"Do you know what to do when a patient dies?"

Dr. Hu asked Zhou Can.

"I didn't deal with it!"

Zhou Can shook his head.

"When a patient dies, announce the patient's death to the family in a timely manner. Immediately stop all long-term medical orders of the patient, transfer the computer to zero bed fee, register the discharge or death, and report to the department director in a timely manner. ”

Dr. Wu taught him some general procedures.

Almost every day in the Department of Critical Care Medicine, patients pass away, and this is a must for every doctor in the Department of Critical Care Medicine.

At this time, under the guidance of the nurse, the family members had already changed into protective clothing and came in.

"My husband...... Woohoo......"

A thirty-five- or sixteen-year-old woman, before she reached the bed, began to sing and cry sadly.

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

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

In addition to this woman, there is also an elderly woman with a similar face to the patient. Lying in front of the hospital bed, he stroked the patient's cheek with tears in his eyes.

"Baby, why are you so stupid and ruthless? You're gone, how can you let your mother live! ”

The old woman's voice was mournful, and it was very uncomfortable to listen to.

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 gathered around the bed crying. Especially the patient's wife, who cried very hard, didn't see many tears, but her singing voice was full.

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

But the man's family is certainly responsible.

If you can enlighten in time, you won't come to this point.

"Please control your emotions and say your final goodbye to the patient as soon as possible! He's no longer good. ”

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

The man on the hospital bed was already breathing very weakly, and his eyes were trying to open a slit, looking at his relatives and wife in front of the bed.

Tears slipped from the corners of the patient's eyes.

"Juan......

He was calling his wife's nickname.

"Yes, I'm here!" The woman hurriedly shook his hand.

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

Anyway, it's someone else's family affair, and he definitely won't talk too much.

And will not interfere with anything.

"Shine...... Gu 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 with confidence!" The woman cried and nodded in agreement.

The man's mother was already crying silently, snot and tears mixed together.

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

The breath was gone.

Immediately after, the blood pressure disappears, the brain waves slowly disappear, and the heartbeat stops.

Multiple alarm sounds from the monitoring instrument.

The patient's eyes have been closed forever.

It must be said here that after the death of a patient, some brain-dead patients do not immediately have a heart rate that goes to zero.

But in the medical recognition of death, it is never necessary to reset the heartbeat to zero.

Brain death, dilated pupils, respiratory arrest, can already be defined as medical death.

The beating of the heart may need to wait until the patient dies for some time before it stops beating completely. This time may be half an hour to several hours.

Zhou Can stood in front of the hospital bed, watching the patient's death with his own eyes, and was not as frightened as he was at the beginning.

Maybe I have already accepted this in my mind.

Be mentally prepared.

So he was calm about the patient's death.

The patient's mother fainted directly from crying at the bedside. That's really broken liver and intestines, and the pain is unbearable.

The patient's wife was also weeping bitterly.

Dr. Hu and the nurses handled the matter step by step and according to the procedure.

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

Then ask the family to settle the hospitalization bills.

This is important.

If the fee is not settled, the family will generally not be allowed to pull the body out of the hospital.

Tuya has a dedicated morgue, also known as a morgue.

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

Some family members may abandon the body.

This happens very rarely, but there are still a very few strange family members encountered.

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

During the period when the family has not settled the hospitalization expenses, the nurse will usually take the body to the morgue first.

The vast majority of family members are based on the deceased, and there is no abandonment of the body.

Soon, the nurse who specializes in pulling corpses came. The two nurses have removed various instruments and intubations for the patient, and performed the cadaver preparation and final treatment.

The body was pulled away.

The family members have also been called out of the ICU long ago.

After filling out the death record, Dr. Hu temporarily called a doctor to help take care of the other two beds that he was responsible for.

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

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 being treated in the hospital, and the family was not in a good mood.

If you find out that the patient has died, is still taking medication, and is still charging for the bed when you go through the discharge procedures, there is a chance that you will quarrel.

At that time, the hospital side will be particularly passive.

After learning the process of dealing with the patient's death, Zhou Can followed Dr. Hu back to the ward to continue his work.

The vacant bed No. 6 has been cleared and will soon welcome the next critically ill patient.

The ICU is expensive, but the beds are particularly tight.

As soon as beds become available, patients waiting in line outside to be admitted to the ICU are immediately filled.

For a well-known hospital like Tuya, there is never a shortage of patients.

On the contrary, what is lacking is the number of beds.

……

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

He looked a little depressed.

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

Handle it with extra care.

I'm afraid that the patient will be gone at once.

Dr. Hu took advantage of this rare gap and began to teach him how to use various medical equipment in the ICU.

There is basically no need to teach external defibrillators, and Zhou Can has long learned how to use them.

The rest are infusion pumps, microinjection pumps, expectoration machines, invasive ventilators, non-invasive ventilators, hemofiltration machines, flexible bronchoscopes, and so on. The same teaching, all kinds of uses are clearly explained 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 work together.

And the cost of this thing is high, so it will not be used by patients.

It is only used by patients whose heartbeat and breathing have stopped. Usually, after respiratory and cardiac arrest, an extracorporeal respiratory and blood circulation pathway 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 use all kinds of equipment in the ICU ward proficiently, and he did not teach him all in one go.

It's intermittent.

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

Bed 6 was quickly filled with a new patient.

It was a car accident patient with a cerebral hemorrhage and a deep coma.

As soon as he was brought in, he had three ventricular fibrillations, and the situation was extremely dangerous. Dr. Hu appeared very calm and composed, and first operated the defibrillator to administer electric defibrillation to the patient.

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

"Doctor Hu, why are the three beds in our charge all patients in extremely dangerous conditions?" Zhou Can asked with some puzzlement.

After coming in for so long, he secretly observed.

It was found that there were some patients lying on the beds, and there was hardly much going on.

Some patients have nasogastric tubes inserted from which food comes in.

Then there was a urine bag hanging on his body, and he barely had to take care of urinating. Breathing is done with endotracheal intubation, and there is no need to tube.

The stool is handled by the nurse master.

The nurse just needs to run over and take care of it once in a while.

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

Turning over the patient, Zhou Can was terrified.

"The greater the ability, the heavier the burden on your shoulders, haven't you heard of it?"

Dr. Hu choked him back.

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

The difficulty of managing patients by the attending physician is naturally much higher than that of the resident doctor.

That's what Dr. Hu means.

Zhou Can's eyes looked at bed 17 and saw two doctors and two nurses working around the patient.

All of them have an expression of facing a great enemy.

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

The two doctors and the two nurses never rested.

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

"Xiao Zhou, after the patient is on the ventilator, you must remember to suck the patient's sputum in time. Don't be lazy. In particular, the patient with bed 8 has a lot of phlegm, and if he is not suctioned in time, it is easy to block the respiratory tract and sometimes even cause coughing. Be sure to wear a mask when handling it. There are often novice doctors and nurses who are sprayed with phlegm in the face by patients. ”

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

Most of the patient's phlegm is purulent, and if it is sprayed on the face, it will be disgusting to think about.

What's more, many of the patients who live here have sepsis and various infections.

Zhou Can's hairs stood up when he heard this.

When suctioning sputum on a patient in bed 8, special care is always taken. Fear of being sprayed with phlegm on the face by the patient.

Fortunately, this hasn't happened yet.

After the condition of the car accident patient with cerebral hemorrhage stabilized a little, Zhou Can ran to bed No. 7 again and picked up the patient's information for research.

In this patient with diffuse intestinal bleeding, can't the cause of the bleeding be found?

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

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

Of course, it's certainly not as simple as it seems.

For the patients who have been admitted here, the attending physician and chief physician of the specialty have all been checked.

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

"Xiao Zhou, I always take the data of 7 beds of patients to study, is there anything I 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?"

"Who knows! A number of chief experts in the Department of Gastroenterology have been consulted, and at present, it can only be identified as intraintestinal bleeding, which can rule out tumors and polyps. The attending physician took the risk of giving the patient a colonoscopy, using hemostatic enzymes, and even spraying epinephrine on the bleeding spot. But the effect is not obvious. Like whack-a-mole, the bleeding stops, and a new source of bleeding emerges. ”

"The final conclusion was that there was diffuse bleeding in the large intestine segment. The reason why he was willing to be admitted 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.

From these conversations, it can be seen that Dr. Hu is definitely a qualified ICU doctor.

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

All the treatments that can be done are in place.

In this way, the patient should have extensive bleeding from the lining of the large intestine with multiple lesions. It stands to reason that if there is bleeding in multiple parts of the large intestine, will the patient not develop wound ulceration and infection? ”

Zhou Can asked curiously.

The bacterial community in the large intestine is very high.

It is here that human feces are formed.

"Strange to say, the patient had black stool for more than half a year before being admitted to the hospital. It stands to reason that the infection and intestinal perforation should have occurred long ago. But that didn't happen to him. ”

Dr. Hu was also very puzzled by this.

There are a lot of irregularities in this patient.

There are many strange diseases in the world, and there are many causes and symptoms that are beyond the scope of a doctor's understanding.

Just as 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 in bed 8.

Zhou Can hurriedly put down the information in his hand and walked over to deal with it.

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

And it's falling rapidly and continuously.

The machine keeps giving off alarms.

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

There must be something wrong with breathing.

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

Not long after the condensate was poured.

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

There was also no sign of loosening of the pulse oxime.

He couldn't find the reason, so he turned around and called Dr. Hu to come and help.

As a result, Dr. Hu was standing behind him.

"In this case, don't panic. You can adjust the breathing parameters first. ”

Dr. Hu appeared extremely calm.

After adjusting the respiratory parameters, the patient's blood oxygen index finally stopped falling and began to rise continuously, quite quickly.

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.

The problem was solved.

"Did you learn?"

Dr. Hu asked him.

"It turns out that breathing parameters can't be fixed! It seems that I still have a lot to learn, and I will ask for more guidance in the future. ”

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

Before you know it, it's time to get off work.

It was clearly said that he would leave work at four o'clock, but the doctor who took over the shift did not enter until five o'clock.

The doctor who came to hand 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 to become numb to everything in this world.

This Doctor Shi is a man of few words, and he does not have a smile when he speaks.

After completing the handover and coming out of the ICU, Zhou Can couldn't help but ask, "The doctor Shi who handed over is so cold and serious!" ”

"Just get used to it. Dr. Shi is actually a very good person, and he is also warm-hearted when he encounters things. He used to be an anesthesiologist before transitioning to the Intensive Care Unit as an attending physician. If nothing else, he will be promoted to deputy senior title this year. ”

Dr. Hu explained to Zhou Can.

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

It's not that they're cold.

It's about their profession. When working, you must always keep an eye on the patient's vital signs, and if there is any trouble, you must deal with it immediately, or give some correct advice to the surgeon.

This dooms them to work without smiling and maintaining a serious expression all the time.

Over time, it has become such a character.

Anesthesiologists are not only hard, but also have limited room for promotion and a less promising future.

At least for now, at home.

Anesthesiologists in developed countries, Japan and Germany are very popular and have a high status. Anesthesiologists in the United States earn $190,000, which is the highest among doctors.

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

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

However, most doctors in the United States are family doctors, which is equivalent to community doctors in our country. Of course, people's incomes are much higher. There are only two kinds of doctors who really have status in the United States, one is a medical doctor or professor who is engaged in research, and the other is a leader in a certain discipline who works in a medical center. Those who have achieved it are called super doctors.

The status is comparable to, if not higher, that of our domestic first-level directors.

"Do you know what type of doctor is the best in the intensive care unit? It's an anesthesiologist-turned-doctor. Director Hu exposed him another astonishing fact.

(End of chapter)