I happen to go to the cardiothoracic surgery department every day to help, and when I see Director Xueyan, I can ask her about the postgraduate entrance examination.

After checking the room in the emergency department, Zhou Can went to the hospital canteen to eat, and hurried to the cardiothoracic surgery.

Recently, he always felt that someone seemed to be secretly following, and for Su Qianqian's safety, Zhou Can asked her not to come to the hospital to deliver food. If time permitted, he would go home and eat with her.

When you come to the cardiothoracic surgery department, it presents a busy scene.

Zhou Can's suggestion of high-profile publicity of diagnosis and treatment achievements has played a very good publicity effect. It was even much better than he expected.

Since a large number of specialists and main nurses in the Department of Cardiothoracic Surgery were poached, people in the department were panicked, and everyone was worried that the department's business would plummet. As a result, in the past half month, the number of outpatient and emergency departments has increased instead of decreasing. And it continues to rise, and some difficult cases in the cardiothoracic surgery cases received every day are gradually increasing.

There are even patients who have been transferred from other hospitals.

"Dr. Zhou is here, great! There is a patient over there who said that he has chest pain and difficulty breathing, can you help me take a look? ”

A female nurse at the nurse's desk was as happy as seeing Zhou Can arrive, as if she had seen a savior.

"Inpatient or new?"

Zhou Can asked.

Now that it's past the end of work, it's either a wild patient or an emergency department.

As long as there is a bed for outpatient patients, they will generally be admitted to the hospital after the examination.

"The emergency department just notified the patient who came from our department. After the intern Xiao Wang fished the patient over, his senior doctor was still operating with Director Xue in the operating room, and he heard that something was wrong with the operation, and he didn't know when he would come out. Neither of the two doctors on duty in Corey dared to take the patient. ”

The female nurse's surname is Luo, and I heard that she will be promoted to a nurse in charge this year.

She has a slight status in cardiothoracic surgery, especially after the three chief nurses were poached, her status has obviously risen a lot.

Just look at the fact that she directly calls the intern Xiao Wang, and you can understand that she is very confident in her status.

"Where's the patient?"

Zhou Can heard that he was fished from the emergency department, and judged that he might not have done an examination yet.

In the emergency department, after the end of work, patients with chest pain are generally directly notified to the doctors in the specialist department to take the person away. Because the emergency department is not equipped to handle such patients.

If something happens, it's another big trouble.

The patient was brought to the cardiothoracic surgery department, indicating that the emergency department doctor had determined that the patient was likely to need surgery after a preliminary understanding of the patient's condition.

There are also novice doctors who want to save trouble, as long as the patient who feels the same chest pain, he will push to the cardiothoracic surgery.

Because the Department of Internal Medicine has two subdepartments: thoracic and cardiology.

"That's the gentleman!"

Nurse Luo took Zhou Can to a flat bed not far away. The patient clutched his chest and lay on a flat bed, staring at the ceiling with his eyes hollow. His breathing was heavy, like a bellows.

There were two women standing by the cart, one old and one young.

The older woman looked at the patient with tears on her face.

The young woman was twenty-one or twelve years old, dressed very innocently, like a college student who had just left school, or was studying. Judging by her appearance, she was supposed to be the daughter of the older woman.

The face shape and facial features, the mother and daughter are quite similar.

"Where do you have pain in your chest?"

Zhou Can asked the patient directly.

Because this person's eyes are hollow and a little indifferent, it looks quite scary. Sometimes there is excessive blood loss and is about to go into shock, and this kind of look is most likely to appear.

The patient simply ignored him.

The mother and daughter next to her were worried about offending the doctor, and the older woman hurriedly said, "Son, where does it hurt, you can say it quickly!" Want to kill me? ”

The patient's mother was really anxious and tears kept flowing.

"My brother only said that his chest hurt and it seemed to be difficult to breathe, which was very scary. I was working at the company and my mom called, so I hurried over and took him to the hospital with my mom. ”

The young woman told everything she knew.

"How did it happen?"

Zhou Can examined the patient while asking the family.

"He's my son, and he's twenty-eight years old. Not long ago, I was having dinner at home, and I saw that someone else's child was married at this age, but he never looked for a girlfriend. I also sleep at home during the day and go out at night, and I don't know if he is working, so I mutter a few words to him. Then he roared twice and suddenly fell to the ground clutching his chest and screaming. Not long ago, he coughed up blood, which frightened me, just such a son, if something happens, how can I live? ”

The more the patient's mother spoke, the more she blamed herself, looking at her son with tears in her eyes.

Chest pain, difficulty breathing, coughing up blood, these are the symptoms that Zhou Can has learned so far.

When examining the patient, Zhou Can tested the tenderness response.

Pressing slightly the patient's left chest reveals a painful expression on the patient's face, and blood is still coming out of the cough.

There is no significant tenderness in the right chest.

Moreover, the patient did not say a word from beginning to end, and was indifferent to the doctor's treatment and the mother's crying.

"Did Mr. Luo measure his blood pressure?"

Zhou Can asked the nurse.

Usually call this kind of older nurses, especially nurses who work longer hours and have older qualifications, can be called so-and-so teacher. Calling Nurse Luo directly in front of the patient will make the family unhappy.

There is also a suspicion of stepping on others and elevating oneself.

Doctors should be as humble as possible when dealing with the caregiver relationship. Because doctors' status, income, and future are better than nurses', if they still feel discriminated against in their faces, this will seriously affect their motivation to work.

Many diagnosis and treatment tasks require close cooperation between medical staff and nurses, and the importance of nurses is self-evident.

Patients and their families can look down on nurses and discriminate against the profession, but doctors are definitely not.

Not only should nurses not be discriminated against, but they should also be cared for everywhere.

"Blood pressure 115/79mmHg!"

Normal blood pressure for adults is systolic blood pressure between 90 mmHg and 140 mmHg and diastolic blood pressure in the range of 60 mmHg to 90 mmHg. The patient's blood pressure is normal.

Zhou Can breathed a sigh of relief.

Normal blood pressure, can generally discharge cardiovascular and cerebrovascular acute and critical diseases.

Chest pain, tightness, difficulty breathing, coughing up blood, these are very dangerous symptoms.

"Is the blood pressure the same on both arms?"

Out of prudence, Zhou Can still rule out high-risk factors such as aortic dissection and heart disease through some preliminary simple examinations.

"The blood pressure on both sides of the body is basically the same!"

Nurse Luo's ability is really good, and you can see it from these details.

When a novice nurse measures a patient's blood pressure, she often measures only one side. If the patient is a common disease, there is naturally no problem. However, if the patient has chest pain, an experienced nurse will measure the blood pressure on both sides of the body.

Zhou Can probed the patient's forehead temperature with his hand, and it was normal.

When he was doing a tenderness test on the patient just now, he was already silently calculating the patient's pulse and breathing.

The pulse rate is about 100 beats per minute, and there may be some error, but it is not too large.

Indicates that the patient's heart rate is normal.

Once again, the suspicion of heart disease is ruled out.

The patient's breaths are about 40 breaths per minute.

The normal breathing rate for an adult at rest is about 16-20 breaths per minute. If it exceeds 24 beats per minute, it is considered tachypnea. Apparently, this patient had a problem with breathing.

When Zhou Can observed the patient just now, he found no obvious yellowing and bleeding of the skin, no swelling of superficial lymph nodes all over the body, correct facial features, and only slight cyanosis of the lips.

This is likely to be related to the patient's dyspnea, although the degree of cyanosis suggests that hypoxia is not severe.

Seeing this, Zhou Can's heart became a little calmer.

This patient cannot die for the time being, and the possibility of dying without immediate rescue can be basically ruled out.

He further examined the patient's pupils, which were equally round and large on both sides, and had a good light reflex. It further states that the patient is not in danger of life for the time being.

If your pupils are constricted, your light reflex is poor, and your chest pain is a symptom, you should be especially careful.

Such patients are highly susceptible to death.

When a novice student receives such a patient, it is best to consult a senior doctor immediately. However, for the average patient with chest pain, the senior doctor will not be so big as to leave it to the intern to deal with it.

Usually it is checked first, and it is not a high-risk fatal acute illness, which will be handed over to the intern to practice.

"Here, I'll look at your neck!"

Although the patient's face was indifferent, he did not respond to Zhou Can's examination.

Zhou Can still tries his best to establish an initial relationship of trust with the patient. A person's neck, head, waist, armpits, and private parts all belong to specific areas, and when touched by outsiders, they will instinctively repulse.

Men and women who have been in love will have the experience that if they have a deep relationship with their boyfriend, the woman will enjoy the man's caresses. Whether it's a hug, or touching the waist or ordinary private parts, it is generally not repulsive.

But being slapped on the butt by a strange man, or hugged, or even just patted on the shoulder, she will be especially vigilant and may be disgusted.

After examination, the patient's neck is soft, there is no resistance, and there is no neck rigidity.

There was no distension in the cervical veins, and the thyroid gland was normal and not enlarged.

Out of caution, Zhou Can examined the patient's heart area, and there was no obvious bulge in the precordial area, and the heart boundary was not large.

"Teacher Luo, borrow your stethoscope!"

"Give!"

Nurse Luo happily took off the stethoscope and gave it to Zhou Can.

After that, he focused on listening to the patient's heart area, the heart rhythm was neat, the heart sound was strong, and no murmur was heard.

It doesn't seem to be a big problem with the heart.

This is strange, the patient's severe pain in the left chest is not caused by heart disease, so what could be the cause?

Reminiscent of the patient's dyspnea, slightly cyanotic lips.

The above symptoms only occurred after the patient was muttered by his mother and then yelled.

At this time, Zhou Can had already begun to seriously suspect that there was something wrong with the patient's lungs.

He presses on the patient's abdomen, which is flat and soft, and there is no tenderness response. There is also no rebound tenderness. The liver and spleen area did not have a hard lump or mass, indicating that there was basically no enlargement in the liver and spleen.

The patient's limbs are examined and muscle strength is normal, as is joint mobility.

Originally, the patient's physiological response could have been tested, but due to the patient's non-cooperation, Zhou Can tried not to do anything that stimulated the patient.

"Doctor, does my son's illness matter?"

"People are vomiting blood, it must be important. Young people are stressed nowadays, so try to give your children as much understanding as possible in the future. When I was diagnosed, I saw that your son had thick calluses on his palms, which shows that he is not as unprofessional and not working as well as you can see. On the contrary, he should work very hard, and it is very hard. ”

Zhou Can said to the patient's mother.

Sometimes, children are good news to their parents but not bad news. Parents can easily mistake their children for what is wrong with their children based on superficial assumptions.

In fact, children are working harder than they might think.

"It's my fault, and I will correct it later." When the patient's mother heard this, she blamed herself even more. "Son, wow, it's all bad mom, I shouldn't talk about you. Hurry up and get better, and go home and your mother will make you something to eat. ”

She took her son's hand and rubbed the thick calluses on his hands.

After Zhou Can's reminder, she learned that her son had suffered a lot outside. It's not what she thinks, sleeping during the day and hanging out at night, fooling around.

"Mom......"

The patient was sobbing, his eyes were red, and he called out to his mother for the first time after being sick.

It also means that his hatred for his mother disappears, and the mother and son open the knot.

"Huh! My good son, it was my mother who wronged you, hurry up and get better! I'm not going to talk to you again. The patient's mother was pleasantly surprised and held her son's hand tightly.

The younger sister next to her quietly wiped her tears.

Zhou Can has long been accustomed to seeing all kinds of touching scenes of family interaction, so there is not much fluctuation in his expression.

"The patient's chest is symmetrical, no subcutaneous emphysema is found, the left chest is slightly raised, and the respiratory movement of the left lung is significantly reduced. There was a tympanum sound on percussion of the left chest, the breath sounds of the left lung disappeared on auscultation, no dry or wet rales were heard, and the breath sounds of the right lung were normal. I recommend a chest CT scan right away. ”

Considering that it is already off-hours, there is usually only one doctor on duty in the CT room.

And it's shared by multiple departments.

In addition, the patient's family is dressed in shabby, and it looks like the family's financial situation is not very good.

There is also the fact that CT scans take longer.

Now the cause of the patient's coughing up of blood must be ascertained as soon as possible.

In order to save the cost of examination for patients and shorten the examination time, Zhou Can thought about it and changed his words, "Let's do a chest X-ray examination first!" Don't do a good CT scan yet. ”

The patient was prescribed a request for routine blood and chest X-ray.

All that's left is to wait for the results of the check.

Zhou Can entered the office, logged in to his personal department account, and then began to check some difficult cases pushed to him by Director Xueyan, Director Le and others.

Often, the diagnosis of difficult cases is made by consultation with multiple physicians.

The main purpose is to reduce misdiagnosis and missed diagnosis.

"Another patient with serious postoperative complications who was transferred from another hospital was admitted, and the operation was done at Xinxiang Hospital. It seems that after a period of recruitment, Xinxiang Hospital has become very strong! ”

Zhou Can found that the first difficult case to be consulted by him was a postoperative patient transferred from Xinxiang Hospital.

This kind of patient is generally called a rotten patient.

Tuya's side is improving its popularity by diagnosing and treating some difficult cases and rotten patients, so when admitting such patients, the threshold is much lower than usual.

This is also Director Xueyan and others in response to Zhou Can's high-profile suggestions.

Xinxiang Hospital should not have been able to do this kind of thoracic surgery before, but now it can complete sternal resection and reconstruct the chest wall, which shows that the surgical strength has improved very quickly.

It indicates that Xinxiang Hospital has the surgical strength of the compound.

"Dean Tian is a pragmatic person, she has been reborn after experiencing great ups and downs, which is obviously much different from hanging a foreign signboard in the Third Hospital."

Zhou Can had two dealings with President Tian of Xinxiang Hospital.

I was more impressed by this woman.

To be honest, when he was dug up by Dean Tian two years ago, he never thought that Xinxiang Hospital would have today's development.

At that time, Xinxiang Hospital was half-dead and was already a remnant.

Although many hospital experts were sent to study abroad, in Zhou Can's opinion, it was the same thing. It doesn't change the big picture.

No one could have imagined that the woman did not play according to the routine, and frantically poached people from other compounds.

And the digging of the whole department and the whole department is too ruthless.

This simple and crude approach just worked.

No wonder even the Third Hospital is starting to follow suit.

(End of chapter)