After checking bed by bed, Director Liu will take the initiative to explain to Zhou Can the symptoms of the patients and what targeted treatment has been given to them. Whether it is medication, respiratory support, blood filtration, or physical cooling, decompression and other treatments, they are all carried out around the theme of life preservation.

Compared with Dr. Hu, Director Liu basically taught him various treatment theories in simple terms and their application in practice.

Dr. Hu taught him how to use various instruments and adjust the parameters.

There are also the most basic critical care knowledge and routine operations such as pumping medicine, observing urine output, body temperature, respiration, etc.

It can be understood that the rescue knowledge and skills taught by Director Liu belong to the advanced version.

"The 11-bed female patient is 17 years old, which is very young. Current symptoms are recurrent low-grade fever, difficulty breathing, and lung infection, accompanied by cough and phlegm. The attending doctor investigated the cause of her and preliminarily determined that it was caused by a small cold. ”

Zhou Can looked at the dying girl on the hospital bed, and the whole person was completely in a coma.

A persistent low-grade fever can make you tired, weak, and drowsy.

A small cold directly put her in the ICU, and I don't know whether to say that she is unlucky or fatal.

The inconspicuous flu actually kills many people every year.

Even if the girl is sick like this, her face is haggard, but she still looks very beautiful.

Tall, with very fair skin, the kind that is red in the pink.

The hair is not black, but somewhat yellowish.

I don't know if it's dyed.

Her high nose bridge is also impressive.

This girl exudes the beauty of a half-breed.

Zhou Can's gaze looked at the ventilator parameters.

The tidal volume was set at 9 ml/kg and the respiratory rate was 16 breaths/minute.

Look at the inspiratory flow rate, 80ml/min.

This inspiratory flow rate is significantly higher.

Dr. Hu told him that patients need to increase their flow rate when they have fever, irritability, and convulsions. When you fall asleep quietly, you need to reduce your flow rate.

"Does she have COPD?"

Zhou Can asked curiously.

"Not bad! This is the disease, and it is likely to be congenital. ”

Director Liu nodded slightly.

Congenitally caused by obstructive pulmonary disease?

Zhou Can's brows furrowed slightly, and he picked up the patient's examination report to check it. Chronic airway inflammation with a lack of antichymotrypsin in the blood.

No wonder Director Liu said that she was a congenital disease.

Chronic obstructive pulmonary disease (COPD) is abbreviated as COPD. It is a chronic inflammatory disease of the airways.

Due to the presence of chronic airway inflammation, it can lead to some pathophysiological changes in the patient.

The most common is airflow restriction.

The patient then develops clinical symptoms such as cough, sputum production, and difficulty breathing.

There are many causes of COPD, and the lack of chymotrypsin in the blood is a very rare congenital condition.

It is said that this is related to race.

Yellow people rarely get the disease, and when the gene mutations in white people cause babies to be born deficient in chymotrypsin.

No wonder this girl looks like a half-breed.

Her father or mother, most likely Caucasian.

Antichymotrypsin is mainly found in α1 globulin.

Its action can inhibit a variety of enzymes. For example, trypsin, chymotrypsin, plasmin, thrombin, collagenase, leukocyte protease, elastase and other activities.

Its deficiency can lead to the occurrence of emphysema.

There is currently no cure for this disease.

"You are an expert in the field of respiratory. Lack of chymotrypsin, can't be cured? ”

"At the moment, there are too many diseases that we humans cannot cure. Doctors are powerless in the face of many diseases. Director Liu shook his head helplessly.

What this patient can do right now is to do his best to help her get through the difficult times of life.

After checking the patient's body temperature, sputum suction, urine output, etc., Director Liu told the doctor in charge of the bed, "Her phlegm is obviously too much, the moisture in her lungs may be very heavy, and the tidal volume must not be too large." ”

"Okay!"

The doctor who performed the operation was a senior resident, about 30 years old, tall and not very talkative.

Judging from the bed card records he made, he should be a very serious person.

Director Liu took Zhou Can to continue to examine other patients.

……

The eight-hour commute flies very quickly.

Zhou Can followed Director Liu to inspect the patients in his group, and then when the patients in other groups encountered danger, Director Liu took him to take the initiative to help. Sometimes, other doctors would anxiously ask him for help.

After the shift was completed, in the doctor's duty room, Director Liu checked the doctor's orders and there was no problem.

looked up at Zhou Can behind him.

"Xiao Zhou, follow me for a day, do you have any gains?"

"I have gained a lot, and I have learned a variety of medicines, treatment methods and means for seriously ill patients. There is also a deeper understanding of the flexible use of instruments. ”

Zhou Can did learn a lot of knowledge and methods for the treatment of seriously ill patients.

"It's a bit general, so let's sum it up in general terms."

Liu Ren deliberately tested him, wanting to see if he had studied with his heart.

Zhou Can thought for a while, and then concluded, "If you encounter a problem with your heartbeat and breathing at the same time, give priority to restoring your heartbeat." Because the oxygen contained in the blood can support ...... for a while."

"Who asked you to say this, it is to summarize what you learned today, don't be so specific."

Director Liu didn't wait for him to finish, and quickly stopped.

seems to be determined to make things difficult for Zhou Can.

"Uh...... In the process of treating patients, the operation of the internal and external cycles is first ensured. Among them, breathing and heartbeat are the most important. Ensure these two items, and then deal with body temperature, blood pressure, low blood oxygen, and so on. When there is a problem with the nervous system that causes respiratory and cardiac arrest, it is necessary to decisively establish extracorporeal dual circulation. ”

Zhou Can made a summary summary.

In most cases, only brain death leads to nervous system malfunction and respiratory cardiac arrest.

At this time, there is not much point in saving the patient's life.

However, there are also many examples of vegetative people being successfully aroused.

The fight is to hope for the miracle of life.

"Well, that's a lot better this time. It seems that you have been busy all day, and you have not worked in vain. ”

Director Liu nodded with satisfaction.

Zhou Can is very satisfied with his learning ability, understanding, and work attitude.

He, the chief physician, spent a lot of time personally guiding Zhou Can, and if Zhou Can was a fool of himself when he learned, or pretended to be very serious, he didn't actually learn it.

Then Director Liu will stop teaching him.

"Remember, we intensivists, the way of thinking about treating patients should be fundamentally different from that of specialists. The first thing a specialist thinks about is to treat the disease, and the doctor in our intensive care department thinks about saving lives first. Go back and think about it again, and then summarize what you have learned today, and tomorrow you will still work the evening shift. ”

After Director Liu finished speaking, he left in a hurry.

Zhou Can was also about to leave, but Dr. Shi stopped him.

"Doctor Zhou, I am going to write a paper for the 7-bed patient, and I will sign your name when the time comes. If you want, you can study it with me. ”

Dr. Shi is always so direct.

"Thank you! As long as you don't think I'm a burden, you can call me at any time to do research. ”

With such a good thing, Zhou Can naturally did not refuse to come.

Dr. Shi is very kind.

It is okay not to write Zhou Can's name when writing a paper.

"Doctor Shi, Doctor Shi, the patient in bed 6 has woken up!" The nurse excitedly ran over to inform.

"Awake? I'll go over and have a look. ”

Dr. Shi walked briskly to the intensive care unit, and Zhou Can followed.

The patient in the 6th bed can be revived, or is it the surgery he performed on the patient?

Upon entering, it was found that the patient had opened his eyes and appeared to be conscious.

Because the patient's eyes are not glazed.

"Great! It seems that there is still a lot of room for improvement in the treatment of patients in the intensive care department! ”

Dr. Shi's feelings were too deep.

Just yesterday, the patient was still in need of emergency rescue from time to time.

After the operation, it took only one day and one night, and the patient woke up directly from the extremely critical condition and coma, and his vital signs were stable and all aspects improved rapidly.

Sometimes, treating the sick is like fighting a war.

Once you find the 'command post' of the disease and defeat it, the enemy will be defeated.

In a very short period of time, the patient's condition will improve rapidly.

Transferring out of the intensive care unit in two or three days is not a dream.

"Dr. Zhou's fighting spirit may lead the intensive care department to start an upgrade and reform of the treatment model. Previously, we were really too conservative in our treatment of patients. Perhaps learning to be proactive is the right treatment concept. ”

Dr. Shi said to Zhou Can.

The treatment of patients in the intensive care department is indeed conservative. Many doctors and nurses want to save the patient's life, and don't care about the rest.

More aggressive, bolder treatments mean high risk, and few doctors are willing to take that risk.

"Doctor Shi, the patient in bed 22 needs to establish central venous pressure, but the blood vessels are difficult to puncture, can you please come over and take a look?"

A nurse walked briskly.

"Okay!"

Dr. Shi is an anesthesiologist himself, and he is familiar with the operation of establishing various life monitoring.

Monitoring central venous pressure is an invasive monitoring method.

A central venous catheter is placed in the internal jugular vein or subclavian vein, and testing is performed after indwelling at the junction of the right atrium and the superior and inferior vena cava. The process of inserting the catheter is not so easy.

Especially when encountering some patients with thin blood vessels and inconspicuous veins, the operation is even more difficult.

The resident doctor, who was trying to establish central venous pressure monitoring, was already sweating profusely.

"I'll try it!"

Dr. Shi took the initiative to take over.

It's just that his brow quickly furrowed, and his expression became extremely focused.

The instrument next to it emitted an annoying alarm and kept ringing.

The patient's oxygen saturation was frighteningly low.

It's no wonder that residents are in a hurry to establish central venous pressure monitoring for their patients.

"Hell, this patient's veins are thin and slippery."

After Dr. Shi missed twice, he may have lost his face and cursed to himself.

Zhou Can originally came over to learn from him, and stood by and watched.

Doctors generally don't pay much attention to the practice of injections, just an injection, who wouldn't?

In particular, many drugs can be injected directly into the muscle, so it is even more casual.

"I've had injections, can you give it a try?"

Zhou Can was anxious for a while.

This operation was trivial to him, but the resident doctor, even Dr. Shi, was doubly difficult to operate.

The patient's small blood vessels are indeed a reason.

At the end of the day, it's still a doctor's technical dish.

"Be careful, don't puncture an artery or nerve."

Dr. Shi was a little worried, but out of trust, he still asked Zhou Can to give it a try.

I saw Zhou Can take the needle, and it was just like that.

Seeing that Dr. Shi and the resident doctor's hearts jumped to their throats.

Is there such a needle?

It's scary.

It's a neck!

It's just that when they saw the dark red blood flowing from the catheter attached to the needle, they immediately showed a look of surprise.

The beautiful little nurse next to her looked at Zhou Can with great admiration.

This new Dr. Zhou is so handsome.

The level of injection is more powerful than that of the head nurse.

Zhou Can is currently a fourth-level injection surgery, and the attending doctor is at a medium level, which is infinitely close to the excellent level of the attending doctor. The average head nurse really can't compare to him.

"That's it!"

Zhou Can retreated to the side for a long time.

"Thank you, thank you!"

The resident doctor thanked him again and again.

Once central venous pressure monitoring is established, mixed venous oxygen saturation can be measured.

This parameter, called SOv2, gives doctors a clear picture of how much blood is being excreted from the heart.

SCVO2 is currently approaching 40, no wonder the sirens have been going off there.

When the oxygen saturation drops to this threshold, the mortality rate is very high.

"The blood output of the heart is too low, give him a cardiotonic immediately!"

Doctor Shi commanded from the side.

After the patient was given a cardiotonic agent, the oxygen saturation improved significantly and began to climb.

Everyone was relieved.

A crisis has been resolved.

"I really didn't see that Dr. Zhou's injection skills are so strong! In the future, if we encounter this kind of patient with thin blood vessels and slippery blood vessels in our intensive care ward, we will look for you if you want to stay in an indwelling or something. ”

It is not easy to get Dr. Shi, a silent and rarely spoken person, to make such a big call.

The main thing is that Zhou Can's injection technique shocked him too much.

Looking back now, I still feel scared and incredible.

With such a casual piercing, it was pierced into the veins with great precision. This kind of easy-to-use, shocking operation shows Zhou Can's high level.

"Okay, no problem! As long as the other doctors aren't afraid of me getting into trouble! ”

Zhou Can's words made several people laugh.

It was already time for him to leave work and he didn't linger too long before leaving.

However, about his skills and some deeds, it has begun to spread quietly in the intensive care department.

Just three days after entering the intensive care department, two critically ill patients have been saved, and there are many other dazzling small operations.

A person with the ability is always easy to be liked and admired by his colleagues.

In the next few days, as the 6-bed and 7-bed patients were transferred out of the intensive care ward one after another, Zhou Can's fame became even greater.

When he was on duty, more and more people asked him for help.

In the beginning, the other doctors were somewhat unable to save face. After all, it was a little embarrassing to ask a regular trainee to help.

Later, Zhou Can helped three high-risk patients get better quickly and were quickly transferred out of the intensive care ward.

Now it's a big deal.

Other doctors don't care about face, unless it is a terminally ill patient such as cancer, they will talk to Zhou Can and ask him to help take a look.

Zhou Can is also very willing, not only can he have a good relationship with other doctors, establish friendships, but also earn diagnostic experience points, why not?

Sometimes, with a bit of luck, you can earn some other healing experience.

In particular, the increase in the experience value of pharmacological differentiation made him very happy.

As he gradually became familiar with his colleagues in the intensive care department, Zhou Can often took the initiative to take care of urinary catheter intubation, tracheal intubation, puncture and other work.

His placement experience has finally skyrocketed in the critical care department.

Some people jokingly call him a master of urination, and he doesn't give a damn about it.

Urinary catheter intubation is already difficult to operate, and doctors and nurses are somewhat shy about it. Zhou Can is as willing as he gets.

Because inserting a urinary catheter is 1 point of experience point insertion.

His placement is now level 4, and to reach level 5, he needs to earn 10,000 XP.

You have to be diligent and quick in order to realize this wish as soon as possible.

As he became more and more proficient in critical care medicine, so did the burden on his shoulders.

At first, only Director Liu gave him an extra weight.

Later, the deputy chief physician and chief physician of other groups also took a fancy to him. As long as Zhou Can is not so busy, all kinds of calling.

(End of chapter)