The origin of ICU construction in foreign countries is not very clear, and the earliest ICU construction in China was led by anesthesiologists.

Speaking of which, I have to introduce the emergency department first.

In the past, there was no emergency department in domestic hospitals, and it was a department that was later established to rescue emergency patients. Later, a series of norms and discipline definitions were carried out, and finally in line with its name, all emergency patients can be called the emergency department.

And the emergency department cannot refuse treatment.

Also, the clinic is closed at night.

There is a doctor on duty 24 hours a day in the emergency department, and a doctor is required to receive a doctor whenever he goes to the hospital to hang up the emergency.

With these two gold standards, the emergency department later added some privileges.

For example, after a car accident patient was brought over, there was no family member. For a while, there was no way to contact the family or the patient's immediate family. The patient's life is in danger, and according to the rules of the hospital, the family must sign and pay the fee before the treatment is given.

In this case, the emergency department has an extra privilege, during working hours, without the signature of family members, go directly to the medical department, and then the director of the emergency department will sign on his behalf.

No one pays, but if surgery or resuscitation is not scheduled immediately, the patient will die immediately.

Easy to do!

If you are in arrears, treat it first.

Even today, the department with the most bad debts in the hospital, the emergency department is still the number one.

In addition to these privileges, emergency examinations are generally written as expedited.

A lot can be done without queuing and preferentially.

If a specialist wants to be admitted, you have to wait until the bed is available before you can be admitted.

The emergency department is not so particular, it is really not good, and it is okay to lie down in the observation room.

You doctors can't watch patients die in the hospital anyway, right?

With all the conveniences and privileges, patients love the services of the emergency department.

As a result, the emergency department became one of the busiest departments in the hospital.

The department directors, experts, doctors, and nurses of the major specialty departments naturally did not agree when they saw that all the patients had gone to the emergency department.

As a result, the congenitally deficient emergency department has become a transit station for guidance.

Only acute and critical patients are treated, and only initial treatment is carried out, and after the patient's condition is stabilized, he is guided to the corresponding specialist for further treatment.

In this way, the specialist department is at ease.

It is equivalent to an extra helper who can screen and treat patients in the early stage.

When they are sent to the specialist for treatment, the specialist doctors and nurses just take their time step by step.

The specialist found that the small day was much more comfortable than when there was no emergency department.

Key revenues are not decreasing.

Because the emergency department only provides initial treatment to patients, the majority of the medical expenses such as medication, surgery, and hospitalization are almost not 10% of the emergency department.

But the emergency department does more work than any other specialty.

I also have to endure all kinds of abuse and even beatings from patients and family members all the time.

The work in the emergency department is tiring and dangerous, and the pay is low.

Therefore, there is a saying in the medical community that advises people to enter the emergency department and be careful of thunderstorms.

Over time, few doctors are willing to stay in the emergency department for long periods of time. Especially those powerful doctors, after they have been trained one by one, they have jumped to the weight department, eating and drinking spicy, and their status is still high.

The inability to retain elite-level doctors will inevitably lead to a poor level of rescue in the emergency department.

What to do?

Later, the Department of Critical Care Medicine was introduced.

Some critically ill patients received by the emergency department are irregularly treated by the medical staff of the intensive care department to save the lives of the patients.

In terms of life support and life monitoring, the doctors in the anesthesiology department are naturally well-deserved brothers.

This is also the early intensive care medicine department in China, and the backbone doctors are basically anesthesiologists.

Later, the nutritional support of internal medicine was integrated into the intensive care medicine department, and the life support of anesthesiologists was combined. It's perfect.

Gradually, some critically ill patients were admitted to the ICU, no longer entering alive and being carried out dead.

The number of patients who are transferred to the general ward alive is increasing.

Up to now, the Department of Intensive Care Medicine has absorbed the examination of medical technology, the nutritional support of internal medicine, the life monitoring and life support of anesthesiology, and the surgical support of surgery. For example, invasive ventilators, tracheostomy tubes, hanging urine bags, etc.

It can be said that the current intensive care medicine department represents the comprehensive strength of a hospital.

Elite medical care is dispatched from each department to provide patients with the best medical resources and life support, as well as a variety of treatments.

However, no matter how it develops, the doctors of anesthesiology have a first-mover advantage, and their position in the intensive care department is still very important.

"It turns out that Dr. Shi used to be an anesthesiologist, so it is understandable that he is silent. Do you say that the development of intensive care medicine is better compared to anesthesiology? ”

Zhou Can is curious, which department is better?

Anesthesiology, Critical Care Medicine, both of which seem relatively mysterious to most doctors.

Little is known about income and development prospects.

"To each his own! Dr. Shi's transition to the Department of Critical Care Medicine should be considered a very successful transformation. Although he was promoted to the attending level in the anesthesiology department before, he changed his title after moving to the intensive care medicine department. However, he is likely to be rated as a deputy senior professional title this year, and if he is still engaged in anesthesia work, he may not be able to be evaluated. ”

The evaluation of deputy senior professional titles is a hurdle for many attending doctors.

At least one topic at or above the provincial level, three core journal-level papers are enough to kill many people.

As for the written examination for the deputy senior professional title, it is only the easiest first small level.

Dr. Shik's age should be around 39 to 40 years old.

Some doctors with good talent, good foundation, and good luck may be rated as deputy senior professional titles at the age of 38. But after all, there are only a handful of them.

Many people are thankful that they can be rated as deputy senior professional titles before the age of 45.

Why add a lucky one?

Because when choosing a research topic, if you can hold the big thick legs of a certain big guy, participate in a good project, or assign you a more ordinary topic to host.

These good things require luck and character to obtain.

Dr. Shi can be rated as a deputy high at the age of 40, and in a large hospital like Tuya, which is extremely competitive, it is definitely a very successful transformation.

Zhou Can laboriously inquired about this matter in order to prepare for the evaluation of the title in the future.

My family knows my own business.

His low education is a hard flaw. The higher you climb, the more obvious this bruise becomes.

Although with his current development momentum, there is a high probability that he will be able to solve the problem of academic qualifications in the workplace, but he always has to prepare for the worst.

Now it's time to inquire more about a rainy day.

"Xiao Zhou, I will go to the ICU at eight o'clock tomorrow morning to take over the shift, remember to arrive about half an hour in advance."

Before Dr. Hu and Zhou Can parted, they told him.

Today is only the first day of work, and Zhou Can mainly learns the operation of various instruments and is familiar with the environment.

Tomorrow, I should slowly add some tasks to him.

After work, even though Zhou Can was eating dinner in the hospital cafeteria, he was still thinking about the patient in bed 7, what was the cause of lower gastrointestinal bleeding?

The patient's various examination reports are constantly replayed in his head.

Intestinal bleeding, if left untreated, is very prone to perforation. However, the patient was dragged on for half a year without treatment, and his intestines were not perforated.

This should not be a miracle.

There must be unknown reasons.

The patient has already undergone endoscopic hemostasis therapy, and if there is a significant abnormality in the intestine, the doctor will definitely be able to detect it in time.

The patient has undergone a routine stool test with occult blood.

No obvious cause was found on the examination report.

Zhou Can's mind came up with an anatomical diagram of the human digestive tract.

The human intestine is made up of the small intestine and the large intestine.

The upper part of the small intestine starts from the pylorus of the stomach and the lower end connects to the cecum of the large intestine.

The length of the entire large intestine is about 1.5 m for adults. It is not too long, because the end can be probed through the intestinal hilum, so it is easier to detect the lesions in the large intestine.

Zhou Can secretly pondered that intestinal tumors, polyps, intestinal ulcers, and various enteritis can basically be ruled out now.

Vascular malformations and varicose veins can also be ruled out.

This disease is really hard to deal with.

The doctors in the Department of Digestive Medicine couldn't find out, and they really didn't blame them.

It was this patient's disease that was too complex.

It's complicated, but it's also simple.

Because its bleeding has been basically determined, it is diffuse bleeding in the large intestine.

The large intestine mainly includes the cecum, appendix, colon, rectum, and anal canal.

The appendix can be ruled out first.

There is a problem with it, and the patient will die of pain, and it will not take more than half a year at all.

And it will rot in the abdominal cavity.

The anal canal can also be largely eliminated.

Then only the cecum, colon, and rectum remain.

Starting from these three parts, I'm afraid it will be difficult to gain anything.

His current level of pathological diagnosis is at the average level of a resident doctor, and no matter how arrogant he is, he cannot be more arrogant than the chief physician.

He has been able to make meritorious contributions repeatedly, relying on alternative diagnostic ideas.

Looking at the problem from different angles, you can see some blind spots and blind spots that other doctors can't see.

This is one of his strengths.

"Could it be that there is a malignant tumor in the large intestine and then an invasion occurs?"

He couldn't help but think of a possibility.

The patient has a complete blood test, and leukemia can be ruled out.

Generally speaking, unexplained bleeding begins with screening for leukemia and bleeding disorders.

There is a malignancy that should be detected by the patient when the patient has an angiogram.

Zhou Can tried again to recall the angiography report, and finally, he preliminarily ruled out the possibility of malignant tumor infiltration.

Then only one last inference remains.

He boldly speculated that the cause would be in the small intestine.

The small intestine of an adult is about 7 meters, and the shortest is 5 meters. It is the main nutrient absorption organ of the human body.

The patient's emaciation is certainly due to long-term bleeding.

But it is also possible that the bleeding is just a smoke bomb.

It is for this reason that when doctors diagnose, their minds are led by the nose. In other words, the doctor's diagnosis fell into this almost iron law misunderstanding.

When Zhou Cangang learned about the patient's condition, he heard that the patient had blood in his stool for more than half a year before he came to the hospital for medical treatment.

It is also instinctive to think that the patient's emaciation is caused by too long of delay.

For anyone, blood in the stool for more than half a year, it is impossible to maintain weight without losing weight.

"Yes, the small intestine should be checked."

The more Zhou Can thought about it, the more he felt that it made sense, and his thinking became clearer.

The alternative diagnostic thinking allowed him to break the inherent iron law and get out of the diagnostic misunderstanding.

There is a problem with the small intestine segment, what is the maximum likely to be?

First of all, one condition must be met.

When dirty fluid is excreted from the small intestine and enters the large intestine, it can cause bleeding in the large intestine.

This is a good explanation for the fact that the bleeding site of the large intestine is not fixed.

Zhou Can decided to ask the patient's attending physician about the situation.

The patient was treated by a physician named Xia Ping, an attending physician in the Department of Gastroenterology.

After eating in the hospital cafeteria, it was already half past six.

The gastrointestinal medicine clinic must have been closed for a long time.

But there will definitely be a doctor on duty in the inpatient unit.

Zhou Can has a very good relationship with Director Tan and Director Yin Hua of the Department of Internal Medicine. These are all the top bosses in internal medicine.

At this time, I went to the inpatient department of the Department of Internal Medicine to ask Dr. Xia Ping about the situation, and there should be no problem.

He is a doer, he does what he thinks, and never lets his dreams fall short.

Walked briskly all the way to the inpatient department of the Department of Gastroenterology.

"Hello, I'm Dr. Zhou Can from the Department of Intensive Care Medicine, and I want to find Dr. Xia Ping from the Department of Gastroenterology."

Zhou Can could only ask the girl at the nurse's station.

"I'm sorry, Dr. Xia has already left work. If you're not in a hurry, you can come back to him tomorrow. ”

The nurse's sister has a good attitude.

She is called a nurse sister because she is at least over thirty years old.

It's a lot bigger than Zhou Can.

When you meet that kind of tender nurse in her twenties, you can call it a nurse girl.

"It's not a particularly urgent matter, but it's about the safety of a patient in the intensive care unit, and I want to ask Dr. Xia about the patient's situation now. You can tell me Dr. Xia's phone number. ”

Zhou Can was really worried that the patient in bed 7 would not last long.

Because when I had a bowel movement today, my intestines were pulled out.

And the patient's physical condition is already in an extremely weak state. The sooner you find the cause of the patient's bleeding, the more significant it will be.

"We don't have a doctor's phone here! You can go to the doctor's duty room and ask the doctor on duty. ”

Nurses deal with a large number of family members on a daily basis.

One by one, they were very slippery.

If you want to ask something from them, don't even think about it unless it's an undergraduate doctor with whom you have a good relationship.

Zhou Can can be regarded as a teacher, and he no longer wasted time, and walked directly into the doctor's office.

Knock knock!

The office door was open, the lights were on, and only one doctor sat with his back to the door.

Knocking on the door is a sign of politeness.

"Please come in!"

The doctor looked back.

"It's you! If you don't work in the emergency department, why did you come to our gastroenterology department? ”

This male doctor is none other than Dr. Chi, who went to the emergency department last time.

His impression of Zhou Can should be quite profound.

Otherwise, it would be impossible to recognize it at a glance.

"Hello, Dr. Chi!"

Zhou Can tried to respect each other as much as possible.

Last time, this Dr. Chi went to the emergency department and was so arrogant that he ended up making a fuss.

Zhou Can naturally won't mention the past troubles again.

"Something?"

Dr. Chi's expression was somewhat unnatural, and he probably remembered what happened last time. There is definitely embarrassment.

"I would like to ask Dr. Xia Ping about a patient's condition, can you tell me the phone number?"

Zhou Can asked in a low profile.

"Doctor Xia's phone, okay, I'll look for it, wait a minute!"

Dr. Chi didn't make it difficult, and really put down what he was doing and found a phone number for Zhou Can.

"Well, this is Dr. Xia's mobile phone number, you just need to dial it. But it's time to get off work, so it's hard to say if you can get in touch. ”

"Thank you!"

Zhou Can called according to the phone on the duty schedule.

Luck was good, it was connected.

He is not shy about asking patients directly in the office.

"Hello Physician Xia, I am Zhou Can, a trainee from the Department of Intensive Care Medicine, and I would like to ask you about the situation of a patient with gastrointestinal bleeding named Guo Ziyang in bed 7, is it convenient now?"

Zhou Can asked.

"Convenient, convenient, you say!"

The voice on the other end of the phone was calm and magnetic.

(End of chapter)