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Sometimes I'm really afraid of something.

At half past five in the morning, Fang Han had just found the second observation room when a nurse hurriedly walked over.

"Doctor Fang, bed No. 5 is in trouble. ”

"Bed five?"

Fang Han was stunned for a moment, and then his face changed, wasn't bed No. 5 Ma Meiling?

"What's wrong?" Fang Han asked as he walked out.

"The patient has a period. ”

Fang Han's heart suddenly chuckled.

For leukemia patients and patients with severe disabilities, the most feared thing is bleeding, because the patient's own hematopoietic function is poor, and platelets are low, coagulation function is poor, and every bleeding may cause heavy bleeding, bleeding does not stop, and the patient will face a very serious crisis.

If leukemia is cancer, then severe disorder is the second most soft cancer after leukemia, and the mortality rate is very high, basically reaching about 180%.

First bleeding gums, then menstruation, which made matters worse.

"Inform Director Fang and contact the Department of Internal Medicine for consultation. Fang Han said as he walked out.

"I have already contacted Director Fang, and Director Fang will be there soon. The nurse said.

Fang Han walked out of the No. 2 observation room, and before he could enter Ma Meiling's ward, he ran into Li Wenjun head-on.

In a department like the emergency department, at least one deputy director-level doctor will be on duty every day, and it is Li Wenjun who is on duty today.

In fact, in this emergency, the nurse's first reaction is to first notify the general inpatient officer, and then the general inpatient determines whether to notify the attending physician and deputy chief physician according to the situation.

The rules of the hospital are very strict, and the chief physician is not a robot, it is impossible to keep working 24 hours a day, and any patient is notified to the director, so the director is not busy to death?

The responsibility of the general inpatient is to share the pressure for the attending doctor and the director, and a qualified inpatient general must have the ability to judge the condition, what is the condition of the patient, who needs to be notified, which department to contact, etc.

Ma Meiling's situation is one of the more difficult patients in the emergency department at the moment, and she is Fang Han's classmate, so after the situation occurred, the nurse notified Li Wenjun on duty as soon as possible, and called Fang Haoyang, and came to inform Fang Han at the same time.

Li Wenjun nodded to Fang Han, and the two of them didn't say much, and went directly into the observation room.

On the hospital bed, Ma Meiling's face was pale, much haggard compared to just now, and Ma's mother and Ma's father's faces were full of worry.

Li Wenjun stepped forward to check the situation and asked a few words about the patient's family, and then said: "For the time being, it is stable, and the amount of bleeding has only increased slightly." ”

Fang Han said: "But also just in case." ”

Li Wenjun nodded, and at the same time instructed the nurse: "Prepare the special care ward, transfer the patient to the ward first, contact the blood bank, prepare plasma, and prepare for blood transfusion at any time." ”

Blood transfusion emergency has now become part of routine first aid, and the emergency department of Jiangzhong Hospital is no exception, and blood transfusion is essential for some critically ill patients who have lost too much blood.

Although Jiangzhong Hospital is a traditional Chinese medicine hospital, it is not old and stubborn, since the emergency department is opened, it is still prepared for some standing first-aid means and first-aid equipment.

The nurses transferred Ma Meiling to the ward, and Fang Han and Li Wenjun discussed Fang Han together.

"Director Li, blood transfusion is only a first-aid measure, and we still have to discuss a hemostasis plan as soon as possible. ”

"I know. Li Wenjun nodded: "Change the ward for the patient first to prevent various infections, and the patient may bleed heavily during menstruation, and it is not convenient to stay in the observation room." ”

Fang Han nodded, it is said that Ma Meiling's situation should be in the special care ward twenty-four hours a day, but the cost of the special care ward is much higher than that of the observation room.

After about ten minutes, Fang Haoyang hurried over, and a deputy director of the Department of Internal Medicine also came to the emergency department.

Several people gave Ma Meiling a comprehensive examination, and then came to the consultation room to discuss the treatment plan.

"Let's go with Xiao Fang. Fang Haoyang greeted Fang Han.

Fang Han originally planned to follow, but Fang Haoyang didn't greet him, and he also planned to follow.

Entering the consultation room, Fang Haoyang was the first to speak: "The patient is on menstruation now, and the amount of bleeding has increased significantly for the first time, this is not a good signal, what do you think?"

Ma Meiling had just come to her period, and she had a lot of bleeding, but there was no crisis situation yet, and Li Wenjun asked her to prepare plasma just in case of emergency.

The deputy director of the internal medicine department said: "I should not observe for two days to see the situation, and if the amount of bleeding continues to increase, I will see again." ”

Li Wenjun pondered for a moment: "It's okay to observe, but you have to guard against it." ”

Fang Han interrupted everyone: "There is another situation, the patient began to have symptoms of bleeding gums last night, and he has already bleeding twice. ”

Fang Haoyang's face changed, and Li Wenjun and the deputy director of the Department of Internal Medicine were also silent in an instant, this question is a big deal.

Bleeding gums in the patient are an indication of the risk of cerebral hemorrhage, which must be controlled as soon as possible, and if left unchecked, then there is a risk of life.

If it was a simple bleeding gum, it would be slightly better, but now the patient has a period again, which is simply worse.

You must know that bleeding gums mostly belong to the upper fire, and the lower bleeding mostly belongs to deficiency, which belongs to the disease of deficiency and reality.

For bleeding gums, the best way is to direct the blood downward, and the blood from above will not be too abundant, so that the bleeding gums can be contained.

However, if the blood is drained downward, it will cause the menstrual bleeding to increase again, and if there is a blood collapse or heavy bleeding, the situation is also critical.

The fire needs to be vented, and the deficiency needs to be repaired, and the situation is very tricky.

"Director Li, Director Qian, what do you think?" Fang Haoyang frowned, he had never encountered such a tricky illness.

Li Wenjun didn't speak for a long time, and was silent for a while, and then he said, "I think we should attack it first now." ”

"Attack it?" Fang Haoyang groaned slightly: "What do you say." ”

Li Wenjun said cautiously while organizing the language: "As the saying goes, it is better to attack the whole body, it is better to cut off one of its fingers, the situation faced by the patient is indeed very dangerous, the gums are bleeding above, and there is a period on the other side, the virtual and the real are alternate, the truth and the false are difficult to distinguish, we can't take into account both, since we can't take both aspects into account, so why not pick the most tricky solution first." ”

"Director Li means that we should solve the problem of bleeding gums first?" said Director Qian.

"Not bad. ”

Li Wenjun nodded: "The patient is only on his first menstrual leave now, as long as the patient's menstrual leave does not end, the danger exists at any time, since this is the case, we will ignore it for the time being, but if the gum bleeding continues, causing the patient to have a cerebral hemorrhage, then the problem will be serious." ”

Fang Haoyang said: "If we use drugs and cause the patient to bleed more or heavily, have you considered this consequence?" ”

Li Wenjun smiled bitterly: "I said it, we can't take care of it, if we are worried about the patient's bleeding under the patient, then how can we solve the problem of the patient's bleeding gums, if we are worried about the patient's bleeding gums, we can't take care of the patient's bleeding under the patient, this is a contradiction." ”

"Xiao Fang, do you have any ideas?" Fang Haoyang looked at Fang Han.

Fang Han was listening very carefully at this moment, and just now he exchanged for a temporary advanced medical case analysis.

Case analysis itself is to analyze and summarize some cases that have been treated, summarize experience, and learn lessons. This is like some doctors always tell interns to copy medical records, the process of copying is a process of growth, to see how others treat, to see other people's diagnostic ideas, so as to absorb the good side and change the bad side.

But at this time, Fang Han's case analysis has another great advantage, that is, it can check and fill in the gaps in the existing treatment plan.

At this time, Li Wenjun and others were discussing the treatment plan, and Fang Han could analyze the feasibility of this plan according to the condition and the plan, just like when Fang Han first came to the Jiang Intermediate Hospital to listen to Guo Wenyuan's consultation, he could quickly judge Guo Wenyuan's intentions.

The medical case analysis skills may not be very good at formulating treatment plans, before others have no treatment ideas, Fang Han has no ideas, but others have ideas, but he can judge the accuracy and feasibility of this idea.

"I think Director Li's idea is feasible. ”

Fang Han first affirmed Li Wenjun's treatment ideas, and then continued to analyze: "Now the patient is facing two conditions, one is gingival bleeding, the consequence of gingival bleeding is cerebral hemorrhage, once cerebral hemorrhage, then the condition will become uncontrollable, the second condition, the patient has a period, for female leukemia patients and patients with severe disabilities, this is unavoidable, even if the patient does not have bleeding gums, there will be a crisis of hemorrhage......"

Fang Haoyang and Director Li Wenjun nodded one after another, Fang Han did not say anything too complicated, but analyzed the situation considerably, and what he said was the truth.

"Therefore, in the current situation, I think Director Li's treatment idea is correct, we first solve the uncontrollable factors, solve the patient's gingival bleeding worries, as for the patient will because of our treatment will lead to an increase in menstrual bleeding, there are other dangers, we can not ignore it, nor can we be too scrupulous, do a good job of preventive measures, after all, one of the two situations is inevitable, the other is only possible, we can't give up because we are afraid that it may happen. ”

There is a sentence that Fang Han did not say, what doctors can do is to minimize all the dangers, it is impossible to completely eliminate the dangers, for very critical diseases, the level of doctors is one thing, and the luck of patients is also one thing.

Li Wenjun glanced at Fang Han with a smile: "Yes, that's what I mean." ”

He didn't have Fang Han's eloquence, and he didn't think about it so comprehensively, but it probably meant the same.

Fang Haoyang pondered for a while, and then made up his mind: "Since this is the case, let's first formulate a treatment plan according to Director Li's treatment ideas, and try to consider the patient's menstrual situation in the medication to minimize the risk." “

As he spoke, Fang Haoyang looked at Fang Han again: "You go and communicate with the patient's family, although our treatment ideas are realistic, but there will indeed be some uncontrollable factors, which must be explained to the patient's family to avoid disputes at that time." ”

Fang Han said bitterly: "Okay, I'll say it." ”