed his eyes tightly, unable to speak out the pain, cold sweat was all over his forehead, and his collar was soaked.The nurse who followed has already gone to the emergency room to prepare the oxygen tube, and the nurse station is facing a big enemy.The nurse in the office shift was stunned for two seconds, and quickly picked up the phone to call Li Panqiu: "I'm having a heart attack, come here for a consultation."

The ECG monitor was placed on the head of the bed beeping. After some movement, the heart rate was all chaotic, and the oxygen saturation did not show.The nurse quickly unplugged the tube from the oxygen bag and inserted it into the oxygen channel at the head of the bed, and put indwelling needles on both hands.

Zhao Bin and the two emergency doctors who came out in the ambulance quickly handed over: "I got sick when I went for a walk this morning, and I walked home with strength. I took the nitroglycerin prepared at home, and the pain did not relieve. Forbearance, the family quickly dialed 120. There is no problem with consciousness. The heart rate was more than 100 times in the car just now, the blood pressure was 147/84mmHg, and the oxygen saturation was good. The underlying diseases such as hypertension, diabetes, and coronary heart disease have been for more than ten years... "

Having said that, the monitor over there beeped.Everyone looked over, and the ECG monitored a straight line.

"Sudden stop!" Zhao Bin immediately went to see the patient, patted the patient's shoulder, and shouted into the patient's ear: "What's your name? Surnamed Wang? Uncle Wang! Uncle Wang! Can you hear me, Uncle Wang?"

The patient did not respond.Zhao Bin immediately touched the carotid artery and counted "1001, 1002, 1003..."

While he was judging consciousness and the pulsation of the aorta, the nurse quickly pushed the ambulance in and put the defibrillator aside.

"Aortic pulse disappears, cardiopulmonary resuscitation! 1 epinephrine, push in, push first!" Zhao Bin didn't stop his hands, and immediately started to press: "01, 02, 03...". The emergency doctor at 120 also took over the mask and connected the oxygen to the mask.

"Family, family!" The head nurse also came out and asked the family members to be pulled away, "Do you have dentures?"

"No! No! He was told to put on dentures a long time ago. He said that he would just eat porridge in the future. Don't go..." The patient's son was looking in at the door. The head nurse interrupted him and pushed him to hurry up. Go through the green channel procedures.

"Student, go over and squeeze the airbag for the visiting teacher," the head nurse directed Luo Mingyao to take over.The doctor receiving the treatment has to continue to follow the ambulance, and cannot be rescued here all the time.

Luo Mingyao's palms were full of sweat. He took the mask and the balloon, feeling in a mess, and heard Zhao Bin yell: "...30! Ventilate twice!"

"Tun, vent..." Luo Mingyao quickly squeezed the balloon.There was silence in the emergency room, no one spoke, everyone stared at Luo Mingyao and squeezed the balloon twice.Luo Mingyao's hands trembled at the sight, and it felt like two seconds had passed for a long time.Zhao Bin exchanged glances with the head nurse from the corner of his eyes.The head nurse was about to come over to replace someone, when there was another commotion from the family members over there. It was the son who notified several other relatives that they had arrived.The head nurse took a look at Zhao Bin, seeing him nodding to indicate that it was okay, she quickly turned around and went out to stop him.There are still four more cycles to follow, and Luo Mingyao keeps up with the rhythm, coordinating with every [-] compressions and ventilations twice.

At the end of the five cycles, Zhao Bin shouted: "Five cycles, the defibrillator is ready." After speaking, he touched the carotid artery, "1001, 1002..."

"The aortic pulse has not recovered," Zhao Bin looked at the monitor out of the corner of his eye, and reached out to call the nurse: "It's a ventricular fibrillation rhythm now. The defibrillator, 120J."

"Charging. Charging is complete." The defibrillator was handed over.

"Evacuate." Zhao Bin shouted.He took a special look at Luo Mingyao.

Luo Mingyao trembled when he saw him, his hands were unsteady, and the mask balloon fell off with a crackling sound.

Zhao Bin didn't give him another look, and the defibrillator was pressed down with a "bang".

A straight line was pulled out on the ECG monitor, Zhao Bin handed the defibrillator back, and continued to press: "01, 02, 03..."

The boss of the cardiology department had already come in, and Luo Mingyao just picked up the mask and put it on the patient.Li Panqiu found this disharmonious factor at a glance.Immediately went over to take it, and hurriedly reported to Zhao Bin: "I'll call the intervention room and get ready. I'll go talk when I regain consciousness, and quickly dissolve the thrombosis."

“骤停的现在也敢溶？”赵彬一边按一边问了一句，嘴里的报数也没停，“25、26、27、28、29、30！”

"1001, 1002." Li Panqiu deftly followed the ventilation twice, "The recovery time will be fine within 10 minutes." She hurriedly called Luo Mingyao, "Students will do an electrocardiogram, connect the limb leads first, and wait a while Once recovered, do an EKG immediately."

Luo Mingyao got the order and hurried out to drag the EKG machine in.

After another five cycles, he stopped for evaluation, and the heart rhythm returned. Zhao Bin quickly patted the patient to confirm consciousness.The old man groaned weakly on the hospital bed.Everyone breathed a sigh of relief.Zhao Bin ordered the nurse to draw blood for thrombolysis and pre-intervention surgery preparations, and Li Panqiu went to the next door to give the doctor's order and explain to the nurse to prepare for thrombolysis.

Before Li Panqiu lifted her foot to the door, she heard Zhao Bin's roar: "What are you doing in a daze! Electrocardiogram! Didn't you hear what Teacher Li said just now?" She sighed.I really didn't have time to turn around and persuade Zhao Bin to keep his temper. We had to see how the intern classmate could bear it.

Li Panqiu got in touch with the green channel, and according to the procedure, the patient should be sent to the intervention room.Walking back to the emergency room and wanting to talk to Zhao Bin, I heard a commotion outside.

"Doctor, you must save our old man! He is so old, it's not easy for him!" It was the patient's wife crying at the door, her voice was too loud, and the head nurse kept consoling her and reminded her to keep her voice down. .

"Who are the family members?" Li Panqiu caught up and talked to the family members about the intervention. "Are you all family members of Uncle Wang Hailin?"

"Yes!" "We are all!" "Our brothers and our mother!" Four or five people gathered around, chattering.

"Okay, okay. The one of you who can do it is the master. I will talk to this person about the illness. Don't talk about the others, just wait outside for a while." Li Panqiu asked his family members to follow him to the consultation room to talk.

The old lady and the eldest son came in, and when they met, they kept complaining that life was not easy for the old man.Li Panqiu was upset when she heard this, and interrupted her and said, "Uncle Wang has a heart attack this time. What is a heart attack? It means that a blood vessel in the heart is blocked. This blood vessel is thinner than other blood vessels, so it is easy to If it is blocked, the part of the heart that is in the blocked blood vessel will be completely broken. Our treatment consists of two steps. The stent holds up the vessel. Do you understand, old man?"

The eldest son had an expression of "I understand very well": "I understand, I understand." The old lady looked at the doctor and her son suspiciously.

"Okay then," Li Panqiu looked at the son's expression, feeling bad in his heart, "Both thrombolysis and intervention require your signature and consent. If you understand, we will sign and do thrombolysis first. If you agree to intervention, we will do thrombolysis." It will be sent to the intervention room as soon as it is finished. This process is the green channel of our hospital, and the whole country has learned from our hospital, so we will do it as soon as the decision is made, and the treatment effect will definitely be better."

The family fell into silence, and suddenly no one could make up their minds.

"Is it sure to be good after doing this?" the eldest son asked.

Li Panqiu knew that today was going to be difficult, so she hurriedly replied cautiously: "There must be risks." She took out the consent form for thrombolysis and intervention to show to the family members, and the detailed rules covered a whole page.She briefly explained the contraindications and risks of thrombolysis, and reminded again, "You have to make a decision quickly, this is a matter of time, the sooner the better!"

The family members went out to discuss, and Li Panqiu returned to the emergency room to explain to Zhao Bin.Zhao Bin probably also heard the attitude of the family members.Sighing very slightly and shaking his head, he rushed Luo Mingyao to write the observation records in the emergency department with a bad face: "I'll change it after it's written! Write the rescue records first!"

The breathing of the old man on the hospital bed was a little more stable, and his groaning voice was slightly stronger than before, and all the signs had recovered.She went over to comfort the old man, reassuring him that the doctors and nurses would save his life.