To be honest, this round of ward rounds took about an hour, mainly spent on the link of "chasing" the patient to be discharged.Back in the office, Chen Wenqiang said: "You can read and write the ward round records."
The one with breast cancer, Director Liang will be the surgeon tomorrow. ”And then, no more."
Lao Liang, are you leaving?
I'm going to the front. ”Chen Wenqiang was going to the dean's office to greet Director Liang who was off the night shift."
Let's go.Go home and catch up on sleep. ”Thinking about the pancreatic cancer surgery last night, Director Liang couldn't sleep soundly.He didn't expect Chen Wenqiang's ward rounds to be so crisp and decisive.Now that he can go home immediately, he smiled and took off his white coat and took out the two cigarettes that Chen Wenqiang gave him in the morning from the drawer.When Director Li saw it, he said to him: "You take it out so ostentatious, be careful that others sue the medical office." ”Director Liang smiled and said, "Lao Chen gave it to me."
Don't you have that too?
”"I'll just keep it and smoke it in the hospital."
Director Liang hesitated, unpacked and took a box, stuffed the rest into a drawer and locked it, and walked a few steps to go out with Chen Wenqiang, who was standing at the door waiting for him.It seems that according to what Chen Wenqiang and the head nurse said, the outpatient clinic was quickly sent to an emergency department: it was still an acute abdomen.With yesterday's lesson, Dr.
Wang hesitated and did not rush forward, but asked the nurse who came over."
What kind of patient?
How old are you?
”"Old man, 84.Abdominal pain to be investigated. ”Director Li waited for a while, and when he saw that Dr.
Wang was silent, he stood up and said, "Dr.
Li, do you want to go with me to have a look?"
”Li Min quickly stood up, and replied with a smile while tightening the pen: "Okay." ”The two of them followed the nurse out.The patient was brought in in by an outpatient flat car.The man was still lying on the flat car, but he was lying on his side.Two middle-aged men with gray sideburns, one left and one right, stood nervously by the side of the car to protect him, for fear that he would turn over and fall.The appearance of Director Li made the men and women who followed the old man immediately set their eyes on him.That ardent anticipation and longing is like seeing a bodhisattva who saves suffering and salvation come."
This is Director Li and Dr.
Li of our department."
The nurse confesses to the middle-aged woman standing at the desk.The woman hurriedly handed over the things in her hand, "Director Li, please show my father, the emergency department said that my father had upper gastrointestinal bleeding and said that it was a gastric perforation." ”Director Li took the plain abdominal x-ray and saw that it was not taken by this hospital."
When is this film?
Where was it filmed?
”"Yesterday I saw a doctor in the district hospital, I had a fluoroscopy, and it was a gastric perforation, my dad is so old, and the doctor said that he could try conservative treatment.After this morning's emergency filming, the doctor asked us to transfer to the hospital. ”Li Min followed Director Li to read the X-rays and the simple medical records of the outpatient clinic of the provincial hospital, and took on the work of receiving patients very clearly."
Did you bring any other test results?"
The patient's family members shook their heads."
Didn't the district hospital introduce you to another hospital?""
I gave us this film.said that the provincial hospital understood after watching the film. ”Well, yes, understood.But those tests of blood and urine are better than none.Li Min took the first page of the hospitalization medical record and looked at the diagnosis above: abdominal pain to be investigated.
(Upper GI bleeding?)
）He said to the nurse, "Take your blood pressure and pulse first." ”The nurse moved quickly, "Blood pressure 101/67mmHg.Pulse rate 85 beats per minute. ”This blood pressure and pulse?
Li Min's intuition was not very good.Looking through the outpatient medical records again, there were indeed no records such as blood pressure in the outpatient medical records - it was not that she didn't notice or remember.She immediately frowned and asked the patient's children, "Do you know what his usual blood pressure is?"
”Several middle-aged people shook their heads.The woman opened her mouth and replied: "My dad usually doesn't have any serious illnesses, but when his stomach is upset, he goes to the health center of the unit to prescribe some stomach comfort and eat, and he will be fine."
I don't think I've had my blood pressure measured. ”Gotcha, lost to these people.The nurse asked, "Is it okay to put bed No. 1 in ward 1?"
”With so many beds vacated at once, I finally have a little choice.Director Li nodded, it doesn't matter where you put it now.If surgery is necessary, the person at this age will have to be sent to the intensive care unit after surgery.Now Dr.
Wang is slippery and refuses to pick up this elderly patient, and Lao Liang is off the night shift, so it seems that this operation will have to be done by himself.After a while, I asked Dr.
Liu if he was willing to come to the stage, and if he didn't go, he called Chen Wenqiang to come back.The nurse said to the old man's children, "Come with me." ”The old man's son was pushing the cart, and the daughter asked Director Li: "Is it for my father?"
”Director Li said, "We'll check on your father later." ”Director Li took Li Min to follow, and when the old man was placed on the hospital bed, Li Min stepped forward to ask about the medical history: "Master, how many days has your stomach hurt?"
”The patient's half-open and half-closed eyes opened slightly and replied, "It's been two or three days." ”"What kind of pain is it?"
The patient frowned and tightened, hesitating and not answering Li Min.Li Min guessed that the old man could not describe his pain."
Does it hurt or is it a tolerable pain?""
Can you bear it, but you can't bear it."
This question cannot be asked any further, so let's leave it at that."
Then have you vomited these days?""
Nope.Not once. ”"Do you have diarrhea?"
The patient shakes his head slightly.The old man's son added: "My dad had a black stool the day before yesterday.I felt bad when I got off work and took him to the district hospital early yesterday morning.The doctor there didn't let my dad eat any more, and gave me an infusion and decompression. ”The man gestured as he spoke.He tried his best to explain the matter to Li Min, but that was all he knew.Li Min was busy for a while, and finally asked about the medical history.To sum up: epigastric pain with melena for three days as the main complaint.Medical history: unprovoked epigastric pain, vague pain, no nausea, vomiting, fever, radiating pain three days ago.It is accompanied by one melena, and the exact amount of melena is not described.Yesterday, he was hospitalized in the district hospital, and he had gastrointestinal decompression and infusion, but the specific treatment was unclear.This morning, the abdominal pain intensified and was unbearable, and the emergency department of the district hospital transferred the patient after taking a flat abdominal x-ray.Physical examination: no jaundice, poor spirit, can basically answer questions correctly.The breath sounds in both lungs were clear, no dry and wet rales were heard, the heart rhythm was uniform, no pathological murmur was heard in the valvular areas of the heart, the abdominal muscles were tense and tough, the upper abdomen was diffuse tenderness, there was no rebound tenderness, bowel sounds were weakened, and no abnormalities were found.Anamnesis: Stomach problems for more than 20 years.INVESTIGATIONS: Orthostatic abdominal x-ray of the district hospital showed dissenting gas and several fluid levels in the diaphragm.Combined with the medical history, Li Min preliminarily gave a diagnosis of upper gastrointestinal perforation in his heart."
Director Li, I don't think my heart rate is 85 enough, so I can barely reach 80."
After Li Min did the physical examination, he directly picked Director Li and reported the results first if he failed to get the results as soon as possible."
Expand first.Let's get ready for surgery. ”"Shall I go get a abdominal puncture kit then?""
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Go ahead.I'm waiting for you here. ”Li Min walked quickly to the dressing room, "Aunt Luo, help me prepare a belly piercing bag."
It's the stuff that Director Liang used yesterday.I'll pick it up later. ”"Okay."
Sister Luo agreed very happily.Li Min went to the nurse's office, neatly picked out a few test sheets, and quickly filled them out."
Xiao Zhai, just now the patient went to prepare the skin, decompress the lower gastrointestinal tract, indwelling catheterization, procaine skin test, open the liquid pathway, and then I will do an abdominal puncture."
Good.I'm going to explain to the person who went to work. ”Xiao Zhai agreed and went out.Soon she was back."
Is there an emergency surgery?""
Yes, I still have to draw blood for these tests, and I will come back and give a temporary doctor's order, and you will help me draw blood according to these test sheets first.""
Okay.Don't forget it for a while. ”Xiao Zhai didn't feel at ease and admonished."
How could it be.I don't care when I speak.I did the abdominal puncture and wrote it when I came back. ”Li Min took the abdominal piercing bag and went over, and Director Li held his hands in front of his lower abdomen interactively, without the slightest intention of moving.Li Min adjusted the patient's position by himself and repeated Director Liang's abdominal puncture operation yesterday.What is drawn out is a purulent discharge.There was no food debris.Director Li raised his eyebrows and looked at Li Min, waiting for her to explain the secretions to herself."
The time for stomach emptying is 4 to 6 hours.The patient had tolerable abdominal pain after having a black stool the day before yesterday and was fasted for a day yesterday. ”Director Li nodded in agreement: "That's the truth." ”Li Min immediately explained to several family members: "Fifteen minutes later, a person from your family who can talk and handle things will come to the doctor's office."
I'll take care of your father's specific treatment.Don't worry, don't look at me young, and Director Li has been watching from the side all the time. ”After explaining, Li Min didn't wait for Director Li and took the lead out of the ward.If she had to have an emergency surgery, she would have had too much to prepare.Unexpectedly, when they returned to the empty office on the front foot, the family members of the patients on the back foot followed them.Li Min was busy preparing the necessary hospitalization summary, operation notice, surgical consent form, etc., and Xiao Zhai came over with a temporary doctor's order."
Dr.
Li.""
Good, good.I'll make up for it.This operation notice, Director Li, who is on it?
”Director Li stretched out his hand and took the notice, "Give it to me, I'll arrange it." ”Li Min wrote all the temporary medical orders, and Xiao Zhai carefully read them one by one, before signing a string of her names and leaving satisfied.Li Min buried himself in writing wildly, and then handed over the written surgical opinion to the servants."
You read it first, if there is anything you don't understand, I'll explain it to you later.I'll have to write down a summary of his hospitalization first, or I'll not be able to do surgery for a while. ”Although this couple didn't understand the preoperative explanation on the surgical opinion, they didn't bother Li Min when he saw that he was writing medical records like a fly.When Li Min finished writing, the daughter spoke first."
Doctor Li, what is my dad's disease?
Is it a gastric perforation?
”"The initial diagnostic bias is gastric perforation.The exact details will not be determined until surgery.Xiao Zhai," Li Min suddenly remembered something, and shouted loudly to the responsible nurse."
What's the matter, Dr.
Li?""
You go and take your blood pressure and pulse in bed 1.""
Okay."
Li Min turned around and spoke to the brothers and sisters: "If your father's physical condition allows, I mean that there is no continued blood pressure drop, etc., I want to do some other auxiliary examinations for him to see if he can be treated conservatively."
Because he is too old, even if it is surgery, we are likely to only repair the perforation, and more is not reluctant. ”Although the three brothers and sisters didn't understand much, they could hear something from Li Min's words, and they couldn't help but feel a little disappointed on their faces."
The main reason is that your father's body can't withstand a bigger operation."
Li Min patiently explained to the three of them."
For example, if you're your age, we might treat a gastric perforation with a large gastrectomy, which takes three or four hours."
When she heard that the operation would take three or four hours, the woman immediately nodded her head and said, "Doctor Li, we understand."
But what you wrote here......"
Li Min smiled."
That's how we have to explain all the surgeries to the patient's family.For example, I have not encountered an anesthesia accident so far.However, the older the person and the person in poor physical condition, the more likely it is to have these accidents and complications.This is also the reason why the district hospital first treated conservatively. ”After a pause, Li Min continued: "You have all seen the pus I drew from my abdominal cavity just now.He is now having purulent peritonitis.For young people, there should be a fever at this time.But his temperature did not rise.This indicates that his body has aged to the point where it cannot respond as well as it should. ”Director Li sat at the junction of the two offices and listened to Li Min's preoperative explanation to the patient's family.For patients of this age, it is not to blame Dr.
Wang for refusing to touch his hands.Director Li, who closed his eyes and listened to the sound, was heard by Xiao Zhai's hurried footsteps."
Director Li, Dr.
Li, the patient's blood pressure is 91/55mmHg.Pulse 73 beats per minute. ”Li Min stood up: "Director Li." ”Is the patient going into shock?
Director Li said unhurriedly: "When the family members sign and agree to the operation, we can notify the operating room."
You will send a critical illness notice to the patient's family and don't forget to send it to the medical department for backup. ”() The distance is a bit far