My Medical Skills Give Me Experiences

"Do you know what to do after the patient dies?"

Dr. Hu asked Zhou Can.

"I haven't dealt with it!"

Zhou Can shook his head.

"When a patient dies, announce the patient's death to the family members in a timely manner. Immediately stop all long-term medical orders for the patient, switch the computer to zero bed charges, complete the discharge or death registration, and report to the department director in time."

Dr. Hu taught him some general treatment procedures.

Almost every day in the intensive care medicine department, patients die unfortunately, which is a must-learn content for every doctor in the intensive care medicine department.

Under the guidance of the nurse, the family members had already changed into protective clothing and came in.

"My husband... woo..."

A thirty-five or six-year-old woman began to 'sing and cry' mournfully before she even got to her bed.

Women in many places have the custom of 'singing and crying'.

It can be understood as crying for others, or to prove to others that she is very sad.

In addition to this woman, there is also an elderly woman who looks similar to the patient. Lie down in front of the hospital bed, stroking the patient's cheek with tears in his eyes.

"Baby, why are you so stupid and cruel? You're gone, what will your mother do!"

The old woman's voice was sad, which made people feel very sad.

It is definitely a tragedy in the world for a white-haired person to send a black-haired person.

The mother-in-law and daughter-in-law were crying around the bed. Especially the wife of the patient, she cried very hard, she didn't see many tears, but she sang very well.

Although it is not known what happened to the family, it eventually led to the man committing suicide by drinking pesticide.

But the man's family is certainly responsible.

If he could be enlightened in time, he would not have come to this point.

"The two family members, please control your emotions and take the time to say goodbye to the patient at the end of his life! He is no longer able to die."

Seeing the two family members crying all the time, Dr. Hu had no choice but to persuade them.

The breathing of the man on the hospital bed was already very weak, and he tried to open his eyes a little, looking at his relatives and wife beside the bed.

Tears rolled down the patient's eyes.

"Juan..."

He was calling his wife by her nickname.

"Yes, I'm here!" The woman quickly grabbed his hand.

I don't know if it's an illusion. Zhou Can always felt that this woman was not as sad as she imagined for her husband's death.

In any case, this is someone else's family business, and he will definitely not talk too much.

It will not interfere with anything.

"Take care of my mother..." The man squeezed out these words with all his strength, and when he looked at the woman, his eyes were full of pleading.

"I will, you can leave at ease!" The woman cried and nodded in agreement.

The man's mother was crying beside her, with snot and tears mixed together.

Seeing that his wife agreed, the man's desire to survive completely dissipated.

Breathing is gone.

Immediately afterwards, the blood pressure disappeared, and the brain waves slowly disappeared.

The monitoring instrument beeps multiple alarms.

The patient has closed his eyes forever.

It must be said here that after the death of the patient, the heart rate did not return to zero.

However, the determination of death in medicine never requires the heartbeat to return to zero.

Brain death, pore enlargement, and respiratory arrest can all be defined as medical death.

The beating of the heart may not stop completely until some time after the death of the patient. This time may be half an hour to several hours.

Zhou Can stood in front of the hospital bed and watched the patient die with his own eyes, not as frightened as before.

Maybe you have already accepted it mentally.

I have made sufficient psychological preparations.

So regarding the death of the patient, he behaved fairly calmly.

The patient's mother cried and fainted beside the hospital bed. It was really heartbroken, and the pain was too painful.

The patient's wife also cried bitterly.

Dr. Hu and the nurses dealt with the procedure step by step.

Dr. Hu removed the patient's ventilator and declared him clinically dead.

Then let the family members settle the hospitalization expenses.

this point is very important.

If the expenses are not settled, the family members will not be allowed to pull the corpse out of the hospital under normal circumstances.

Tuya has a special morgue, also known as the morgue.

Bodies can be left there for up to twenty-four hours.

Some family members may abandon the corpse.

This happens very rarely, but you will still encounter very few wonderful family members.

At this time, the hospital reported according to regulations. There will be a special department to deal with it.

During the period when the family members have not settled the hospitalization expenses, the nurses usually take the corpse to the morgue first.

The vast majority of family members are based on the spirit of the dead, and there is no behavior of abandoning corpses.

Soon, the nurse who specialized in pulling corpses came over. The two nurses have removed various instruments and intubation for the patient, and have done the body preparation and terminal treatment.

The corpse was pulled away directly.

The family members have also been invited out of the ICU.

After filling out the death record, Dr. Hu temporarily called a doctor to help take care of the other two beds under his responsibility.

Then he took Zhou Can to the duty room and taught Zhou Can to operate on the computer to stop the long-term medical order for the patient and change the bed fee to zero.

This is a matter of detail and must be done in a timely manner.

Otherwise, it is very easy to cause doctor-patient disputes.

The patient died after receiving treatment in the hospital, and the family members were in a bad mood.

If when going through the discharge procedures, it is found that the patient has died, is still taking medication, and is still charging the bed fee, there will probably be a quarrel.

At that time, the hospital will be particularly passive.

After learning the process of dealing with the death of a patient, Zhou Can followed Dr. Hu back to the ward to continue working.

The vacant bed No. 6 has been cleared, and the next critically ill patient will soon be ushered in.

The hospitalization fee in ICU is very expensive, but the beds inside are extremely tight.

As soon as a bed becomes vacant, patients waiting in line outside to enter the ICU will immediately fill in.

For a famous hospital like Tuya, there will never be a shortage of patients.

Instead, there is a shortage of beds.

…

It can be seen that the death of the patient in bed No. 6 in charge of Dr. Hu has affected his emotions after all.

He looked a little downcast.

When Zhou Can returned to the ward to deal with other patients, he also had some shadows in his heart.

Handle with extreme care.

I'm afraid that the patient will die soon.

Taking advantage of this rare gap, Dr. Hu began to teach him how to use various medical devices in the ICU.

There is basically no need to teach the external defibrillator, Zhou Can has already learned how to use it.

The rest are infusion pumps, micro-injection pumps, expectoration machines, invasive ventilators, non-invasive ventilators, hemofiltration machines, fiberoptic bronchoscopes, and so on. The same teaching, all kinds of uses are explained clearly to him.

In the ICU ward, the most complicated operation should be the artificial extracorporeal lung membrane, also known as ECMO.

A doctor can't do it at all.

It requires multiple experienced doctors and nurses to operate together.

Moreover, the cost of starting up this thing is extremely high, so it is not easy to use it for patients.

Only patients whose heartbeat and breathing have stopped will use it. Usually, after respiration and heartbeat stop, extracorporeal respiration and blood circulation pathways must be established for the patient in a very short time.

Otherwise, it doesn't make much sense.

Dr. Hu taught Zhou Can how to skillfully use various instruments in the ICU ward, but he didn't teach him all at once.

But intermittently.

Because in this process, various situations arise from time to time and need to be dealt with urgently.

Bed No. 6 was quickly filled with a new patient.

He was a car accident patient with cerebral hemorrhage and fell into a deep coma.

Three times of ventricular fibrillation occurred just after he was sent in, and the situation was once extremely dangerous. Dr. Hu appeared very calm and composed. First, he personally operated the defibrillator to defibrillate the patient.

He also taught Zhou Can various defibrillation techniques and key points.

"Doctor Hu, why are all the three beds under our management filled with patients in extremely dangerous conditions?" Zhou Can asked a little puzzled.

After coming in for so long, he observed secretly.

It was found that some patients lying on the beds had almost nothing to do.

Some patients have a nasal feeding tube inserted through which food enters.

Then, with a urine bag hanging on his body, he almost didn't need to urinate. Breathing is doing endotracheal intubation, and there is no need to control it.

The stool is handled by a nurse.

The nurse occasionally ran over to take care of it.

The three beds managed by Dr. Hu are all critically ill, and each is more dangerous than the other, so none of them is easy.

Turning the patient over, Zhou Can was terrified.

"The greater the ability, the heavier the burden on the shoulders, never heard of it?"

Doctor Hu choked him back.

"Although the patients in the three beds under my care are all serious, they are not the most critical. Did you see the patient in bed 17? That's really scary."

The patients under the care of the attending doctor are naturally much more difficult than the residents.

That's roughly what Dr. Hu meant.

Zhou Can looked at the 17th bed, and saw two doctors and two nurses working around the patient.

They all looked like they were facing an enemy.

In the following time, Zhou Can glanced at the side of bed 17 from time to time.

The two doctors and the two nurses never rested.

I don't know what kind of patient it is, and the situation is so serious.

"Xiao Zhou, after the patient is on the ventilator, you must remember to **** the patient's sputum in time. Don't be lazy. Especially the 8-bed patient has a lot of sputum. If you don't **** the sputum in time, it is easy to block the respiratory tract, and sometimes even cause coughing When dealing with it, you must wear a mask. There are often novice doctors and nurses who are sprayed with phlegm by patients."

After Dr. Hu taught Zhou Can some basic equipment operations, he began to teach him how to take care of patients.

Most of the patient's sputum is purulent sputum. If it is sprayed on the face, it would be disgusting to think about it.

What's more, many of the patients living here are suffering from sepsis and various infections.

Zhou Can's hairs stood on end when he heard it.

Special care is always taken when suctioning the patient in bed 8. Fear of being sprayed with phlegm all over the face by the patient.

Fortunately, this has not happened yet.

After the car accident patient with cerebral hemorrhage stabilized a bit, Zhou Can ran to bed No. 7 again, picked up the patient's data and studied it.

This patient with diffuse intestinal bleeding, can't the cause of the bleeding be found out?

He likes best to ponder such difficult cases that are difficult to diagnose.

If the cause of the bleeding can be found, there may be a cure. At that time, the patient's condition may improve and he can return to the general ward.

Of course, it is definitely not as simple as imagined.

The patients who live here have been checked by the specialist attending physicians and chief physicians.

Even they couldn't find the cause, which is enough to show that the difficulty is extremely high.

"Xiao Zhou, you keep researching with the data of 7-bed patients. Is there something you don't understand?"

Dr. Hu took the initiative to come over.

"What do you say is the real cause of this patient's gastrointestinal bleeding?"

"I don't know! Many chief experts in the gastroenterology department have already consulted. At present, it can only be identified as bleeding in the large intestine, and tumors and polyps can be ruled out. The attending doctor took the risk of doing a colonoscopy on the patient, using hemostatic enzymes, and even checking the bleeding point. Sprayed epinephrine. But the effect is not obvious. It's like whack-a-mole, this bleeding stops, and a new bleeding source pops up."

"The final conclusion was that there was diffuse bleeding in the large intestine. The reason why he was willing to admit him to the ICU was because he had chronic bleeding in the digestive tract, and there was no intestinal perforation."

Dr. Hu explained the patient's condition to him in detail.

It can be seen from these conversations that Dr. Hu is definitely a qualified ICU doctor.

He has a clear understanding of the patient's situation.

All possible treatments were done.

"In this way, the patient should have extensive bleeding on the inner wall of the large intestine, with multiple lesions. It stands to reason that the patient will not have wound ulceration and infection if there is bleeding in multiple places in the large intestine?"

Zhou Can asked curiously.

The bacterial flora in the large intestine is very diverse.

It is here that human feces are formed.

"It's strange to say that the patient had black stools for more than half a year before he was admitted to the hospital. It stands to reason that infection and intestinal perforation should have occurred long ago. But this did not happen to him."

Dr. Hu was also very puzzled by this point.

There was indeed a lot of anomalies about this patient.

There are many strange diseases in the world, and there are many causes and symptoms, which are beyond the understanding of doctors.

Just like there are countless unsolved mysteries in the world today, which cannot be explained by human science today.

At this time, the machine alarm sounded again on the 8th bed.

Zhou Can quickly put down the documents in his hand and walked over to deal with them.

I saw that the patient's blood oxygen saturation dropped to 75%, which is already very scary.

And it is still falling rapidly and continuously.

The machine kept beeping.

The patient's face and lips are cyanotic, which is the most direct manifestation of hypoxia.

There must be something wrong with breathing.

Zhou Can hurriedly checked the patient's ventilator and it was installed correctly.

The condensate has just poured out not long ago.

Then leaned over and listened, and there was no obvious phlegm sound.

There was no sign of loosening of the pulse oxygen clip.

He couldn't figure out the reason, and turned around to call Dr. Hu to help.

As a result, Dr. Hu stood behind him.

"In this situation, don't panic. You can try to adjust the breathing parameters first."

Dr. Hu appeared extremely calm.

After adjusting the breathing parameters, the patient's blood oxygen index finally stopped falling and began to rise continuously, which was quite fast.

Zhou Canchang breathed a sigh of relief and saw with his own eyes that the cyanosis of the patient's lips disappeared little by little.

Problem solved.

"Have you learned it?"

Doctor Hu asked him.

"It turns out that the breathing parameters can't be fixed! It seems that I still have a lot to learn. Please guide me in the future."

Zhou Can has never worked in an ICU, and he feels that he has learned more in one day than in a year.

Before I knew it, it was time to get off work.

It was clearly agreed to leave work at 4 o'clock, but the doctor who took over the shift did not enter until 5 o'clock.

The doctor who came to take over was a middle-aged doctor in his forties, with a thin body, no expression on his face, and his eyes lacked the vitality of a normal person. It seems that everything in this world has become numb.

This Dr. Shi was very reticent, and he didn't even have a smile when he spoke~www.wuxiax.com~ After completing the handover, after coming out of the ICU, Zhou Can couldn't help asking, "The Dr. Shi who was handed over is so cold and serious! "

"Just get used to it. Dr. Shi is actually quite a good person, and he is also warm-hearted when encountering things. He used to be an anesthesiologist, but later he transformed into an attending physician in the Department of Intensive Care Medicine. If there is no accident, he will be promoted to assistant doctor this year." High title."

Dr. Hu explained to Zhou Can.

Most anesthesiologists are self-admired and don't like to talk too much with people.

It's not that they are cold.

It's about their profession. When working, you must keep an eye on the patient's vital signs all the time. If there is any trouble, you must deal with it immediately, or give some correct suggestions to the chief surgeon.

This means that they do not smile all the time while working, and keep a serious expression all the time.

Over time, it became such a character.

Anesthesiologists are not only hard-working, but also have limited room for promotion, and their development prospects are not ideal.

At least that's how it is in the country.

In developed countries, anesthesiologists in Japan and Germany are more important. The United States pays more attention to nurses.

Huaxia is similar to France, and the status of doctors is very high.

In fact, the status of doctors in the United States is also very high.

However, most doctors in the United States are family doctors, which are equivalent to community doctors in our country. Of course, their income is much higher. There are only two kinds of doctors with real status in the United States, one is a doctor of medicine and professor engaged in research, and the other is a certain academic leader working in a medical center. The accomplished ones are called super doctors.

The status is equivalent to that of our domestic first-level directors, or even higher.

"Do you know what type of doctor is the most powerful in the intensive care unit? They are doctors transformed from anesthesiologists." Director Hu revealed another amazing fact to him.