Li Min was so frightened that he shrank into the corner, Mom, I usually look at a very kind teacher, why is it so scary to be angry!
Compared with Chen Wenqiang, Xie Xun was gentle in the operating room that day.Director Liang saw that Chen Wenqiang was furious, and hurriedly opened his mouth to divert Chen Wenqiang's attention, he grabbed Dr.
Liu and asked, "Dr.
Liu, how long does the child fast water before surgery?"
”"I basically didn't eat much for lunch, and I didn't eat or drink water in the afternoon."
Dr.
Huang didn't wait for Director Liang to speak, so he immediately followed up and said: "The intraoperative rehydration solution is 450ml of sugar saline, I just considered that the postoperative child had not eaten or drunk in such a hot weather all afternoon, and I should fast water after the operation, and before leaving the operating room, I was afraid that if something went wrong on the way to the surgery, I changed a bottle of 10% glucose liquid and hung it up." ”"What about after the surgery?"
Chen Wenqiang asked."
I gave 500ml of saline and 6.4 million u of penicillin, this child usually rarely gets sick, basically does not use medicine, and is not allergic to penicillin skin test."
Doctor Liu replied with a reasonable answer, and he thought that there was nothing wrong with his disposition.Chen Wenqiang snorted coldly and said, "Let's not care what the nurse does with the 500ml of 10% glucose."
Xie Xun, you come to give a lecture to these two fools. ”Xie Xun sat up straight before speaking: "I support Dr.
Pan's opinion, and I tend to prefer acute left heart failure pulmonary edema caused by too rapid infusion in a short period of time.The child was a minor, and combined with the amount of fluid rehydrated during and after the operation, the time of fluid entering the body, and the pink blood flowing from the nostrils, which was consistent with acute left heart failure pulmonary edema.In addition, excessive and rapid infusion leads to acute left heart failure, pulmonary edema, and cerebral edema also occurs.Hypoxia, convulsions, coma, and cerebral edema can all be explained.However, I believe that the child's sudden change from a semi-sitting position in bed to an upright position was a direct factor in his death.If the child does not change his position, Dean Chen may be able to find out what is wrong with the child during the ward rounds after the shift this morning. ”After the arrogant Xie Xun finished talking about his inference, he still patted himself in front of all the surgeons.Regardless of whether this sycophant is clever or not, Chen Wenqiang's face improved a little after Xie Xun finished speaking.Director Shi sighed: "Dr.
Huang's consideration in the anesthesiology department is reasonable, and Dr.
Liu's postoperative administration is not out of line.But the immediate cause of the child's death ......
Let's not talk about whether the patient was rehydrated too quickly in a short period of time, causing left heart failure pulmonary edema.I would like to ask you both, did you ever consider that this is an 11-year-old when you were giving fluids to your child?
Ever wanted to slow down your infusion?
So as to adjust the amount of fluid injected into the body per unit of time?
In the operating room, there was only a little more than an hour, and 450ml of fluid was infused, with glucose in the middle, but 500ml of saline was infused.Yes, when it is hot, the child will lose a lot of body/fluid when he sweats, his body temperature rises, and he does not feel evaporation.But from 6 p.m. to 24 p.m., it's okay for adults to infuse these fluids, but it's a child......
"Dr.
Huang understood, he raised his head in a cold sweat and wanted to speak, but was forced by Director Zhou's stern eyes.Dr.
Liu, who was in charge of documenting the death discussion, was already stupid.Dr.
Chen, who participated in the operation, also recklessly - Director Shi's words, although he did not mention him, also made him feel inferior to Pan Zhi.Director Liang pressed the angry Chen Wenqiang down and sat down, and said slowly: "In our surgery, especially in general surgery, we tend to give patients a large amount of fluids after surgery.Often, on the day of surgery, 2,000 or 3,000 fluids were injected, and the infusion was completed in the second half of the night, and after work the next day, 2,000 or 3,000 liquids were poured in.It's okay not to drown the patient. ”Director Xiang said on the side: "Our orthopedic department does not have these stinky problems that you have in general. ”Director Liang didn't seem to hear it, and then said to Chen Wenqiang: "Are you going to hand this matter over to the Medical Department or let Dr.
Liu and Dr.
Huang handle it?"
What about the nurses?
”Dr.
Liu immediately begged, "Dean Chen, let me talk to the family first." ”Doctor Huang couldn't wait to hide his body when the shrunken turtle hid his body at this time, and under the pressure of Director Zhou's gaze, he said curtly: "I'll try it with Dr.
Liu."
But doesn't it take an autopsy to determine the cause of death?
”Director Shi said, "You just don't see much.Let's talk about how to deal with it in the future.We now discuss the management of left-sided heart failure pulmonary edema.Dr.
Chen summoned all the surgeons to come over and discuss the death records, with the purpose of reminding the young doctors.Xiao Li, what are the principles for the treatment of acute left heart failure in this child?
”There are several people with the surname Li in the house, but everyone knows that this Xiao Li refers to Li Min."
Oxygen, cardiotonic, diuretic, antispasmodic."
After Li Min answered, he saw that Director Shi was still looking at him, so he continued: "If this child was at that time, at that time, I should have given 20mg or 40mg of furosemide, no, 20mg intravenous bolus; Li Min was nervous because she was also considering the dosage of furosemide from an adult perspective."
Keep him sitting, limit his movements, and give him hemodialysis in the emergency room."
Dr.
Liu screamed sadly: "When I listened to the heart sound, he had no heartbeat and no breathing. ”The young man who had not passed through the unknown cause of the deceased in his hands could not understand Dr.
Liu's loss of control.But more people, including Director Xiang, were changed by Dr.
Liu's grief.The most obvious is Chen Wenqiang.- He relented again.Director Shi looked at Chen Wenqiang's face and patted Dr.
Liu's shoulder and said, "There is also a possibility of sudden cardiac death.Such sudden deaths often have hereditary cardiovascular and neurological disorders.If the parents agree to an autopsy, the cause of death can be determined—whether it is acute left heart failure pulmonary edema caused by infusion after surgery, or an underlying cardiovascular medical condition such as cardiac ion channel disease. ”There were many people present who were told by Director Shi to become "square", and Li Min couldn't help but hide behind Xie Xun.Director Bishi stood diagonally facing Li Min and their corner.Director Shi caught her and asked, "What if there is cerebral edema?"
”This Li Min knew very well, and she immediately replied: "Give 25% mannitol a quick intravenous drop."
It is best for the child to watch the rate of mannitol infusion at bedside. ”"What if it's an ion channel disease?"
Li Min wanted to hug his head and wail: Why are you staring at me and asking.But she couldn't help but answer."
For this, we need to first determine what type of ion channel problem it is.Specifically, it seems that the provincial doctor cannot do the test at present. ”After asking Li Min, Director Shi said lightly: "There is no hospital in the provincial capital that can test it.Experimental administration is not consistent with first aid for the child. ”Li Min breathed a sigh of relief.Chen Wenqiang, who has eased his emotions, added: "There is also a special postoperative cause of chlorine/amine/ketone allergy.Especially in children, when they are allergic to chlorine/amine/ketone, they are prone to cramps, convulsions, and coma during this period of time after surgery.But no matter what kind of cause of death we speculate, let me remind you and all the doctors here that we must keep in mind in our future work: children are different from adults, and we can't be too cautious.Before the doctors in the pediatric surgery department are complete, when you encounter a small pediatric patient, you should not be afraid of trouble, and you must ask Director Wu of the pediatric department to help check it. ”The young doctors immediately agreed, "Yes." ”"The rest is for you to ask yourself today: When you give the doctor's order, do you consider the child's age and weight, and do you know that you need to indicate the infusion speed at the back of the doctor's order, or verbally inform the nurse of the infusion speed?"
All three shook their heads slowly."
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That's where you guys are wrong.Others take this as a warning. ”Dr.
Chen, who was outside the general public, reacted a little slowly, and the expression on his face was not so in place, and he was immediately grabbed by Chen Wenqiang and asked: "Dr.
Chen, you graduated from a bachelor's degree, unlike Dr.
Huang and Dr.
Liu's medical classes to junior college, have you forgotten all your knowledge of pediatrics?"
Or do you think that this patient is in charge of Dr.
Liu, and you are just a junior physician who follows the stage?
”Dr.
Chen's face changed back and forth, and finally he exclaimed, "Dean Chen, I have both of these."
I was wrong. ”Chen Wenqiang is like this.Thou art straighter than any other man with his neck and his neck; If you sincerely admit your mistake, he accepts it, and his heart is so soft.
*"This is a surgical malpractice anyway. ”Chen Wenqiang has the ability to "Chrysostom and Jade Words" in this kingdom that belongs to him."
As for whether it is a technical accident or a liability accident, it cannot be determined by our hospital."
Director Li called him: "Chen Wenqiang, he is still young." ”Li Min has been working for a year in a few days since he came to the provincial doctor, and for the first time he heard someone call Chen Wenqiang's name.Director Liang and Director Xiang also begged: "Old Chen, they are all young." ”Director Shi also begged Chen Wenqiang: "Dean Chen, they just don't see enough."
Or those of us who will talk about a rare death record every week or month. ”Chen Wenqiang clenched his fists with both hands, he understood what Director Shi meant, but he just reminded himself that everyone under them had Qu Death Ghosts.He took a deep breath and said, "Everyone write a reflection on this matter and give it to me in three days."
You go and ask for forgiveness from the parents of the sick child.We have to admit how much compensation we should give.Meeting. ”The three parties understood that Chen Wenqiang was raised high and fell gently.Others also understand.The man standing in the doorway began to walk out.Dr.
Chen first said gratefully, "Thank you, Dean Chen."
Thank you, Director Li, Director Liang, Director Xiang, and Director Shi. ”Dr.
Liu bowed to several directors with red eyes.Doctor Huang hesitated for a moment and bowed behind Dr.
Liu.Director Zhou said to Director Li, "Lao Li, can you accompany me and them to meet the parents of the child?"
”Director Li nodded.* After the crowd dispersed, Chen Wenqiang called the head nurse and Lu Qing and told them the two of them the guessed cause of the child's death.Then he said very sadly: "That child's matter, the night nurse last night was the most responsible."
How could she not adjust the rate of the infusion when the baby returned?
She has to take her responsibility.Go back and let her and Dr.
Liu compensate together. ”The head nurse nodded repeatedly."
Dean, I know.The nurse on the night shift should slow down the rate of infusion.I will stress this to all the nurses repeatedly.I'll talk to Sister Fang there. ”Lu Qing reminded the head nurse: "Sister Fang is also in her forties, do you want her to go out of class?"
Maybe it was because last night her attention was on the serious infection of those wounds. ”Without waiting for the head nurse to speak, Chen Wenqiang said: "When this matter is dealt with, let Xiao Fang go to the supply room head for the day shift."
If there are enough people, the nurses on the twelfth floor and the eleventh floor will be on duty completely separately. ”"Are you going to divide the subject right away?"
Chen Wenqiang shook his head: "For the time being, it can't be divided."
If you can't do it, you two nurses will be sent to the pediatric department for a week, or the head nurse of the pediatric department will come and give a lecture.All nurses in our department must pass the postoperative care of children, and in the future, not only small patients in neurosurgery, but also patients in trauma surgery will increase after the admission of patients outside the department. ”The head nurse and Lu Qing nodded again and again, they had long understood this truth, in the past, Dean Chen's operation and handed over the child to pediatric care was a temporary transitional matter, and it was impossible to continue like this.The head nurse thought for a while and decided to do both."
Dean, I would like to invite the head nurse of the pediatric department to give a lecture, and at the same time send Nuan Nuan and Xie Shanqian to study in pediatrics.They are young and can devote themselves to their work for the next three years. ”"Okay."
Chen Wenqiang agreed to the head nurse's arrangement.※※※※※※※※※※※※※※※※※※※※ The Nobel Prize in Physiology in 1991 was awarded to German scientists Erwin Nel and Bellet Zuckermann for the discovery of intracellular ion channels and the pioneering patch-clamp technique.Ion channels are made up of special proteins produced by cells, which are aggregated and embedded in the cell membrane, forming pores occupied by water molecules, which are the channels through which water-soluble substances can quickly enter and exit the cell.The activity of ion channels is the ability of cells to regulate the speed of corresponding substances entering and exiting cells through the opening and closing of ion channels, which is of great significance for the realization of various functions of cells.() The distance is a bit far