"Sir, the patient you want to visit is in that bed!"

After the nurse saw Zhou Can enter the ward, she looked around, and she thought that Zhou Can was looking for a visiting patient.

Because all the patients who enter here have to cut their hair and nails clean.

All of them have turned bald, and some of the patients are even covered with bandages, like mummies, which is really difficult to distinguish.

"Oh, okay!"

Zhou Can had actually guessed that the bed in the distance was likely to be Deputy Director Lu. Because there are multiple doctors around the bed, the nurses are busy. Various salvage measures are being used.

Director Xiang Fei, who has the reputation of 'Hades', is playing the role of commander-in-chief.

He himself is also involved in the technically difficult rescue work.

"You can only stand by and watch, and don't interfere with the rescue of the doctors."

The nurse was worried that Zhou Can would get into trouble, so she took the preventive shot in advance.

"Understood."

Zhou Can walked over there.

Because he was wearing a disposable sterile gown, the doctors and nurses could tell at a glance that he was a family member who had entered the ward to visit.

Everyone has their own work to do, so naturally no one pays attention to him.

Only the nurse who accompanied him followed by him. Family members must also be accompanied one-on-one by a health care provider during visits. In case some family members inadvertently mobilize other patients' ventilators, hemoperfusion machines, hemodialysis machines, monitoring instruments, etc., some behaviors are enough to cause fatal injuries to those patients whose lives are already fragile.

This is one of the reasons why healthcare workers don't like to let family members into the ICU for visits.

Coming in with a stranger, it means that there are a lot of unknown risks.

Everyone's work is already busy enough, and they have to allocate energy and time to receive visiting family members, which is equivalent to adding a burden to their own work. Naturally, no one wanted to.

When Zhou Can was about to approach the 13th bed, the nurse hurriedly stopped him and told him not to go any further.

On the hospital bed, Deputy Director Lu's hair has been shaved, and obvious traumatic hematoma can be seen on the back of his head. The whole person's face looked very gray and lifeless.

In addition, his right hand fell to his side at an unnatural angle, and with Zhou Can's diagnosis and treatment experience, it could be seen at a glance that the hand bone must have been fractured.

He had a very large hematoma in both legs, and both legs should have some degree of fracture.

From this fracture and the hematoma in the back of the head, it can basically be inferred that Deputy Director Lu landed in his posture.

It should be that the legs hit the ground first, and then the body was unbalanced, and the huge impact made his body fall to the ground. The right hand instinctively wants to be supported, causing a fracture. When he fell to the ground, the back of his head hit the hard ground.

But the ground should be flat concrete and something.

If the ground is rocky, or if there are edges and corners in the place where the head is hit, it is easy to form a wound and bleed.

This large area of hematoma wound can only be formed if the place of impact is on flat ground.

Bruising is a build-up in the skin.

After learning about Deputy Director Lu's fall and injury, Zhou Can felt that there was a lot more hope for rescuing people.

Depending on the anatomy, the back of a person's head is closer to vital brain tissue.

Even in combat and fighting, it is generally forbidden to hit the back of the head and the male perineum. This is a critical area.

A blow to the back of the head makes the person faint easily and even die outright.

The location of Deputy Director Lu's injury is probably located in the occipital bone.

The parietal bone was also affected.

It is estimated that the impact of falling to the ground at that time was very strong.

It's hard to say whether the legs hit the ground first. Only the parties themselves know.

The cerebellum, the brain, and even the pineal gland may have been violently impacted and destroyed, but where is the bleeding in the skull? What is the nature of bleeding? There is no way to know this with the naked eye.

Diffuse bleeding is more likely.

Of course, there is also the possibility of intracranial artery rupture, single or multisource hemorrhage.

Zhou Can's eyes looked at the screen and dial of the monitoring instrument, the alarms came and went, and Deputy Director Lu's blood oxygen, heart rate, blood pressure, breathing, and brain waves were all abnormal.

The situation is far more serious than imagined.

I have done central venous pressure monitoring and am on a ventilator.

Deputy Director Lu's problems seem to be a lot, but as long as the real cause of the coma is found, perhaps most of the problems can be solved. If you only start from a certain problem in blood pressure, breathing, or blood oxygen, you will only fall into a situation of blinding and dazzling.

This is the most common mistake made by doctors at and below the attending level.

Because of the limited ability to apply clinical knowledge, it is not possible to see the overall situation when diagnosing, and it is very easy to limit one's thinking to a very narrow range.

Director Xiang Fei is a critical care medicine professor at the Provincial People's Hospital, and he is an absolute hegemon.

His diagnostic thinking is certainly far beyond the level of the curator.

The clinical experience is even more abundant.

At present, the idea of directing everyone to rescue is mainly symptomatic treatment, striving to improve the patient's blood oxygen saturation, stabilize the patient's heart rate, increase blood pressure, assist breathing, and so on.

This is also the most commonly used rescue idea in Western medicine in clinical practice.

If any sign is bad, I'll help you correct it.

It is also the most effective rescue method in the emergency rescue of critically ill patients.

If time is sufficient, there are more advanced ways to rescue them.

It's about peeling back the dots, finding the true cause of the patient's condition, and then treating it.

For example, Deputy Director Lu has been found to have intracranial hemorrhage, so he must find a way to stop the bleeding and reduce intracranial pressure. You just help the patient raise blood pressure, or increase the assistance of the ventilator, which is a bit of a fish for a while.

Zhou Can stood not far away and watched, looking five or six meters away. His diagnostic thinking has been directly locked on the coma of Deputy Director Lu.

With his rescue experience and unique reverse diagnosis thinking, he instinctively felt that the cause of the coma was the key to solving all problems.

There are three main pathogenesis causes of coma.

The first is pathophysiologically induced disorder of normal state of consciousness. The second is changes in the microstructure and neurotransmitters of normal states of consciousness. The third, the main neural structures in the normal state of consciousness.

The most likely cause of Deputy Director Lu's coma is the main neural structure of the state of consciousness.

For example, the brain is traumatically damaged, the brainstem is severely affected by intracranial hemorrhage, and so on.

Even problems with the blood supply to vital tissues in the skull can cause coma.

The major neural structures are divided into three parts, the cerebral cortex, the thalamic diffuse projection system, and the brainstem reticular ascending activation system.

In which the cerebral cortex is destroyed on impact, this is the first direction of diagnosis to be suspected.

The cerebral cortex is bounded by cerebral fissures and sulci and is divided into more than a dozen gyria or five lobes.

They are connected by white matter nerve fibers, and the corpus callosum connects the two cerebral hemispheres.

If it is a diffuse lesion, it is very easy to cause varying degrees of impaired consciousness.

Therefore, Zhou Can thinks that the first thing that should be checked is the cerebral cortex.

Unfortunately, he is only here as a visiting relative and friend, and it is impossible for him to see the patient's examination report and auxiliary examination results.

You can only see the data on the bright side.

For example, blood oxygen index, heart rate, blood pressure, central venous pressure, etc.

Even here, ordinary family members can't read the screens and dials of those instruments. Zhou Can belongs to professionals, so he can see it at a glance.

"Sir, your visitation time is over, please get out! According to the regulations, family members cannot come in for a visit, and the time cannot be too long. Because this is aseptic management, you can easily increase the risk of bacterial contamination in the ward if you stay too long. Thank you for your understanding. ”

The nurse was very polite to him.

Through her contact with Zhou Can, she must be able to feel that Zhou Can is not an ordinary person.

"Director Xiang, when did the patient get the central venous blood pressure monitored?"

Zhou Can saw that he was about to leave, and at this time, he made a quick comprehensive diagnosis from some of Deputy Director Lu's physical fluctuations and the most intuitive visual inspection results, and came to an astonishing conclusion.

Deputy Director Lu's coma is likely to have been caused by a number of reasons.

Now the need for emergency rescue is likely to be related to some minor negligence or mistake in the operation of the doctor.

The nurse didn't expect Zhou Can to be bold and ask questions directly to Director Xiang, who has the highest status here.

Her face turned white with fright.

She didn't know why Zhou Can was able to know Director Xiang, and the questions raised were quite professional.

At this moment, what she wants to do most is to quickly invite this 'master' out.

"Sir, please go out immediately, don't interfere with the medical staff here."

There was a hint of anger in the nurse's voice.

It is estimated that he dares to be angry and dare not speak.

I told this family member well beforehand, why is it so ignorant?

Isn't that causing her trouble?

Director Xiang Fei, who was directing the rescue work, was a little annoyed at the moment. Because he found that the usual rescue techniques seemed to be out of order in this patient. He secretly speculated that the patient's injuries might be too severe.

Rescuing people injured in high falls is already difficult.

All kinds of internal bleeding and internal organs are damaged, and there is no way to find out in a short period of time.

Not to mention a series of complications caused by internal bleeding and damage to internal organs.

The rescue was in trouble, and at this time, the family member who visited him actually openly asked him questions, interrupting his ongoing thinking. A surge of anger rose in his heart.

But in the end, he is a battle-hardened veteran.

He has been engaged in clinical work for many years, and reason tells him that it is easy not to conflict with his family.

He just raised his head and glanced at Zhou Can lightly, and then replied in a cold tone, "If you have any questions, you can ask the nurse directly, the visiting time is over, please go out quickly!" ”

Obviously, he didn't take Zhou Can seriously.

In clinical diagnosis and treatment, he often encounters some 'Baidu Heroes' and 'Cops', who question the doctor's operation with some medical knowledge he has seen on the Internet and in medical books.

For this type of family member, there is no health care provider who does not have a headache.

In many cases, when encountering such family members, everyone is basically able to push the patient away. I really can't afford to push it, and most of them will start defensive medical care in order to protect themselves.

Of course, the attitude of medical staff towards such family members will most likely become more and more cold.

"Director Xiang, it's not that I'm looking for trouble. I'm just offering a diagnostic idea, will the patient have a combined decline in signs due to blood clots in the veins? In particular, central venous thrombosis can be investigated. ”

Zhou Can could only bite the bullet and offer advice again.

People who don't understand think he's a psychopath.

One of your visiting family members is actually here to direct Director Xiang Fei how to rescue him?

"Please get out! If you have any questions, please tell our nurses. ”

The young male doctor under Director Xiang Fei, who was quite tall, walked over directly and 'invited' Zhou Can out.

His eyes were full of unfriendliness.

If it weren't for the intensive care ward, it is estimated that the security guard would have been called directly.

The young female doctor under Director Xiang also glanced at Zhou Can with the same look at neurosis. I guess I'm sneering in my heart, where did this 'great god' come out? He actually taught Director Xiang how to save patients.

These days, the world is really big, and there are all kinds of birds.

"Wait!"

Xiang Fei stopped Zhou Can out loud.

His apprentices are very obedient to the master's orders. Immediately stopped the act of driving Zhou Can away.

However, looking at Zhou Can's eyes, it was still very unfriendly.

"Why do you think a blood clot has formed in a patient's central vein?"

Director Xiang Fei seemed to wake up after Zhou Can's reminder. No wonder all kinds of rescue have no effect, if a central venous thrombosis is really formed, it is indeed extremely harmful.

"I'm not sure, I'm just skeptical. As for the most common cause of central venous thrombosis, it is possible that the air is not exhausted during the puncture, or the air is accidentally brought in. I'm just giving an assumption, and I'm not questioning the doctor's intentions. ”

After Zhou Can finished speaking, he quickly explained again.

The doctor who questioned the piercing was not doing it properly, and he didn't want to provoke everyone's hostility.

After staying in the hospital system for a long time, Zhou Can knows that when there is a conflict between doctors and patients, everyone will join together and become comrades-in-arms on the same front.

Just like corruption or other problems in officialdom, it is easy to cling together to resist the censorship of superiors.

To put it bluntly, this is a kind of self-preservation behavior of people.

The establishment of intravenous access is very common in clinical resuscitation. It is mainly used for circulatory support, as well as central venous pressure monitoring, hemodialysis, etc.

"You're also a doctor?"

Director Xiang Fei looked at Zhou Can for the first time.

"Yes!"

Zhou Can did not deny it.

"Who is this patient?"

"He's my colleague."

Hearing that Zhou Can and the patient were just colleagues, Director Xiang Fei's eyes eased a lot, and his vigilance was lightened.

"Tell me why you suspect venous thrombosis."

Director Xiang Fei's tone of voice with Zhou Can has obviously changed.

Those who are familiar with Director Xiang can hear that he has a little more respect when he talks to Zhou Can.

"When resuscitating critically ill patients, it is often necessary to open at least two or more peripheral venous access. If possible, it is preferable to establish a central venous line directly. It can be used for large doses in a short period of time or for central venous pressure monitoring. You can see, whether it's the monitoring of central venous pressure, or the administration of drugs, it seems that there is an abnormality now. Combined with the patient's various physical data, it can be concluded that the presence of thrombus in venous access is extremely likely. As for the cause of the formation of blood clots, there is no need to delve into it. ”

After Zhou Can analyzed the reasons, he deliberately released some kindness.

Doctors understand the suffering of doctors best.

It is very common for there to be some negligence and mistakes in the operation.

It's a time when we all make mistakes.

If Zhou Can now wants to find out which doctor misoperated and caused the formation of blood clots in the central veins, then he will stand on the hostile side of these medical staff.

Deputy Director Lu's rescue could not make a quick breakthrough.

(End of chapter)