Since 1981 Health School

  Chapter 637 Hemodynamic Monitor

  Chen Qi slammed out the door, leaving a crowd of people staring.

  Especially Chen Qi said in the end that he would let the patient stay and hand it over to the Yuezhong Hospital team, or the Dongshan Hospital team would transfer the patient to another hospital and leave. This was the ultimatum.

  As a layman, Qi Guomin was a bit puzzled. Healing diseases and saving lives is a public-to-public matter. Is it worthwhile for you, Chen Qi, to make such a big fuss and offend a large number of people for the sake of business?

   As an expert, Deng Changle could understand Chen Qi's mood.

  Doctors always hope that patients can be saved. This is the bounden duty of medical personnel. Deng Changle wants to save patients, and Chen Qi also wants to.

   But now a patient has died in front of him, which makes the doctor very distressed.

  If a doctor thinks he has the ability to save patients but can’t intervene, the feeling of watching people die is even more uncomfortable, so it is understandable to get angry.

  Deng Changle is definitely the smartest group of people in China to be the deputy director of a top hospital and a professor at Fudan University.

   From Chen Qi's complaining and venting words, he keenly grasped an important point, CVP, PAWP, CO, these English words that came out of his mouth.

  As a professor, Deng Changle naturally understood what these English words meant, so he was even more surprised.

  Because hemodynamic indicators such as central venous pressure (CVP), pulmonary artery wedge pressure (PAWP) and cardiac output (CO) are used to guide the monitoring of fluid resuscitation, this concept is also newly proposed abroad.

  There is no hospital in China to carry out this.

  Dongshan Hospital once wanted to use these imported equipment, but foreign countries are only in the promotion stage, and there is no mass production, so the price is ridiculously expensive.

  My good fellow, a country hospital in Yuezhong actually has such advanced equipment?

  Deng Changle lived over 50 years old, and he is not a young man. When he was scolded a few times, he would rush forward and fight, all kinds of dissatisfaction.

  He is an old fox who has practiced for decades, so he still has some skills in nourishing Qi.

  So Deng Changle decided to go to see how the Yuezhong Hospital treats patients. Do they really have any good ways to rescue severely burned patients?

   By the way, when Chen Qi returned to the doctor's office, he was still cursing.

  Zhu Huoyan, Luo Yuyang, and Zhang Xing also got up and sat there waiting for news.

   "Chen Qi, what's the matter? How's the situation over there?"

   Facing Zhu Huoyan's question, Chen Qi was so angry that he sat down on the chair: "What else can I do? I'm still trying to rescue him. I think one of them will die tonight."

  Hearing Chen Qi's words, the atmosphere in the office was a bit silent, only the heart-piercing cries of family members in the corridor were heard.

  Zhang Xing asked weakly: "Dean Chen, is there any possibility for us to take over?"

  Chen Qi sighed heavily:

"I've already told them, either hand over the patient to us, or leave immediately, but I guess things won't be that simple. It's unlikely that such a seriously injured person will be transferred to the Shanghai City. He really died on the way to the Yue Steel Factory. There must be trouble again, and I am also talking about anger."

   Zhu Huoyan patted Chen Qi on the shoulder and comforted him:

   "Now is not the time to be angry. It is time to save people or be saved. You are now the head of the company. You must see the big picture. Let's talk to the people from Yue Steel Plant tomorrow."

  Chen Qi scratched his hair irritably: "Okay, okay!"

  After half an hour of rescue, worker Chi Shanjun's heartbeat and breathing did not recover in the end, and the doctors at Shanghai Hospital had to declare the worker dead.

  The family members did not blame the doctor. After all, their relatives were burnt like that. There is no good skin all over the body. It is normal that they cannot be saved.

   It’s just that the relatives are fine when they go out in the morning, but they become a dead person at night. The family members are the most difficult to accept this kind of sudden death, and they still die in pain, so they cry so badly.

  Although Lu Wenjie and Wang Chuanbing did not die and are still being treated, their burn condition is not much better.

  When I thought that my relatives would die at any time, the remaining two groups of family members also cried to death. For a while, the whole burn surgery was like "Wang Qinshan".

  As the director of the factory, Qi Guomin also suffered from severe heartache, and was even more afraid that his family members would make trouble and his hat would be unstable, so he comforted him while making a wish:

"Brothers and sisters, don't worry, Shanjun belongs to the one who sacrificed on the job, and we will not lose a penny of the pension. In addition, we will reserve the post of Shanjun for him. When your eldest son becomes an adult, let him go to work. Make an appointment Can't treat him badly."

  When the family members heard this, the condition was not bad, and it was a comfort.

   But what they don't know is that when Chi Shanjun's eldest son takes over, it will also be the time when the Yue Steel Factory closes down, and he will sadly become a laid-off worker.

  Deng Changle has seen a lot of life and death, and the death rate in the burn department is still very high these days, so he has no sadness or joy in his heart.

   He was just curious about the rescue procedures, medicines, and equipment of Yuezhong Hospital, so when it was dawn, he quietly came to the ward of Ding Xinjuan and Song Yanzi's mother and daughter.

  Cao Junnan stood outside the ward, observing the patient's condition at any time.

  Seeing the Shanghai experts coming, he quickly stood up, Chen Qi could lose his temper, and a small doctor like Cao Junnan was far from qualified.

   "Hello, teacher, this is..."

  Deng Changle smiled: "Hello, I just want to see how your Yuezhong Hospital rescues patients and learn from each other. Could you please take me in for a visit."

   Cao Junnan thought to himself that the sun came out in the west, and experts from Shanghai and Shanghai healed the dead, so he wanted to come to us to learn skills?

  Chen Qi has explained before that if the other party wants to visit, there is no need to stop him.

  So he put on a disposable isolation suit, disinfected his whole body, and took Deng Changle into the ward.

  Deng Changle had seen patients through the glass before, but now he walked into the ward and observed carefully, and found that the degree of burns on the patient on the hospital bed was quite severe, and all he could see were burnt yellow wounds.

  He roughly calculated that the back torso and limbs were all burned. He didn't know what the situation was like in front of him. Based on what he saw in front of him, the burn area reached more than 70%.

  Deng Changle also noticed that several wires were connected to the upper and lower body of the patient.

  He looked aside slowly along the wires, and saw a "small TV" in front of the bedside table, which displayed different waves and numbers.

  Deng Changle is familiar with ECG monitors. No matter how poor the top hospitals are, they still have these devices.

  But the monitor in front of him was obviously different, so he asked curiously:

   "Little comrade, this instrument of yours is so strange, what do these data represent?"

  Cao Junnan was delighted when he heard it, thinking that you are still a Shanghai expert, and you looked down on us in various ways before, so you can’t even understand a single statistic?

"Oh, that's right. These are indicators for monitoring hemodynamics. For example, this is an indicator of central venous pressure, and this is an indicator of pulmonary artery wedge pressure. These are monitoring indicators used to guide fluid resuscitation, so that doctors can understand the body's blood pressure. flow state, and accurately evaluate the effect of fluid resuscitation in burn shock.”

  Deng Changle's eyes lit up. He had heard of these indicators, but this was the first time he saw them, so he asked.

   "Comrade, for example, the central venous pressure, how do you evaluate it? And how do you make adjustments based on different indicators?"

   "These indicators are actually very simple. For example, when the central venous pressure is less than 50mmH2O, it means that the blood volume is insufficient, indicating that the patient is in shock, and blood volume needs to be replenished in time, so we need to increase the amount of fluid infusion.

  When the central venous pressure is greater than 100mmH2O, it means that the volumetric vessels are excessively contracted or there may be heart failure. At this time, we will stop the fluid infusion. If the patient has symptoms of heart failure such as dyspnea, we will immediately diuretic and dilate the blood vessels. "

  Deng Changle immediately recognized the advanced features of this monitor, and asked further:

   "That is to say, when you rehydrate this patient, how much fluid do you need to replenish completely based on these indicators?"

  Cao Junnan nodded, continued to point to a few numbers and said:

   "Our Dean Chen said that everyone has individual differences, and the disease also has priorities, so the amount of fluid replacement, the formula is only a preliminary estimate, and fluid supplementation cannot be blindly based on the formula. He called this individualized fluid supplementation.

Indicators such as urine output, blood pressure, pulse rate, and mental state are indeed important, but they cannot accurately reflect whether the amount of fluid replacement is too much or too little. What Dean Chen means is that we need to monitor scientifically, systematically, standardizedly, and accurately, rather than roughly Gross estimate. "

  Hearing this, Deng Changle thought about how crude, backward, and unscientific his team's monitoring of fluid replacement was.

   At the same time, it also complicates a very simple matter, and mechanically copied the formula in the book to calculate the amount of fluid replacement, without starting from the perspective of the individual needs of the patient.

  Deng Changle remembered that when Chen Qi scolded them before, he accused them of giving Chi Shanjun too much fluid, which was too much for the patient to bear, which directly caused the patient's heart failure and lung failure.

  Maybe he was really scolded by Chen Qi.

  Thinking of this, Deng Changle felt very bitter in his mouth, and silently walked out of the burn ward with his hands behind his back and his head bowed.

  Cao Junnan blinked his eyes, thinking that you are leaving now? I didn't even introduce what imported medicine we used, I haven't shown enough yet.

  In the morning, at the exit of Etsuchu Railway Station, five elderly people who looked like cadres came out.

   A little old man in the lead grabbed a train station worker and asked:

   "Comrade, how many buses do you take to the Vietnam People's Hospital? Is it far?"

   The staff saw that the other party was an intellectual and had a good attitude. He pointed to a row of buses in front of the station and said:

"Old comrades, you can take the No. 1 or No. 2 bus over there, just get off at Dongjie Station, and you will arrive at the 4th stop, which is quite close. If you walk, you will pass by the Lanxiang Pavilion halfway. The noodles there are a must. If you don’t want to eat noodles, go to Rongchun to eat small steamed wontons, the taste is very good.”

The old man headed by    smiled:

   "Okay, it seems that people in Yuezhong love their hometown very much and are willing to sell their hometown, young man, let me ask you again, have you heard of Director Chen Qi and Chen of Yuezhong People's Hospital?"

"Hey, I know. Dean Chen and his wife, Dr. Lan, are amazing. They are the genius doctors of our Yuezhong. He treats illnesses, by the way, you also came to him for treatment?"

The little old man headed by    laughed loudly:

   "Yeah, we also come to him for treatment, and we come here because of the name."

  The staff kindly reminded: "President Chen's name is very difficult to hang up. If you really can't do it, you should go and find the scalpers. Don't meet up then."

   "Okay, thank you little comrade, we have been on the train all day and we still need to exercise. Let's walk to Yuezhong Hospital."

  The little old man who spoke was Peng Yongyan, the president of Southwest Hospital, and also the chairman of the Chinese Society of Burn Surgery. The other five beside him were directors of burn departments of major hospitals across the country.

  Professor Ni Zhihua from Dongshan Hospital, Prof. Zhu Lianggong from Jishuitan Hospital, Prof. Wang Qizheng from the Second Hospital of Hai Medical University, and Prof. An Yongchun from Xiangya Hospital

  This time they went to Shanghai to participate in the annual meeting of the society together. I just heard that Yuezhong Hospital and Dongshan Hospital had a rivalry, so they wanted to see the excitement.

  Of course, as a member of the National Burn Society and the director of the Burn Department of Dongshan Hospital, Professor Ni came to Vietnam this time to supervise the war.

  However, the main reason that attracted these veteran experts is that the patients in Yuezhong Hospital and Dongshan Hospital are all severely ill patients with 90% burn area.

  No matter which side wins, it will create a national or even world record, which is of great significance to burn surgery.

  When Professor Peng and the others showed up at the Burn Surgery Department of Yuezhong Hospital after breakfast, before they had time to contact the hospital, they saw that the Burn Surgery Department was already busy.

  As a doctor, Professor Peng and the others immediately knew that an accident must have happened to the hospitalized patient, and they were giving first aid.

   They have seen this scene a lot.

  Professor Peng grabbed a little doctor who was also watching the excitement with his hands in his pockets:

   "Little comrade, what's going on in the ward? Didn't you say that Shanghai Dongshan Hospital is fighting with your Yuezhong Hospital?"

  The little doctor is the frontier. He is a young doctor in terms of age. In fact, he is now the deputy director of the Plastic Surgery Department of the People's Hospital and one of Dean Chen's confidantes.

  After the merger of Vietnam Fourth Hospital and the People's Hospital, the plastic surgery department was moved to the People's Hospital as a whole.

  Bianmeng came here early in the morning, in fact, he came to consult with the boss, Dean Chen, to report early and report later, and to watch the gossip that happened in the hospital by the way, who told him to be restless by nature.

   Seeing an old man who looked like an intellectual ask him, the border alliance got excited:

   "Old comrade, don't tell me what Dongshan Hospital is fighting with our Yuezhong Hospital. Did you see that the patients in our Yuezhong Hospital are in serious condition. Nothing is wrong now, and they have been receiving treatment safely.

Look at this Dongshan Hospital, one of them died last night, and the other died this morning, cardiac arrest, and is being rescued now, there are only three patients in total, one died, and the other is about to die , You said that the level of experts in Shanghai is just like that. "

  The border alliance obviously wanted to remove the signboard of Dongshan Hospital, so they spoke very bluntly.

  Professor Ni Zhihua frowned even more when he heard this, "Little comrade, this may not be a problem of level, but a result of a more serious condition!"

  Professor Peng also quickly smoothed things over:

   "It seems that the treatment of patients with severe and severe burns is still difficult to break through, and Dongshan Hospital cannot be blamed. At present, there is no history of successful rescue of burns with an area of ​​more than 60% in China."

  The border alliance is not convinced:

"Old comrade, that's not necessarily the case. Our Dean Chen is best at creating miracles. He has one with a burn area of ​​90% and one with a burn area of ​​83%. It has been burned for a month when it was delivered, and now both of them are alive." It's doing well, I'm preparing for a skin graft in two days."

oh?

  The old men were stunned.

  (end of this chapter)