"Just wait for me in the office around half past three tomorrow afternoon."

It seems that Director Liu will be on the evening shift tomorrow.

"There's WeChat, right? Later, we will add the work groups in the group. If there is a temporary shift change in the group, or other things, it will be notified in the group. ”

Doctors in almost every department are divided into several medical teams.

For example, in the group of extraosseous and bone trauma, the doctors in this group basically study diseases in the field of bone trauma. Then the bone joints are a group. Microsurgery in one group. A group outside the hand. A group outside the ankle. Spine Surgery One Group.

Zhou Can has just entered the intensive care department, and he doesn't know much about the grouping of this department.

Intensive care medicine is generally divided into three groups.

It mainly includes respiratory, multi-organ dysfunction, cardiovascular and cerebrovascular and nervous, these three areas.

To put it bluntly, it is the three major systems of internal and external circulation and nerves.

As long as there are no problems with these three systems, a person's life is guaranteed.

External circulation mainly refers to respiration, including the entire respiratory system, blood oxygen exchange, synthesis, etc.

Internal circulation mainly refers to blood delivery, the supply of blood and oxygen in the body, and the supply and excretion of nutrients.

Needless to say, nerves are the entire nervous system with the brainstem as the center.

After analyzing the three major systems of a person's life support, it seems that the work of anesthesiologists is not so mysterious.

If you want the patient to lose the sense of pain, you just need to cut off the nerve signal.

General anesthesia and spinal anesthesia are the most commonly used methods by anesthesiologists. As for local anesthesia, this rarely bothers them.

Considering the cost of surgery, the surgeon in charge usually does this together.

"Doctor Hu, after getting off work, remember to pull Dr. Zhou into the work group of our group."

After Director Liu explained, he didn't wait for Zhou Can to say anything more, and left directly.

By the time Director Liu left, Dr. Hu was visibly much more relaxed.

"In the future, it's the world of you young people! The Yangtze River is in front of the waves and in the back, and one generation is stronger than the next. Dr. Hu's expression was very complicated.

Looking at Zhou Can's great achievements, if you want to say that it is not sour, it is fake.

Now, Zhou Can has won the appreciation of Director Liu, and he can be called hardened with wings.

Dr. Hu can only accept reality.

Strive to maintain a good colleague relationship with Zhou Can, and no longer treat him as an ordinary standard trainee.

At this time, the alarm of the 6 beds went off.

The alarm sound is actually different for each machine.

Zhou Can has been working here for a day. As soon as you hear the sound, you know that there is a problem with your blood pressure.

When I ran over to see it, my blood pressure was dropping vertically.

I'm afraid I'll have to send away another bed No. 6, when will this spell be broken!

Dr. Hu has long been accustomed to all kinds of big scenes, so he doesn't panic.

After checking it, he said categorically, "It's ventricular fibrillation, it's definitely ventricular fibrillation." Defibrillation immediately. ”

Ventricular fibrillation is a rapid and weak contraction of the ventricular muscles or an uncoordinated rapid flutter.

As a result, there is no blood leakage in the heart, and all heart sounds and pulses disappear.

Blood perfusion of organs such as the heart, brain, and surrounding tissues stops.

The human heart is like a water pump, pumping blood out through the arteries and blood vessels to all major organs and tissues throughout the body.

When ventricular fibrillation occurs, it is equivalent to a problem with the water pump, and the blood is not pumped out.

Irreversible damage occurs within three minutes of ischemia in the brain. Brain cells begin to die.

Ventricular fibrillation can be dangerous.

At this time, the most common rescue method is defibrillator defibrillation.

"Xiao Zhou, defibrillation taught you yesterday, can you operate?"

"Yes!"

Zhou Can took the prepared defibrillator and didn't talk nonsense.

Defibrillation is administered to the patient's chest.

The patient's body bounces violently after receiving an electric shock.

This is a normal reaction.

[First Aid, XP +1.]

Zhou Can was a little confused.

I've never had this kind of medicine before! Why did a first-aid intelligent medical technique suddenly appear?

In his current rush to save the patient, he couldn't delve into it.

The first time I gave the patient an electric shock defibrillation, the effect was not very good.

"Come again!"

Dr. Hu stood by and calmly commanded.

Zhou Can once again administered electric defibrillation to the patient.

[First Aid, XP +1.]

The patient's heart rate and blood pressure gradually returned to normal, and this fate was temporarily rescued.

Both he and Dr. Hu breathed a sigh of relief.

It was really scary to see the patient's blood pressure drop straight down just now.

Some of the patients in the ICU ward have to go around many times a day.

Doctors and nurses work together to pull them back each time, and then continue various life supports and treatments. Until all means are exhausted to help them successfully turn the danger into a disaster and transfer them out of the ICU.

Or finally send people away.

There are also special circumstances that will allow the patient to be transferred out.

For example, the family members do not agree to the treatment. Or patients with malignant tumors, other terminally ill patients, knowing that they cannot be cured.

In principle, such patients will let them go.

Some private hospitals or small hospitals, considering the operating costs of the ICU, may be one of the common operations to stay for a few more days when there are not enough patients.

For a regular doctor like Tuya, patients in the ICU are rescued, and the material fee exceeds 200 yuan, and they have to ask their family members to sign and agree.

And the operating costs of the ICU are very high, and they are basically at a loss.

Let's give two examples of fees to explain why the treatment fee in the ICU is at least two or three thousand a day, and the highest is tens of thousands.

Thoracentesis or abdominal puncture for a patient is charged about 90 yuan at a time.

At least two nurses are required to do a thoracentesis.

A senior attending doctor, plus a nurse to help.

If the puncture goes well, it will take half an hour. This is because the attending physician has excellent operating skills, skillful techniques, and proper cooperation with nurses. The patient's condition should be relatively normal.

Otherwise, various difficulties arise with puncture. In this case, ultrasound positioning must be used to complete the puncture.

Two or three people are busy for at least half an hour, and they also need to use B-ultrasound, which is not cheap and not particularly expensive. and consumables. The final charge is 90 yuan.

Do you say that the hospital is at a loss?

As another example, cardiopulmonary compression is believed to be familiar to many people.

This is the often referred to CPR rescue method.

Seemingly simple chest compressions, how tiring they are, I believe those who have pressed them know it. If you are an adult, you will need to press more than 100 times per minute at a depth of about 5 cm each time.

It is best to reach about 120 times.

This kind of high-intensity pressing, one or two people come in turns, and the time is short. If it's been a long time, don't even think about it.

But the family was unwilling to give up, and the doctors and nurses had to continue to rescue even if they were in tears, gritting their teeth, and dying of exhaustion.

Usually this resuscitation process lasts several hours.

Four or five hours is a common occurrence.

Families generally hope for a miracle of life for doctors to resuscitate their loved ones. Therefore, if you don't rescue for a few hours, the family will not die at all.

Even if you press for four hours, it's fine.

For such a long period of compression, it often takes four or five medical staff. The nurse has little force, and it is usually the doctor who comes to compress.

Four or five doctors work hard for four or five hours, and what is the final charge?

100 bucks.

And the hospital has a hard and fast rule, it must only be accepted once.

In some patients, the heart can stop beating several times a day. He's just teasing the doctors, making you desperately press and rescue.

The final charge is still 100 yuan.

Did the hospital lose or gain?

Half a day's salary for a doctor is not enough.

Many family members and patients opened their mouths and said that the ICU of the hospital was really fucking black, and they charged him 10,000 or 20,000 yuan a day to grab money.

It's just that they don't look at what expensive instruments and expensive consumables and drugs are used that day.

Many consumables are imported.

Why not use domestic ones? It's all tears. The quality of domestic production is difficult to describe.

Not to mention medicinal herbs.

In a large public hospital like Tuya, please stop talking about the high cost of ICU treatment in the future. As long as you can save your life, it's definitely worth it.

In case of loss of both money and money, the doctors and nurses really did their best.

……

Zhou Can waited until the condition of the patient in bed 6 stabilized a little, and immediately checked the new medical technique that suddenly appeared just now.

As a result, I don't know if I don't see it, and I am happy to see it.

I don't know when two new medical skills will be introduced.

Probably got it last night while asleep.

Because he returned to the apartment yesterday, he practiced the quick knife technique, and also checked his personal medical attributes. There are no two of these skills.

[First Aid Intelligence, Current Experience Points: Beginner 2/1000.] Special medical skills, when rescuing patients, they can multiply their wisdom, calm their minds, and improve their diagnostic thinking by 50%. 】

It was the first special medical skill he had acquired.

It is very interesting, and this medical technique is only useful if it is necessary to save the patient.

The diagnosis idea has been improved by 50%, which is of great help to him in diagnosing the cause of the patient and detecting the lesion.

It's no wonder that when I defibrillated this car accident patient just now, his mind was obviously clearer than usual.

Maybe it's the art that works.

The diagnostic idea is equivalent to the problem-solving idea, and the clearer it is, the easier it is to answer the question.

The higher the accuracy rate will also be.

Let's look at another new medical technique.

[Pharmacological dialectic, current experience value: level 3 1/1000, inferior level of residency.] 】

This medical technique can deepen the understanding and application of pharmacology, and can be used dialectically to ensure that the medication is correct and the treatment effect is achieved.

This medical skill is directly at the level of resident medicine, which may be related to Zhou Can's solid pharmacological foundation.

His pharmacological foundation is far better than that of ordinary trainees.

Now that he has pharmacological dialectical medicine, he only needs to wait for the medical practitioner certificate to be in hand and has the right to prescribe, Zhou Can can quickly improve this medical skill.

Pathological diagnosis is to identify the cause and determine the pathological mechanism.

Now, Zhou Can has three major means to defeat the disease: diagnosis, medication, and surgery.

As long as he slowly improves these medical skills, he believes that more and more diseases can be treated.

These two new medical techniques must have been acquired by treating patients in seven beds last night.

The pharmacological dialectic is because he prescribed the medicine to the patient, and Dr. Shi probably adopted it.

As for the intelligent medical skills of the first aid, it is equivalent to giving a commendation to him for his active rescue of patients.

Or when he rescues patients, he often seems to be obsessed and is particularly fascinated.

In this state, the diagnostic ideas and wisdom are far beyond the ordinary state.

It is equivalent to the meaning of extraordinary play.

In any case, the two new medical skills obtained made Zhou Canru a treasure, and his heart was full of joy.

"Xiao Zhou, Xiao Zhou!"

Doctor Hu saw Zhou Can standing there stunned, and called out repeatedly.

"Ah...... You call me? ”

After Zhou Can came back to his senses, he was a little embarrassed.

"You can't be a little absent in this work, and you must always be highly vigilant, otherwise a small mistake may lead to untimely rescue of patients, resulting in very serious consequences."

Dr. Hu admonished him in a more serious tone.

"Understood! I'll definitely pay attention next time. ”

Zhou Can's mind couldn't help but come up with the extra-divine Zhushen Peak. Just because of diarrhea and temporary slackness, it almost led to a serious medical accident.

"You keep an eye on it here, I'll go over there and help them."

Not far away, five or six doctors and nurses were already surrounded in front of a hospital bed, trying their best to save the seriously ill patients on the bed.

You can feel the danger of the war from afar.

Dr. Hu took the initiative to help, which made Zhou Can's impression of him change a lot.

At least in the unity of the department, and in the normal rescue process, Dr. Hu is a qualified and good doctor.

He was reluctant to risk giving medication to his patients, and he had his own worries and concerns.

Not every doctor dares to risk his future and his hard-won job.

Any mistake may ruin your job or even a lawsuit.

Sentencing is generally rare.

Even if the doctor is obviously at fault, as long as there is no subjective malice, the most punishment is suspension, suspension of prescription authority, and suspension of surgical authority. In more serious cases, the medical practitioner's license will be revoked. The most serious is the lifetime ban from the industry.

That is, he is not allowed to practice medicine again for the rest of his life.

Zhou Can picked up the patient information of the 6 beds to check. The examination report showed that the intracranial hemorrhage was severe, and as for the leg bone fracture, it was nothing compared to the brain injury.

"The hemorrhage point is close to the brainstem and is profuse, with subarachnoid hemorrhage. There is a fracture of the skull. The patient is in a deep coma. ”

No wonder no doctor dared to operate on this patient.

The risk is too great.

The only way is to stay in the ICU for a few days and see if the bleeding stops on its own.

Wait until the patient has overcome this difficulty and the condition is a little more stable, and then formulate the next treatment plan.

"If the bleeding can be surgically stopped and the intracranial congestion can be removed, at least this patient's life should be saved."

After Zhou Can read the examination report, he quickly thought about the patient's treatment plan in his mind.

The plan he thinks of may not be actually implemented.

But it can help him accumulate treatment experience and expand his thinking.

CT scan of the patient's chest showed no particularly serious injuries. It is likely that ventricular fibrillation is caused by a brain problem.

One of the most common causes of intracranial hemorrhage is intracranial hypertension.

Or a hematoma develops, compressing vital brain tissue.

To make matters worse, the bleeding site itself occurs on vital brain tissue. This condition is usually accompanied by damage to important brain tissue.

"If the patient's condition can be stabilized a bit, maybe a cranial endoscopic surgery can be tried. It mainly includes hemostasis, aspiration of congestion, and reduction of intracranial pressure. ”

After careful research, the only treatment he could think of was surgery.

I am afraid that it will take a long time to do traditional craniotomy, and the patient's physical tolerance requirements will be much higher. For minimally invasive endoscopic surgery, you should wait until tomorrow at the latest to achieve the surgical target.

Zhou Can found that after two months of training outside the gods, the harvest was really great.

Diagnosing this patient at this moment, he was able to confidently formulate some confident surgical plans.

He has performed so many third- and fourth-level major surgeries outside the gods, and his knowledge, experience, and prediction of the entire perioperative period are not the same.

"Brother, if you can hear me, you will grit your teeth and survive today. By then, your condition has stabilized, and I will recommend surgery to my senior physician. Zhou Can said to the patient.

I thought the patient who was unconscious would not be able to hear.

As a result, Zhou Can noticed tears flowing from the corners of the patient's eyes.

Then he noticed that the patient's heart rate had risen significantly, and the brain waves had some high-pitched waves. It seems that the patient really heard what he said, and it caused the patient to get emotional.

Being able to hear me and think normally, with mood swings, it seems that the patient's brain is awake and the degree of coma has lessened.

Zhou Can was overjoyed when he made these discoveries.

This seemingly critically ill patient was saved. As long as he survives this hurdle and helps him perform intracranial hemostasis and hematoma removal surgery, he will be able to live.

While examining the 6-bed patients, Zhou Can recorded various conditions such as central venous blood pressure and urine output.

Patients in the ICU are given urinary catheters, not just to prevent the patient from urinating, or to go to the toilet frequently. It is also to observe the amount and color of urine very accurately.

Hematuria, proteinuria, etc., can be detected as soon as possible.

If a patient has been urinally absent for more than two days, even if all other signs are stable, it is not encouraging.

Basically, if the patient has no urine for a long time, it means that the internal circulation is not working.

The failure of this kind of organ is generally powerless.

It's not a dialysis session or other support that will save the patient.

Therefore, for ordinary people, eating, drinking, and lazing inconspicuously every day are the things that seriously ill patients need most.

Some key data is usually recorded every fifteen minutes.

By the time Zhou Can finished recording, the patient in bed 7 next to him had already begun to make a loud phlegm sound, so he was so frightened that he hurriedly went over to help bed 7 suction.

The nurse is turning over the patient in bed 8 and checking to see if he has pulled on his body.

The nurses who work in the ICU are warriors.

Because suctioning phlegm, wiping feces, scrubbing the perineum, lips, crushing the medicine and carefully feeding the patient to the patient, these are just the simplest daily tasks.

The stench emitted by some patients with sepsis is enough to make many young nurses unable to eat for a day.

However, if you work in it for a longer time, you will gradually get used to it, and your psychology will become extremely strong.

After Zhou Can suctioned the sputum of the 7-bed patient, he checked the blood pressure, respiration, urine output and other data, and there was a significant improvement. This is the most gratifying thing for him.

(End of chapter)