Zhou Can had already helped Yu Xin finish seeing the 65-bed patient at this time, and he walked straight to the outside of the ward.

For the patients in Director Zheng's group, he won't be idle!

Sometimes if he is overzealous, people may not appreciate it, and they will think that he is showing off his skills.

"Dr. Yu, I'll go back to the office to write the medical records and course of the illness first. If you have anything, you can always come to me. After nine o'clock, you'll need to wait until I have surgery to help you. ”

Zhou Can said to her.

"Okay, thank you!"

Yu Xin was very envious of Zhou Can's special treatment in the Department of Gastroenterology. He can follow Director Shang or Deputy Director Shi and others to perform surgery every day, and as long as Director Shang sits in the outpatient clinic, he must call Zhou Can with him.

These treatments are not to mention regular trainees, and even resident doctors are red-eyed.

Take Dr. Huang Liang as an example, he is already a leader in the resident medicine, and he still only has one day of outpatient exercise a week. I haven't brought anyone yet, so I just sit in the outpatient clinic by myself.

Don't look at the outpatient volume of the Department of Gastroenterology of Tuya Hospital, but these residents sit in the outpatient clinic, without exception, there are many doors.

Even if the registration fee is only 8 yuan, there are very few patients who register with these residents.

Occasionally, the front expert, deputy director, and attending number are hung up, and in desperation, the diagnosis number of a resident doctor is hung up, and the patient and his family have to look disgusted.

They would rather rush to hang a director number of a few dozen yuan than hang the cheapest resident doctor's number.

No one patronizes it, which means there aren't many opportunities to exercise.

The harvest of sitting for a day may not be as good as Zhou Can following Director Shang to diagnose a patient.

Because the patients with special needs expert numbers are basically in complex or serious condition. Only by diagnosing such patients can we learn real things.

Zhou Can returned to the office and seized the time to write medical records and disease course records.

One or two patients are easy to write, as many as eleven patients, the task is too much. There's a lot to worry about.

The doctor's orders of each patient should be double-checked, and the room should be checked at least twice a day.

All patients have to worry about discharge, surgery, cause examination, and medication.

If he just managed these eleven patients, he would be able to bear it.

The key is that he has to spare half a day for surgery or accompany Director Shang for consultation. There are only 24 hours in a day, and the working time is 8 hours.

In fact, he worked more than ten hours a day.

Sometimes, when encountering complex endoscopic surgeries, or when the patient in charge of him has a condition, he will leave work later.

For example, the day before yesterday, there was a patient who vomited blood, and he was about to leave work when he was admitted to the hospital.

At that time, the patient vomited two mouthfuls of blood from time to time, and the situation was really scary.

In this case, Zhou Can, as a doctor in charge of the bed, is really difficult to leave.

The cause of the patient is not clear, and the condition is not controlled, so it will be handed over to the doctor on duty, even if the other party does not say it, he will definitely scold his mother in his heart.

Out of the doctor's sense of responsibility, when I encounter such a patient, I will leave work if I don't handle it well, and my heart is not steady!

What if the patient dies at night?

The course of the illness was written here, and Duan Zifu ran over panting.

"Doctor Zhou, Doctor Zhou, please go and help Yu Xin! The blood pressure of the aunt in bed 65 suddenly began to drop for some reason. ”

Seeing Duan Zifu's anxious face, Zhou Can couldn't help but have five words in his mind: 'Goddess's licking dog'.

Duan Zifu seems to be interested in Yu Xin, and has been doing things to pursue her.

But she has always been cold to Duan Zifu and has never smiled at Duan Zifu. Her conversation with Duan Zifu is also like gold. But Duan Zifu didn't care about it, and he has been offering all kinds of courtesy to her.

When they met, they were the first to greet her with a smile on their faces.

Many times, the wards where the two work are different, and Duan Zifu will take the initiative to run over to her.

"A sudden drop in blood pressure? What is Auntie doing again? ”

When Zhou Can heard that the patient's blood pressure had dropped, his nerves immediately tensed.

The aunt herself has just been transferred out of the intensive care department, and her condition has deteriorated, and if it is not handled properly, the patient will die.

Often, a drop in blood pressure is a sign of a rapid deterioration and worsening of the condition.

Zhou Can ran to the ward, and Yu Xin was nervously measuring her aunt's blood pressure.

"Doctor Zhou, the patient's blood pressure has dropped suddenly, and it has been dropping, please help me take a look!"

Yu Xin was so anxious that a layer of fine sweat appeared on her forehead.

"The doctor's order for medication hasn't changed, has it?"

The first thing Zhou Can suspected was the problem of medication.

This is also the most likely cause of a drop in blood pressure in patients.

"No, absolutely nothing. I am a patient who has just been transferred out of the intensive care department, how dare I change the doctor's order! Yu Xin bit her red lip and shook her head again and again in denial.

Zhou Can carefully checked the bottle of the infusion, and the name of the drug was written on it with a black marker, and he was indeed not mistaken.

Wrong medication or overdose may be ruled out.

He looked at the patient, his forehead wet with sweat.

Lifting the quilt slightly, I saw that the patient was covered with a thick coat. It was covered with a hospital quilt.

Is this sweating?

"When was the coat covered?"

Zhou Can asked.

"An hour ago! What's wrong? Does the sudden drop in my mom's blood pressure have anything to do with the covered clothes? ”

The family member asked puzzled.

"When I left, I remembered that the patient was not sweating at that time, and after walking for less than 40 minutes, the patient was already sweating profusely, indicating that her blood pressure had dropped probably due to excessive water loss in a short period of time."

After careful observation, Zhou Can made a preliminary conclusion.

Patients with myocardial infarction, or hypothyroidism, adrenal insufficiency and other causes can be preliminarily ruled out.

This made Zhou Can even more convinced that it was caused by the patient's sweating.

"Oh, I was really in a hurry just now, why didn't I think of this?"

After listening to the cause of Zhou Can's explanation, Yu Xin suddenly realized.

After hydrating the patient, remove the covered garment to avoid continuing to sweat.

It didn't take long for Auntie's blood pressure to rise back.

Yu Xin let out a long sigh of relief.

The sudden situation just now really scared her a lot.

"Well, it's just a false alarm."

Zhou Can shrugged his shoulders and got up to leave.

The 67-bed tube bed intern approached and said to Zhou Can respectfully and nervously, "Doctor Zhou, can you please help take a look at the patients in our bed?" Until now, the cause has not been identified, and the patient had a diarrhea not long ago, and the abdominal pain symptoms have not been reduced. ”

Patients with abdominal pain, especially those with acute enteritis, generally reduce the symptoms of abdominal pain after diarrhea.

The patient's stomach had been aching for more than 14 hours, and his symptoms had not been relieved, which made Dr. Huang Liang, who had almost had an accident not long ago, highly nervous.

He was afraid that the patient would have a sinister disease such as intestinal perforation.

Unlike Gui Peisheng, he is already a senior resident, and he is not just a bed.

They are responsible for the entire treatment process of the patient.

To put it bluntly, it is the treating physician.

Zhou Can turned his head to look at bed 67, only to see Huang Liang standing there with an embarrassed face, barely squeezing out a stiff smile at him.

This guy is really funny.

I couldn't put down my son and asked Zhou Can for help, but I called my interns to come over and ask Zhou Can.

"My level is also very limited, I can only help you staff officers, and the advice I give may not be correct."

Zhou Can is very modest.

When I walked to bed 67, I began to conduct a simple face-to-face examination of the patient with my eyes.

"Dr. Zhou has recently diagnosed a number of difficult cases, Director Zheng asked us to learn more from you, you are too humble! This patient's condition continued to deteriorate, and although I was diagnosed somewhat, I was worried about misdiagnosis, so I wanted to ask Dr. Zhou to help me take a look. ”

Huang Liang said it hard.

There was a hint of praise for Zhou Can in his words, but he refused to lower himself too much.

"I wonder if Doctor Huang can give me a diagnosis?"

Zhou Can asked him.

"Depending on the patient's symptoms, I prefer acute gastrointestinal perforation, or acute cholecystitis." Huang Liang gave two diagnostic opinions, which shows that he has no bottom in his heart.

That's it, still pretending to be a big-tailed wolf in front of Zhou Can.

Zhou Can didn't demolish him either.

Instead, I took the patient's information and began to look at it carefully.

The patient's abdominal ultrasound showed no abnormal shadows, and there was no abnormality in the plain abdominal x-ray.

The patient, who is in the prime of life, was drinking and eating hot pot with a few friends last night, and felt unbearable pain in his upper abdomen after eating. After a few hours of pain, the symptoms did not relieve, so I ran to Tuya Hospital and hung up for the emergency department. After emergency anti-inflammatory treatment, there is no effect. The emergency department has limited capacity to diagnose and treat patients, and patients are sent to specialists for further treatment.

The patient has vomited several times, the vomit is contents, the pain is not transferred, there is no chest pain, chest tightness, no fever and chills, no urgency and pain, no blood in the stool, and hematemesis......

After reading it, Zhou Can made a psychological estimate of the patient's condition, which was an emergency, but it was not as serious as he imagined.

It should be an acute lesion caused by overeating.

Hot pots are generally spicy, have a strong flavor, and are also very hot.

Coupled with drinking, the underlying diseases in the body are directly detonated.

The patient's WBC: 22*10 to the ninth power/L, blood glucose 15.3mmol/L. Heart rate 85 beats per minute, no family history of diabetes......

The patient has normal cardiac enzymes.

Blood calcium decreases, blood sugar is high, blood lipids are also significantly increased, and blood amylase is also increased.

Cholecystitis is a real possibility.

However, acute gastrointestinal perforation is unlikely.

Zhou Can tried to press the patient's abdomen, as long as it was pressed to the upper abdomen, the patient screamed in pain. Pressing on other areas does not respond.

"You bend your knees to your chest and try it."

Zhou Can said to the patient lying in the hospital bed.

The patient did as he was told, with a comfortable expression on his face.

"It doesn't seem to hurt that much!"

The patient's pain was relieved, and he couldn't help but have more trust in the young doctor's medical skills.

"Have you ever had this similar abdominal pain before?"

After relieving the patient's pain temporarily, Zhou Can then asked.

"No, it's never hurt this before."

The patient shakes his head.

His girlfriend was accompanying him in front of the hospital bed, looking haggard. If anyone accompanies the patient for a night, and is frightened, it is estimated that this state will be the same.

"Smoking?"

"Suck!"

"Has his face always been so yellow?"

"I don't think so! It used to be quite fair-skinned. The patient's girlfriend thought for a moment before replying.

"Physician Huang, according to the patient's symptoms and various auxiliary examination data, mild jaundice, plus abdominal ultrasound and plain radiographs were not abnormal. My diagnosis is acute pancreatitis. I think his jaundice is probably due to the enlargement of the pancreatic head and the compression of the common bile duct, which caused the symptoms of mild jaundice. Elevated blood amylase is an important basis for diagnosis. ”

After Zhou Can showed the patient, he made a preliminary diagnosis based on the examination data and the patient's symptoms.

"Not acute cholecystitis?"

After Huang Liang heard this, his expression changed.

He received two diagnoses, but unfortunately none of them were correct.

"Probably not."

Zhou Can shook his head lightly.

"When I did a physical examination on a patient just now, in addition to epigastric tenderness, it was accompanied by tension in the abdominal muscles. In addition, a number of ancillary test data can also indirectly prove that acute adenodenitis is more likely. The pathogenesis is mainly the activation of inogen enzymes in the acinar, which triggers a series of chain reactions, which are strongly related to the patient's overeating. ”

Zhou Can's current level of pathological diagnosis is at the inferior level of the main treatment, and he is moving towards the middle level of the main treatment.

He has the diagnostic bonus of the special medical skill of first aid and intelligence.

Coupled with the supervision of many chief physicians, the diagnosis level is really not comparable to that of a senior resident like Huang Liang.

He is able to point to the source of the lesion through the symptoms and examination data.

If other doctors are not skilled enough and have insufficient experience in diagnosis, there will be a phenomenon of seeing flowers in the fog.

"But B-ultrasound didn't detect any obvious abnormalities in the pancreas!"

Huang Liang still asked a little unwillingly.

"Now I can check the ultrasound again, and I believe that the pancreas is significantly enlarged."

Zhou Can's tone was full of faint confidence.

Ultrasound data are subject to change depending on the patient's progression. In case of some diseases, it is necessary to have two more ultrasound examinations.

Of course, such repeated examinations in a short period of time may be incomprehensible to patients and their families.

Doctors need to be patient in explaining and communicating.

Let the patient understand that the doctor is not making any black examination fees, but to help the patient clarify the cause, find the lesion, and relieve the patient's pain.

After Huang Liang listened, he pondered for twenty or thirty seconds, and finally made up his mind.

"You have heard what Dr. Zhou just said, and I am going to immediately prescribe another application for B-ultrasound examination for the patient and re-examine it." Huang Liang looked at the family members and the patient.

This kind of repeated examination definitely requires the understanding and consent of the family and the patient.

"Okay, I believe in the level of this Dr. Zhou."

The patient's mind has always been awake, and Zhou Can's various performances are indeed different from Huang Liang and others. He has a sense of composure and self-confidence that only chief physicians have.

This is the style of the legendary general.

It can naturally convince people from the bottom of their hearts.

Huang Liang prescribed an abdominal B-ultrasound examination to the patient on the spot, perhaps it was the intestinal perforation patient a few days ago that gave him a psychological shadow, and after opening the examination application, he did not dare to delay and personally accompanied the patient for the examination.

Under normal circumstances, there is a doctor who can take you to do the examination without queuing.

Especially for some acute patients, the examination department also has the responsibility to give priority to this type of patients.

For example, patients with chest pain, when they enter the hospital, they can directly walk through the green channel of the chest pain center.

Soon, the results of the examination came back.

Sure enough, as Zhou Can diagnosed, the patient had acute pancreatitis.

Through this incident, Huang Liang's attitude towards Zhou Can has completely changed. He finally let go of the only trace of arrogance in his heart and was convinced by Zhou Can. Sometimes it may not be so easy to distinguish between the high and the low level of medicine.

But when the level of the two is far apart, it is still easy to compare one high and low.

In the two diagnoses, Huang Liang was obviously inferior to Zhou Can.

I believe that others don't say this, and Huang Liang also knows it.

At this moment, Luo Jingyi, a graduate student under Director Shang, ran over and stood at the door of the office and shouted at Zhou Can.

"Doctor Zhou, Director Shang asked me to ask you, has the patient at hand been handed over? The interventional operating room is ready for surgery immediately. ”

The chief physician took the initiative to invite a regular trainee to go over for surgery, and this kind of treatment made Huang Liang extremely envious.

At the same time, deep down in his heart, he was more convinced of Zhou Can.

"Alright, alright, I'll go with you right away."

Zhou Can now has experience, and before 8:50 every day, he has to hand over the patients at hand to Luo Shengsheng, the chief resident, or other doctors in the group.

Because Director Shang, Deputy Director Shi, and Dr. Huang Xinggui did surgery, most of them looked like nine o'clock in the morning.

(End of chapter)