Wu Hao didn't say a word, and began to take a group of important medical staff to make rounds.

When they came out of the conference room, Dai Yunyang swept it away, and there was basically no one in the originally lively corridor, and the patients and their families had returned to the hospital beds and waited.

The urgent care center has more than a dozen observation rooms, with a total of 60 beds, all of which are full.

It stands to reason that the emergency center is only a place for emergency treatment, not an inpatient department, but some patients need to stay for observation for a period of time after first aid to ensure safety before leaving, and some need to enter the hospital, but the main city hospital as an important provincial and municipal tertiary hospital, the beds have been very tight, basically all departments are full of patients, many are still in the corridor and other places to add beds, so the patients who need treatment and have no beds can only wait for the bed to be hospitalized will also live in the observation room first.

As soon as I entered the first ward, I was stopped by an old man who asked expectantly, "Doctor, can I be discharged today?" ”

Nine times out of ten, you will encounter such a problem during emergency room rounds.

Because the emergency room is not considered a hospital, medical insurance can not be reimbursed, so you can save a day of money if you live one day less, besides, the emergency center is messy, far less quiet than the inpatient department, living here is also a crime, sleeping at night is often woken up by the roaring ambulance siren, of course, there is also the crying of family members when rescuing patients, drunken fights and brawls in the middle of the night, etc., the rest is not good, as long as the condition allows, patients and families hope to leave here as soon as possible.

Wu Hao said half-jokingly: "Why do you want to leave?" Our emergency center is built to five-star standards, is it uncomfortable to live in? If you don't feel well, you have to insist on it, it's important to treat the disease. You barely went out, your condition worsened, and you still have to come back? ”

The patient was so told that he had to grin.

Wu Hao walked to the right side of the first hospital bed and looked down at the patient, an old woman in her sixties, who was lying on the bed with a nasal tube in her nose and inhaling oxygen, looking very haggard. A young woman stood stiffly beside her, looking in horror at a room of doctors in white coats.

Li Yanling followed Wu Hao to the right side of the hospital bed, followed by Ma Feng.

Dai Yunyang was the attending doctor of the patient's bed, he stood on the left side of the bed, and the intern Zhao Guang followed him closely, Dai Yunyang hurriedly whispered to him: "It's too narrow here to squeeze in, you go behind the head nurse to listen." ”

Xiong Shengnan, the head nurse, and two other deputy chief nurses stood in the bed. Behind them stood a row of interns. Including Yu Sasha, who was looking at him coldly.

Zhao Guang just followed his teacher, Dai Yunyang, and forgot the rules.

The director and deputy chief physician stand on the right side of the bed, and on the opposite left side are the bedside physician and the attending physician in charge. At the foot of the bed is the position of the head nurse and the deputy chief nurse. The intern can only listen to the periphery and cannot enter the inner circle.

Seeing this, Zhao Guang hurriedly squeezed behind the attending physician with a red face and came to stand next to several interns.

Yu Shasha gloated and said, "Want to stand there? Wait another ten years! ”

Dai Yunyang began to report his condition: "The patient's female, named Hua Guizhi, is 62 years old, complaining of dyspnea and chest tightness. He was diagnosed with hypertension three years ago, and was hospitalized in another hospital with pulmonary embolism two years ago. Three days ago, there was no obvious cause of sudden chest tightness, dyspnea, more obvious after activity, an electrocardiogram was done in other hospitals, diagnosed as myocardial ischemia, and nitroglycerin was given a static point according to coronary heart disease, but the effect was not good. ”

"Two days ago, my condition worsened and I came to our hospital for emergency. Lips are mildly cyanotic and respiratory sounds are decreased in both lungs. On examination, blood pressure is 60 out of 90, and oxygen saturation is only 90%. Blood gas analysis, electrolytes, and routine blood count are all okay. The initial diagnosis at admission was pulmonary embolism,—— patient had a previous pulmonary embolism. The treatment methods in these two days are mainly oxygen inhalation, subcutaneous injection of heparin sodium for anticoagulation, and at the same time use traditional Chinese medicine to activate blood circulation and eliminate blood stasis. Yesterday there was an improvement in breathing and an improvement in oxygen saturation in the blood. ”

Wu Hao asked: "Have you done cardiac ultrasound and pulmonary artery enhanced CT to help confirm the diagnosis?" ”

"Yes, the echocardiogram showed pulmonary hypertension, enlarged right ventricle, and mild tricuspid regurgitation. Contrast-enhanced CT of the pulmonary arteries showed multiple pulmonary embolisms in both lungs. I'm not sure if I want to do thrombolytic therapy. This is the second pulmonary embolism of the patient, which should be caused by some causative factor, and further investigation and treatment are required, otherwise pulmonary embolism will occur. ”

Wu Hao turned his head to look at Li Yanling and Ma Feng: "What do you think?" ”

Li Yanling didn't wait for Ma Feng to speak, and said first: "The patient has multiple pulmonary embolisms, low blood pressure, and enlarged right ventricle, these are all indications for thrombolysis, thrombolytic treatment can be used, urokinase thrombolysis is used, and at the same time, the oral anticoagulant warfarin, which is overlapped with low molecular weight heparin for a few days, and then we will see the situation." ”

Then, Li Yanling turned her head to look at Ma Feng: "Director Ma, you are a senior doctor, you can guide me." ”

Ma Feng smiled: "I agree with Director Li's opinion. Dr. Dai also said just now that it is necessary to find out the cause of the two embolizations, and pay attention to discovering the causative cause and underlying disease. Ultrasound of the lower extremity blood vessels can be examined to see if there is renal vein thrombosis, which is a common cause of pulmonary embolism. ”

Dai Yunyang took notes carefully and looked at Wu Hao.

Wu Hao said: "I agree with the two of them that thrombolysis and anticoagulation are used for the patient, and at the same time, the ultrasound of the blood vessels of the lower limbs is examined. In addition, the upper respiratory tract and digestive tract are also examined. Because the patient's complaint is dyspnea, and the exact mechanism of dyspnea is not clear, the common cause is respiratory diseases, such as airway obstruction, lung disease, thoracic and pulmonary membrane diseases, diaphragmatic dysmotility, etc......"

As the chief physician and the director of the department, Wu Hao often comments and explains major and difficult cases during ward rounds, which is his duty.

The process of ward rounds is actually a teaching process, and the senior physicians have the obligation to guide the junior physicians, not to mention that there are a group of interns who are staring at them. So Wu Hao said it in relative detail.

As soon as he finished speaking, he suddenly heard a weak voice next to him: "I don't have the money to pay for the medicine......"

Wu Hao stopped, turned his head to follow the sound and looked, but it was the daughter of the patient who was standing aside just now.

Seeing Wu Hao looking over, the patient's daughter blushed and said, "My mother is a farmer in the countryside, and my father came to live with me after he died." I am a factory worker, and my monthly salary is a little more than 3,000. I am divorced, and my son is raised by me, and he gives him 500 yuan a month for living expenses. My son is in his third year of high school and is about to take the college entrance examination. In order to cure my mother's illness, I have borrowed tens of thousands of yuan, and if I do such and such examinations, I may not have the money to pay......"

Everyone was a little dumbfounded, the patient couldn't pay for the medicine, which is a common occurrence in the hospital, but it is generally not brought up in public, and it is all discussed with the doctor in private to delay the payment, and now the woman said it in front of everyone, it depends on how Wu Hao deals with it.