Now that people have died, it is undoubtedly difficult to find out the cause of death without autopsy.

Zhou Can often felt difficult to diagnose the living, and this was the first time he had diagnosed the dead.

Facing Qin Yuanzhu's hopeful gaze, Zhou Can finally chose to try.

"I'll try! But you also know that there is no longer a lot of meaningful diagnostic data available after the death of a patient, so please don't get your hopes up. ”

Zhou Can took on this difficult task.

After death, all symptoms disappear, and key references such as blood pressure, breathing, heart rate, and body temperature disappear.

This is very detrimental to the diagnosis.

Therefore, it can only be comprehensively inferred from some nursing records, films, and symptoms described by the patient before his death, combined with the symptoms at the time of death and some manifestations after death.

"I know that! Let's do our best, it's really not good, the family doesn't accept our opinion, then we can only suggest that they go through the judicial process and perform an autopsy! ”

Qin Yuanzhu nodded.

Director Shi of the Hospital's Infection Office looked at Zhou Can meaningfully.

"Our first group of patients who had died of this kind of death in the past, and almost every time they were able to quickly find out the cause of death. After Lao Song left, this ability of the first group was interrupted. You have now taken over Lao Song's position, and I hope to develop more in this direction. ”

Regarding the old Song mentioned by Director Shi, Zhou Can was full of curiosity.

"Who is Old Song?"

He asked casually.

"A clinically experienced doctor in charge of the bed later joined our quality control department. Starting with the ordinary members of the fifth group, they finally entered the first group. ”

When Director Shi mentioned Lao Song's past experience, he was full of admiration.

From his words, it is not difficult to hear that there is actually a level difference between the five teams in the quality control department. The highest status should be the first group, and the worst status is the fifth group.

Zhong Hui, the team leader who once dealt with Zhou Can, doesn't know which group it is?

was able to be the leader of the group, and Xin Wanshan, the head of the medical department at that time, was very respectful to him, and his status was definitely not low.

Zhou Can and Zhong Hui are now colleagues in the same department, and when they meet, I wonder if the other party will feel embarrassed?

However, the events of that year have long passed, and Zhou Can is not the kind of person with a small belly.

Definitely not going to hold on to it.

He has just joined the quality control department now, and there must be a lot of hospital leaders staring at him. If he retaliates against those who have suppressed him as soon as he takes office, it will only ruin his own good future.

After Lao Song entered the quality control department, he studied forensic medicine by himself in consideration of the needs of his work, and later went to the criminal police team for a period of further study. Upon his return, he showed great talent in forensics. Moreover, his forensic research direction is different from forensic investigation, and he specializes in the clinical treatment of the cause of death of patients. As long as a patient dies in the hospital, he is called to visit him, and the cause of death can often be quickly ascertained. ”

"At first, the family didn't trust the results of his inferences. As a result, after applying for an autopsy, it was almost exactly the same as Lao Song's inference. Later, Lao Song was the hospital version of the forensic doctor. Not only will a patient in our hospital die, but he will be asked to analyze the cause of death, and when the hospital needs it, he will also be asked to help at a high price. Your clinical talent is very demonic, and you can also learn from Lao Song and study forensic science. After joining the quality control department, it is natural to do this job wholeheartedly. ”

Director Shi tried his best to let Zhou Can take the development route of forensic medicine.

And it's the hospital version.

Whether the intention is good or bad is difficult to evaluate.

Zhou Can has his own dreams, and it is impossible to give up chasing dreams for the sake of a job in the quality control department.

What people fear most is half-heartedness.

And he thinks that a career as a clinician is much more promising than being a hospital version of a forensic doctor.

Forensic medicine is all about determining the cause of a patient's death.

Clinicians are to save the living patients, save the lives of each life, and relieve the suffering of the patients. It's certainly a lot more rewarding than being a medical examiner.

"Thank you Director Shi for your suggestion, I will consider it carefully."

Zhou Can replied with a panacea-style cliché.

He no longer wasted time and began to pick up the patient's diagnosis and treatment records and examination reports and carefully review them one by one.

In fact, I had already seen it once when I was outside.

Only this time I looked more closely.

And the emphasis is different.

When checking in the ward, the main purpose is to look for irregularities in the diagnosis and treatment process of the medical staff of the Department of Gastroenterology. Now it's about finding the cause of the patient's death.

The patient had a routine stool check before hospitalization, and the fecal occult blood was negative.

Gastrointestinal bleeding can be ruled out.

However, before the patient's death, he suddenly vomited a large amount of blood and had a bulging abdomen, which indicated that the patient was likely to have gastrointestinal bleeding.

And there is a high probability of upper gastrointestinal bleeding.

"Did the patient defecate before he died?"

"Nope! It was already difficult for him to solve the stool, so he needed to use the cork to help him pull it out with his hands. ”

The attending doctor replied.

Nurses are an absolutely respectable job, and they are more like unsung heroes who work silently. The credit for the patient's cure goes to the doctor, and the nurse is rarely mentioned.

However, all kinds of nursing care and medication during the patient's hospitalization are operated by nurses.

Only a few medications are administered by a bedside doctor.

The nurse is more like a virtuous minister, and the doctor is a king.

If there is a male nurse, it is usually performed by a male nurse. However, male nurses are scarce, and many departments do not have male nurses at all.

All sorts of difficult nursing tasks fall to female nurses.

One by one, they eventually turned into women.

In the inpatient ward, they help the bedside doctor or intern to carry the patient onto the flat bed and take him to the operating room or for some important tests. In the ICU, they help patients feed liquids, turn over, and dispose of feces and urine...... As for the ordinary injections and dressings, this is just their most basic daily operation.

Now that the patient has died, the nurse in question has been called together to be investigated.

Zhou Can looked at the young female nurse opposite with tears in her eyes and a frightened expression, and couldn't help but feel sorry for her.

Especially when I heard the attending doctor say that the patient's stool was picked out with her hands.

This is a heroine worthy of respect.

"Is the patient who died that you have been caring?"

Zhou Can's eyes fell on the female nurse.

"Hmm!"

She bit her lip and nodded heavily.

The tears in his eyes seemed to be squeezed out at any moment.

When she looked at Zhou Can, there was obviously a deep trace of gratitude in her eyes.

Because at the beginning, Director Ju Shiyan of the Nursing Department and Director Shi of the Hospital Infection Office both thought that the urethral catheter was not inserted correctly, resulting in the patient's urine being unable to be discharged, which caused the death.

Indeed, holding back and not being able to pee all the time will really kill people.

But with the current level of medical care, this kind of thing usually happens very rarely.

It really can't urinate, and basically as long as it takes more than a day, the patient will rush to the hospital for treatment. Once doctors have identified the cause, there are a number of ways to help people urinate.

It's not just a means of inserting a urinary catheter, such as creating a fistula from the waist and hanging a urine bag on the body.

If the man's urethral catheter has collapsed or become blocked due to inflammation, a dilator can also be considered.

There are all kinds of specifications.

The taste of dilating the urethral tube is very sour, but it works.

Zhou Can deduced that the patient's death had nothing to do with urinary catheter placement, which helped her clarify her grievances. She was full of gratitude to Zhou Can in her heart.

"Don't be afraid, you do a great job in clinical care, especially the act of picking stool for patients, very brave and very dedicated."

Zhou Can first fully affirmed and praised her work.

When she heard this, she was very pleased.

Nod vigorously again.

"Thank you! Thank you for saying that! ”

"What's your name, please?"

"Luo Xiao!"

"Mr. Luo, when was the last time the patient had a bowel movement?"

The doctor is called a nurse, and if there is a professional title, the deputy chief nurse, or the chief nurse, or the head nurse, can be directly called a certain director. If there is no senior title or position, it is generally called a certain teacher to be more respectful.

However, in recent years, the title of teacher has become a bit unfriendly to female non-education workers.

Because many AV actresses in the island country are called so-and-so teachers by their male compatriots.

The job of a nurse is special, and it is also easy to cause misunderstandings.

In the hospital, many directors don't like to be called their teacher, and there is also a reason for this.

Of course, this reason is only part of the story.

The main thing is people's vanity, and everyone generally thinks that the director is more senior and better than the teacher.

"Uh...... It should be two days before the patient's death, on the evening of the 19th, the patient kept saying that his chest was a little tight, and his stomach was swollen and painful. I helped him manually depoop once. ”

Nurse Luo Xiao replied.

After Zhou Can heard this, his heart couldn't help but move slightly.

As a surgeon in cardiothoracic surgery, he is sensitive to many of the symptoms of diseases in the field of cardiothoracic surgery. Hearing about the patient's chest tightness may be overlooked by other health care providers.

Zhou Can thought of the patient vomiting a lot of blood before he died, and the medical staff didn't have time to rescue him, so the patient died directly.

Make a bold inference, does the patient have cardiovascular disease?

For example, aortic dissection, especially ascending aortic dissection, is the most dangerous. Or an aortic aneurysm.

However, even if the aortic dissection ruptures, the bleeding will accumulate in the chest and abdominal cavity, and it is impossible to vomit directly from the mouth.

Most patients with ruptured aortic dissection begin with acute onset of severe chest pain.

The pain is usually knife-cut, pinprick-like, or tear-like, and is usually persistent and unbearable, and opioid painkillers are often of little use.

However, she mentioned that the patient had experienced chest tightness, which was an important clue.

"Before the patient died, was Mr. Luo present?"

"Present, it's me on the night shift today! As soon as the family rang the bell, I went to the ward to check. At that time, the patient's blood pressure was very low, and I realized that something was wrong, so I immediately called the doctor on duty to deal with it, and also called Dr. Wang, who was in charge of the treatment. ”

When she mentioned the scene at that time, she still seemed to have palpitations.

Watching a life pass away with one's own eyes, even for medical staff who are accustomed to seeing death, every time they see it, it still brings great spiritual pain.

Female medical staff are more fragile than men.

Seeing patients die is often more devastating.

"The patient's blood pressure was low at the time?" Zhou Can couldn't help but suspect that the patient was likely to have a ruptured aortic hemorrhage. "Did you notice the patient's physical features at that time? Does the patient have shock-like symptoms such as paleness, sweating, clammy skin on the extremities? ”

Zhou Can asked.

If aortic dissection is ruptured, the patient usually has only shock-like symptoms, but rarely shock.

Most die within a very short period of time.

It can also be understood as dying before he had time to go into shock.

"Hmm...... At that time, his face was indeed frighteningly white, and I didn't notice if he was sweating. When I took his blood pressure, the skin on my arm seemed to be a little clammy and cold, and I saw that the patient's condition was not good, and I was quite nervous, so I didn't pay too much attention to these details. ”

She was a little embarrassed.

In other words, most young medical professionals tend to behave this way when they see a patient in critical condition.

Nervous, anxious, and only thinking about saving people quickly.

Fear of the sick dying at their own hands.

Zhou Can has also been training in the intensive care medicine department for several months, and he can deal with various emergencies calmly and calmly.

At the beginning of the intensive care medicine department, Vice President Ye personally arranged for him to train for a period of time. It has been of great benefit to him throughout his life as a medical practitioner.

Among the college-level leaders, although Zhou Can has a certain connection with Dean Zhu and Vice Dean Bai, he is the closest to Vice President Ye in his heart.

I can't say it, but from many details, we can find that Vice President Ye is really good for him and thinks about him everywhere.

"The patient had taken a CT of the abdomen at that time, and the film should be archived, can you call it all up now?"

"No problem, I'll contact the medical technology department immediately."

Director Shang was highly cooperative with Zhou Can's requirements.

In the past, Zhou Can had studied with him and was considered his student. Also his subordinates.

However, now Zhou Can has grown more than him.

After having an administrative position, Zhou Can is already a leader.

Of course, this leader has water.

Because he is still only an ordinary member of the quality control department, he does not hold any leading cadre positions.

"Dr. Zhou, has this made a major discovery?"

Deputy Chief Xiong of the Medical Affairs Department asked out loud.

"Sort of! I suspect that the cause of the patient's death was aortic rupture and massive hemorrhage. ”

Zhou Can is not too sure now.

Because there are still many doubts that have not been solved.

"Aortic rupture and massive bleeding? It should be possible to rule out because the patient vomits profusely before death, which is more like death from upper gastrointestinal bleeding. Director Shi retorted beside him.

"Under normal circumstances, it does. However, everyone's body is different, for example, the heart of a normal person grows on the left side, but there are also people with different eccentricities whose heart grows on the right chest. Even in clinical practice, I have encountered a very special case where the heart grows in the abdominal cavity. So, anything is possible. ”

Zhou Can talked eloquently.

The gradual enrichment of clinical experience has made him more confident when dealing with this kind of thing.

Only by being well-informed can we break the conventional fixed thinking.

Thank you very much for your support all the way, speed up the progress of the plot, finish a few climaxes, and strive to finish this month. Criticized......

(End of chapter)