Under normal circumstances, those who are over 45 years old have not yet been rated as deputy high schools, and nine out of ten are stuck in academics.

In this era of increasing emphasis on academic qualifications, even nurses are now starting as undergraduates.

Most of the best nurses have graduate degrees.

Until now, there are still many people who look down on nurses, thinking that they can only give injections, change dressings, and do some work as waiters. That's because most people's impression is still stuck in the past, and the nurses in the past basically graduated from technical schools.

But so what?

Self-motivated nurses have already completed their college upgrades, taken the postgraduate entrance examination, and become the best among nurses. The unmotivated, messy group has retired or changed careers.

In today's big hospitals, the quality of nurses is already very high.

Elle is a relatively alternative existence in Tuya Hospital.

Tuya Hospital wants to build a general department, but it has been stuck in the ideal stage and has never really been implemented.

As a result, there are very few general practitioners in Tuya Hospital.

The general practitioners who can reach the attending level or above, the entire emergency department is only two people, Ai Li and Director Lou.

Director Lou is now a deputy senior professional title and has become the head of the emergency department. Compared with Elle, she is a winner in life.

I heard that Director Lou also encountered the same embarrassing situation as Ai Li back then.

You can't chew too much!

Engaging in all subjects, it sounds very good, but the end result is that each subject will be a little bit.

It's really just a little bit.

It is almost impossible to achieve a high level of medical skills.

Director Lou realized that if he took the route of a general practitioner, it would be difficult to be rated as a deputy senior professional title in his lifetime. He was eliminated from the weight department that year and entered the emergency department, and his own conditions were not particularly good.

But he's much smarter and more far-sighted than Ellie.

Not only after working for 11 years, he worked hard to obtain a master's degree, but also specialized in respiratory medicine in order to evaluate the deputy senior title. In the field of respiratory medicine, it should be the easiest to achieve results among many disciplines.

Director Lou is in the emergency department, and it is the top priority to rescue all kinds of acute and serious patients and ensure that the patients breathe smoothly.

Therefore, his specialization in respiratory medicine is very compatible with the nature of his work.

Needless to say, Director Lou was successfully rated as a deputy senior title, and after the previous director of the emergency department was transferred, he was like a dark horse.

It is said that Deputy Director Han, who competed for the head of the emergency department back then, and another deputy director who has retired, are the most promising people.

No one expected that Director Lou, a junior who was not good-looking, would jump out and pick peaches.

After Director Lou became the director of the emergency department, the deputy director surnamed He heard that it didn't take long for him to fall ill. It's definitely infuriating.

Deputy Director Han was a little stronger, but he was definitely hostile to Director Lou.

It's just that how it was skillfully resolved by Director Lou later, and the two became close comrades-in-arms, which is unknown.

Director Lou is not good-looking, but he has good means and is quite good at resourcefulness. It is a long-term vision and ambitious, and it is a good thing for him to be the head of the emergency department.

If Deputy Director Han Changqing had really been the director of the department, the emergency department would not have been where it is now.

It has to be said that people's fate may sometimes change because of a choice.

Ai Li did not have the courage and foresight of Director Lou back then, and finally arrived at the age of fifty and was still an attending physician.

If nothing else, she will retire at the rank of attending by the age of 55.

In terms of diagnosis and treatment experience, Dr. Elle is extremely rich.

What kind of patient can make her helpless?

Zhou Can followed the nurse to the emergency hall quickly.

From afar, I saw a female family member lying on the side of the patient's bed crying, and several other family members also looked sad and anxious.

Dr. Elle is doing various tests on patients.

At present, it should not be clear what caused the shock, so no first aid measures were taken.

In the emergency department, the death of a patient can be roughly divided into three processes.

Severe illness, shock, death.

Ordinary doctors are likely to panic when they encounter a patient in shock, but for Dr. Ellie, this kind of scene can be encountered every day. You can even encounter it many times a day.

Tuya's emergency department has an astonishing volume, and even though only 1 percent of the patients are in shock, they can see several cases of shock in a day.

"Dr. Ai, what's wrong with this patient?"

Zhou Can squeezed away the family members gathered in front of the portable emergency bed, and while greeting Ellie, he had already begun to look at the patients on the hospital bed.

According to the family, the patient had black stools for nearly a month, and suddenly had a nosebleed while eating breakfast this morning, and then he fell to the ground in a state of confusion. The family was worried that calling an ambulance would delay the condition, so they directly used their own car to send the patient to our hospital for treatment. ”

Elle gave a brief overview of the patient's medical history.

Black stool means gastrointestinal bleeding.

If a patient suddenly has a nosebleed while eating breakfast, is it an upper gastrointestinal bleeding?

Zhou Can secretly observed the patient's appearance, his face and lips were pale and bloodless, he was still conscious, and the expression on his face was slightly painful. There was no rash or ecchymosis on the neck, arms, etc. There is no xanthochromia in the sclera.

He reached out and touched the patient's neck, and there was no obvious enlargement of the superficial lymph nodes.

The thyroid gland is also normal.

Try to press on the patient's chest, but there is no significant tenderness.

"The patient's temperature was 36.7 degrees, his pulse was 100 beats per minute, his breath was 21 beats per minute, and his blood pressure was 90/70 mmHg."

After Ai Li checked the patient's basic signs, she informed Zhou Can.

The level of doctors is really not who is older, who is more powerful.

After Zhou Can came, she obviously regarded Zhou Can as the backbone.

"His blood pressure is obviously low, has his blood been drawn? After knowing the blood type, I have to ask the blood bank to prepare the plasma, and I guess I will definitely have to have a blood transfusion and rehydration. While Zhou Can was talking, he was still doing a physical examination of the patient.

The level of a doctor is sometimes mainly reflected in the details.

Similarly, for a physical examination of the patient, some people may just follow the process according to the script.

A wise doctor can make a comprehensive diagnosis and judgment based on the patient's skin color, spirit, demeanor, body shape, chest and lung percussion, etc.

A normal person's blood pressure is generally around 120/80mmHg.

The patient's systolic blood pressure dropped to 90, which was already dangerous.

If a blood test is done, Zhou Can can even infer the approximate amount of blood loss of the patient based on the hemoglobin.

It is imperative to identify the source of the patient's bleeding and find a way to stop the bleeding.

Otherwise, the bleeding will not stop, and no amount of blood transfusion will be useless.

"Blood has been drawn and sent for testing!"

Ellie is worthy of being an old doctor, much more stable than the young Dr. Xie.

Zhou Can nodded and tried to press the patient's abdomen.

Bleeding from the digestive organs, abdomen is the focus of investigation.

Because the human intestines and stomach are almost all in the abdominal cavity.

The patient's abdomen was still quite soft, and when pressed up, the patient did not react.

No significant mass was felt in the patient's abdomen.

But I heard bowel sounds, and I was quite active.

When Zhou Can pressed under the patient's xiphoid process, the patient immediately let out a painful snort.

"Teacher Lu, give me a disposable glove for digital examination."

While speaking, Zhou Can picked up the patient's hands and examined them carefully.

"Dr. Zhou, what are the items you are checking on the patient's hands?" The young female doctor standing next to Elle was also twenty-three or fourteen years old, which was quite young.

This is a new intern in the emergency department.

Because the frequency of interns changing departments is very high, Zhou Can sometimes doesn't bother to memorize their names.

The female doctor was bold enough to ask him questions on such an occasion.

"The main thing is to check whether the patient has palmar erythema, spider angiomas, and clubbing, and then whether the knuckles and wrist joints are red and swollen. If you don't know which of these characteristics corresponds to the symptoms, you can flip through the book after work and keep them in mind. Because when encountering clinical emergencies, there is no time to look up information and flip through books. ”

Zhou Can's tone was gentle, and he roughly explained the purpose of checking the patient's hands.

At the moment, patients are waiting for their lives, and there is definitely no way to explain them in detail.

There is some knowledge that novice doctors can only turn to books and memorize more.

There are too many knowledge points for medical students to memorize, and if you can memorize a little more when you are young, you can memorize a little more. Then, after the work, I continue to apply it in practice, and slowly I can remember it very firmly.

The nurse handed Zhou Can a thin glove for a digital examination.

After putting it on, Zhou Can took off the patient's pants and directly did a digital rectal examination.

If it is a female patient, the patient may be considered for privacy and the digital examination may be done in a different place. Male patients are not given any preferential treatment in this regard.

In fact, when it comes to the moment when you need to save your life, there is nothing to be pretentious.

Everything doctors do is to save patients' lives.

After a digital examination, Zhou Can found that the patient's sphincter was tense, there were no internal and external hemorrhoids, and there was a little dark red blood stain on the finger sleeve.

Rectal bleeding can be ruled out.

Because if there is rectal bleeding, the blood stain on the finger cuff will be bright red.

"Doctor Ai, do you want to give the patient an urgent chest X-ray and do an abdominal B-ultrasound?"

"Couldn't agree more!"

In front of her family, Ai Li has always been highly cooperative with Zhou Can.

"I suspect that the patient is likely to have upper gastrointestinal bleeding, and the chest and abdomen should be excluded before emergency gastroscopy is considered. Although he is now in a state of shock, judging by some of his symptoms, the bleeding should have become smaller. As long as the plasma is prepared, it should be relatively safe. ”

Zhou Can will definitely not say anything about the packing ticket.

His hemostasis is now level six, which has given him great benefits in the diagnosis.

Through the various manifestations of the patient, the actual situation of the patient's internal bleeding can be basically grasped.

He has just done a number of physical examinations on the patient in order to determine the approximate location of the bleeding, the current bleeding speed and the amount of bleeding. There is no way to make an accurate assessment, only a rough estimate.

The patient was quickly sent for testing.

The intern female doctor who asked Zhou Can questions was accompanied by an examination.

People are already in shock, and they must no longer let patients queue up slowly. This kind of critically ill patients have priority in all examinations and treatments.

Because the purpose of the emergency department is to save the lives of patients.

Dr. Elle pulled Zhou Can aside and whispered, "Doctor Zhou, I don't have any bottom in my heart about this patient, delay you for a while, and wait until the patient's condition is stable, and then you can enter the operating room, is it okay?" ”

She knew that when Zhou Can entered the operating room, he often needed to stay until more than twelve o'clock before he came out for lunch.

Sometimes if you are too busy, you may not even be out of the operating room for the whole day.

"Okay."

Zhou Can nodded happily in agreement.

The old comrade opened his mouth, and it was definitely not easy to refute the other party's face.

Soon, the results of the blood test came back.

The hemoglobin is only 56g/L, and the white blood cell count is 7.3*10 to the 9th power per liter. Neutrophils 0.87, lymphocytes 0.15, platelets 132 * 10 to the 9th power per liter.

Fecal occult blood test, positive, three plus, leukocytes, positive. No eggs, amoebic trophozoites, etc. were found.

Urine routine is negative.

It seems that the patient's bleeding was already heavy because his hemoglobin was low.

However, considering that the patient has had black stools for more than a month, the amount of bleeding this time may not be as large as expected.

How to say it!

This bleeding was more like the straw that broke the camel's back.

If you continue to have blood in your stool for a long time, you can't resist it even if your body is a blood bank!

"Doctor, does my son matter?"

The patient's mother, who is in her forties, has been crying with fear and nervousness in her eyes.

It was the patient's father who asked Zhou Can questions.

The dress of this family is no different from that of ordinary citizens. Should be a permanent resident of the city.

The family's financial situation may not be particularly wealthy, but it is not too bad.

"At the moment, the blood loss is quite serious. Why didn't they bring him to the hospital sooner? It's been delaying for more than a month, and my heart is too big. ”

Zhou Can was slightly reproachful.

But scolding family members, he generally doesn't.

"Well, this kid didn't tell us either. When the children are older, they rarely communicate with us. After the winter break, I knew all day that I would hide in my room and play games, or hang out with my classmates. ”

The patient's father shook his head and sighed.

The 20-year-old son, who is sensible, can already take advantage of the holidays to go out to work part-time to earn living expenses and reduce the burden on his parents.

A little willful.,It's basically a crazy game game with classmates every day.。

Maybe the patient is slightly unwell and too lazy to tell his parents.

As for pulling out black stool, some people don't even look at the color of their stool, and flush it directly after going to the toilet.

Even if you see black stool and lack medical knowledge, you won't take it seriously.

"It's not because you beat and scold your son at every turn, so that he doesn't dare to tell his family anything! My son is like this, and you're still scolding him, woo woo woo ......"

The patient's mother was crying with grief.

When the husband saw his wife crying like this, he did not say anything more.

Soon, the results of the chest X-ray came back.

There is no obvious anomaly.

It indicates that the heart and lungs are basically normal. These two organs are the core organs that sustain the life of the human body. One is for breathing, the other is for blood circulation.

The results of abdominal ultrasound also came out subsequently.

B-ultrasound showed that the spleen was slightly enlarged, and no abnormalities were found in the liver, gallbladder, and pancreas.

Sure enough, similar to Zhou Can's diagnosis, the bleeding location is likely to be in the upper gastrointestinal tract.

It seems that after his hemostasis technique was promoted to level six, he could indeed play a certain role in assisting the diagnosis of patients with this kind of internal bleeding.

As long as he slowly accumulates more experience in diagnosis, he will be able to reach the level of diagnosis of those top experts in the future.

Just by looking at the patient and looking at the medical history, you can basically infer the lesion from eight or nine.

In the past, he thought that surgery could only be used for surgery, but now after being promoted to the director level, he was pleasantly surprised to find that surgery can be used in combination with pathological diagnosis. So as to achieve the role of auxiliary diagnosis.

He couldn't help but sigh that the medical experience point system was really a good thing.

Without this system, his medical skills would never have been promoted so quickly.

It is impossible to get the appreciation of the chief physicians everywhere.

"Give him an emergency gastroscopy! The source of bleeding can basically be locked into the upper gastrointestinal tract. ”

Zhou Can said to Ellie.

(End of chapter)