After the holiday, Li Min went to Corey early in the morning according to the original rhythm of work.Lu Qing didn't feel strange at all when she saw her coming.Intern Fu Yunxiang asked her, "Teacher Li, aren't you going on vacation today?"
”"I had surgery for that cerebral infarction the day before yesterday, and I have to come and see it today."
Li Min didn't just come over to see it today, she came over to see her for more than two or three hours after dinner on the day of the operation, and she didn't go home until Chen Wenqiang came to take over the night shift when he was late drinking.Yesterday, I came to see this patient with three meals in the morning, noon and evening.However, after thrombectomy, the patient has been in a deep coma and has not woken up.The family did not blame her and Chen Wenqiang for this, after all, they already knew that this situation would occur before the operation.After the shift was handed over, Director Li said: "Tomorrow is the operation day of our department, and the two surgeries prepared before the holiday, one thyroid adenoma and one lung cancer, will be opened tomorrow."
Xiao Li, since you are here, arrange for the interns to follow you on stage. ”"Yes."
The morning meeting was over, and Lu Qing grabbed Li Min, who was about to fill out the operation notice, and asked, "Doctor Li, are you still on vacation?"
”Li Min hesitated for a moment and said, "Hugh can't do it."
It's endless. ”"Then I'll count your attendance according to the Changbai shift.""
Hmm.I'm staying in Corey tonight. ”"Understood.It's still your attendance report according to the hospitalization total. ”Lu Qing patted Li Min on the shoulder and said meaningfully: "Anyway, where you sleep, it's all you."
It's better to come to Corey first to finish the year's hospitalization. ”Li Min smiled: "Sister Lu is right." ”After finishing the morning's work step by step, Li Min went to the eleventh floor to round the room.In the ward, only Dr.
Sun, who came from the orthopedic department, was looking after the house.When he saw Li Min, he asked strangely, "Isn't it a vacation?"
”"I had surgery for that cerebral infarction the day before yesterday, and I have to come and see it today.I can't leave the hospital on vacation, and I don't have anything else to do, so I might as well go back to work.Director Zhang, what about them?
”"The surgery went.""
What book are you reading?"
Li Min felt that the book in Dr.
Sun's hand was a little strange.This 32-carat edition is rarely found in clinical specialty books.The provincial hospital's self-printed simple inquiry booklet for clinical medication is much thinner than this."
I'll show you."
Dr.
Sun happily handed the book to Li Min.Li Min took it and flipped through it and found that it was actually a Hong Kong and Taiwan novel.She was very surprised, she couldn't imagine that Dr.
Sun, who was tall and strong enough to rank in the top ten young doctors in the provincial hospital, would actually like to read Yishu's romance novels."
What's that look on your face?"
Dr.
Sun asked dissatisfied.He slashed back the novel."
I, I mean" Li Min has always been articulate, but at this time, he couldn't find the words all of a sudden.She said vaguely, "I didn't expect you to like to read romance novels." ”"And what should I like to watch?""
Romance of the Sui and Tang Dynasties."
Dr.
Sun immediately glared."
Or Jin Yong and Liang Yusheng.""
Do you read martial arts novels?""
Of course.I went on rounds. ”Li Min was followed by 5 interns, 4 upstairs, plus Dr.
Sun's.* Dr.
Sun rolled the novel into a tube in his hand and followed behind them.This time, Li Min took the interns to focus on and pick some inpatients, including those who were hospitalized in fights.Out of the first ward, Li Min found Dr.
Sun behind several of them."
What are you doing with us?""
When you're done, I'll discuss the novel with you.""
I'm going to work."
Li Min felt that Dr.
Sun was a bit outrageous."
I'm not in a hurry, I'll see you round.That's fine, right?
”"No problem.Just give me a copy of the teaching fee. ”"How much is the teaching fee!
The second ward can be hospitalized for a fight before the holiday, and I will be your bodyguard. ”Li Min didn't want to quarrel with him, so he pushed open the door of the second ward and entered.The patient in the first bed at the door was a little irritable, and when he saw them come in, he complained angrily: "Come to the ward round again, what's the use of you just doing the ward round."
I've had a headache for two days. ”Li Min took a look at his bedside card diagnosis: 23 years old, a line of handwriting added after the right clavicle fracture is occipital hematoma headache to be investigated, and it is not the same handwriting as the person who wrote the bedside card in front.The pen handwriting on the back is very fresh, and it seems to have been added today.The patient was admitted to the hospital on the night of September 30.Li Min thought for a moment that it was Pan Zhi's night shift, who belonged to the eleventh floor, and she didn't remember it for a while.I remember that Pan Zhi once said that he received a few fights at night.When No. 2 took the interns on rounds, Director Li and others also reminded themselves to avoid these people.This person's vicious appearance is unwelcome, but this patient has a headache, irritability, and occipital hematoma......
"Did this 1st bed patient have a CT scan?"
”Li Min asked the intern who followed on the eleventh floor.The intern brought by Dr.
Sun immediately shook his head: "Teacher Li, this is not a patient we are in charge of. ”"You go get your medical records.""
How did the hematoma in the back of the head come from?""
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Knock."
The patient's tone was not good, but looking at Li Min's serious expression, he was probably really uncomfortable, and replied with two words in a daze."
How?""
It's all nonsense.I fell, and the back of my head hit the ground. ”"Do you feel anything uncomfortable besides a headache?"
Li Min pretended not to hear or see the message he didn't want to accept."
What more do you want from me?
Why don't you want me to be a little better?
”Li Min reminded herself that she couldn't be angry with this patient, and continued to ask the patient: "When was the hematoma in the back of your head discovered?"
”The patient reached out with his left hand and touched the back of his head and said, "The night before yesterday."
Not right, yesterday morning?
I don't remember.Anyway, I started to have a headache yesterday. ”After taking the medical records, Li Min opened them, and there were only general blood and urine routine and basic biochemical ion tests, and there was an X-ray examination report for clavicle fracture, but there was no doctor's order and report for brain CT examination."
Did you tell the doctor about the back of your head when you were hospitalized?""
Nope.I had a head ache yesterday, and when I touched this big bag, I remembered that the back of my head hit the ground when I fell. ”"I'll give you a check-up.""
Will you?
What will you be?
Little girl piece. ”The escort on the side is not a good person, more fierce than the patient lying on the bed.The gauze on the door of the head showed dried blood stains, and the rolled up sleeve fell out of a tattoo in the middle of the inner part of the forearm."
I will.I am the total inpatient.The patients on the 11th and 12th floors are under my control.If you can decide for him that I don't need to do the examination, then I will write it down in the medical record and take the student to see someone else. ”The patient lying on his side stopped doing it and shouted at the young man whose head was wrapped in gauze: "Don't be a blind beep, my head hurts so much that I can't stand it."
Come and help me sit up. ”Just cooperate with the patient.Li Min carefully examined the patient's occipital hematoma and found that the pupil in the patient's small eye was a little large.However, she didn't bring a flashlight, and it was not good for the students to run again, so after the pathological reflex was not triggered, she underwent brain CT on the temporary doctor's order."
I'm going to give you a brain CT scan in the emergency room.""
You suspect there's something going on in my head?""
You're fine, you don't have a headache, do you?"
Li Min folded up the temporary doctor's order and said to the intern who followed him: "This patient has a bump on his occipital.Fu Yunxiang, you give everyone a paragraph about occipital brain injury. ”Endorsement is Fuyunxiang's forte.She recited aloud: "The medial surface of the occipital bone and the tentorial surface of the cerebellum are relatively smooth, and the bone surfaces of the base of the precranial fossa and the base of the middle cranial fossa are uneven.Therefore, when falling, whether the occipital or frontal region is used as the focus point, brain injuries are more common in the frontal lobe, anterior and temporal lobes and the underside. ”"What about this case?""
It's supposed to be a hedge.Consider secondary intracranial hematoma, cerebral swelling, or cerebral edema. ”"Regarding secondary brain injury and acceleration and deceleration brain injury, you go back to read the book by yourself, and if you don't understand anything, including why you don't understand why you want to do an emergency brain CT scan, go to the twelfth floor after work.I can spare half an hour to answer.Now go to the two boys' carts and take him to the CT room.Somebody go back and help me get a flashlight and a CT scan application form. ”Li Min's words fell, and the three boys immediately moved.When the checklist was brought in, Li Min also finished writing the record of the course of the disease that he had just seen and checked.She did a light reflex test on the patient's pupil, and it was okay!
The light reflex is only slightly dulled, and the pupils are not significantly dilated.After filling out the checklist, the flat cart was also pushed over.Li Min beckoned a few boys to carefully lift the person to the flat car and put the pillow under the patient's head.Tell the patient, "You have to lie on your side back and forth, remember." ”The patient was already frightened by Li Min's cautious attitude.At stake for his own life, all the ferocity was gone, and his attitude was like that of a three- or two-year-old child, or rather like a well-behaved big cat."
Is it okay for you to push him to the CT room for a check-up?"
Li Min asked the young man who accompanied him.Unexpectedly, the escort heard that there was an injury in his brain, and his legs weakened, and he couldn't answer in a cowardice."
Fu Yunxiang, you and he take the patient to the CT room.I'll call right away. ”Li Min looked at the deposit on the patient's homepage, handed the CT list to Fu Yunxiang, and pointed to Dr.
Sun's intern to make arrangements."
Doctor Sun is okay, right?""
Yes.Can you still arrange it?
”Dr.
Sun agreed very happily.He now realizes that it may be because the patient and his companion are too vicious, and the relationship with the doctor in charge of the bed is not good, so that people ignore him, and this result is ......
Tsk, I guess there was a missed diagnosis.Kill yourself!
I'm hospitalized, and I'm still crossing.However, this bed is managed by Lao Yang, and it stands to reason that Lao Yang will not be unable to take down such a patient.How could this happen?
Dr.
Sun was puzzled.Among the other patients in the second ward, Li Min picked out two valuable ones, and then went back to the office to call the CT room."
I am Li Min on the twelfth floor of the Department of Surgery, and now there is a patient with a cerebral contusion and laceration, who needs to be treated with brain CT in the emergency department, and I have written a CT application form for symptoms and physical examination."......
"Okay, thank you." ”* It has been more than half an hour since Li Min finished checking the room on the eleventh floor.When she returned to the twelfth floor, she saw Director Shi sitting and chatting in the nurse's office."
Director Shi, where is Dean Chen?""
I went to the hospital office for a meeting.What's wrong with you?
”Li Min told the patient downstairs.Director Shi asked her, "Whose patient is it?"
”"It should be Dr.
Yang's.He was hospitalized on the night of September 30. ”Director Shi immediately understood, but he still hesitated for a moment and said, "September 30th is my night shift, and none of the patients who fought in the reception said that their heads were injured."
Besides, Lao Yang participated in a group wedding, how could he give him the newly hospitalized?
”But he immediately corrected himself: "Probably the nurse forgot that Lao Yang was on marriage leave." ”Li Min didn't answer his words, and only told Director Shi in detail what he saw and what he subsequently disposed of: "I just read the medical record, and the complete hospitalization serious illness record was written by the intern student on the 2nd, that is, the day before yesterday.The first course of illness was recorded in the early morning of October 1.Neither yesterday nor today was recorded.I just made up the notes for this morning's illness.Dr.
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Yang went to surgery today. ”More Li Min smiled and refused to say, but it also showed that his attitude was not involved in this matter.Today's ward rounds are of a teaching nature, allowing interns to understand the changes in the condition of patients on the 11th floor in the past two days.It can even be said that because she doesn't plan to take a vacation, she has to go through the patients in the two wards, especially the newly hospitalized, in order to know by heart.If the patient hadn't complained of a headache, she might have skipped the patient.She also didn't want to deal with these vicious people.Director Shi also understood Li Min's words.But there is nothing better for this situation, it is obvious that the night nurse on September 30 wants to rectify Dr.
Yang.But the hospital really wants to be held accountable, and the nurse will say that she doesn't know that Dr.
Yang is going to participate in the group wedding.And the day before yesterday, there was a big round......
Once the patient really has something, Zhang Zhengjie, the director of the department, is a little shaken and confused.Director Shi thought for a while and decided not to tell anyone about it first.If the patient is fine, anything can be said.If you have something, you shouldn't be picked up by yourself, and you have offended the people on the eleventh and twelfth floors, what is the point?
So he explained to Lu Qing and went to the CT room.He went to the radiology department to find Director Hu and wanted to see the patient's brain CT examination in person.He secretly prayed along the way that this patient would be fine, secretly hoping that Li Min was just too careful in the whole thing.Although he knew that this was not very likely.
*Director Hu happened to be in the CT room."
Old stone.You come and see this patient.This is your department, right?
”As soon as he arrived at the CT operation room, Director Hu asked him to go over and look at the screen."
Look here."
Director Shi gasped.On the screen, a mixture of high and low densities is displayed on multiple sections.It's simple: the punctate hyperdense opacities are hemorrhagic foci, and the hypodense opacities are edematous areas."
This is the application form opened by your Ke Xiaoli.Looking at the medical history, this patient was admitted to the hospital on the night of September 30. ”Director Hu handed the CT application form to Director Shi, and couldn't help but complain: "Whose patient is this?"
No. 1 is on holiday, why don't you do a brain CT for the patient during the ward rounds on No. 2?
”Director Shi whispered, "Yang Weiguo's."
I was admitted on the night shift on September 30th, and the patient didn't say anything about the head injury.Dr.
Yang, he went to a group wedding on the 1st.It is estimated that the 2nd and 3rd did not come to work.This bed is an intern in charge, and he went to surgery today. ”Director Hu was stunned for a moment and said, "Zhang Zhengjie is not a fool.He didn't find out about it during his No. 2 rounds?
”Director Shi explained awkwardly: "Upstairs and downstairs are divided.I don't know about their big rounds the day before yesterday. ”Director Hu knew that what he said was the truth, and he also knew that he had a good relationship with Dr.
Yang.But Director Hu hesitated for a moment and said: "This patient, alas, you hurry up to find Lao Chen, no matter what, the possibility of consciousness disorder and brain herniation in the future is relatively high."
If you have the heart, remind Zhang Zhengjie and Yang Weiguo to thank Li Min well, otherwise it will be difficult to say that you will suddenly have a brain herniation until the night.And Dr.
Yang, if he doesn't come to work today, it has nothing to do with him.Otherwise, if he is investigated, he will definitely not be able to get rid of the commotion. ”"Well, I understand."
Director Shi grabbed the phone in the CT room and called the hospital office.The pony who answered the phone heard that there was an emergency in the neurosurgery department and that there might be a craniotomy for surgery, so he immediately went to the small conference room and knocked on the door."
Dean Chen, Director Shi's phone number said that there are patients in your department who need emergency craniotomy."
Chen Wenqiang immediately stood up and said, "Then I'll go back first."
You have set the order of your defense. ”Director Qin said: "That Xiao Li is the first in line, and this year she declared an exception by herself."
Is it possible this afternoon?
”"Yes.You waited for her to have surgery. ”Without waiting for others to speak, Chen Wenqiang had already disappeared from the small conference room like a gust of wind.Director Qin was stunned for a moment, and then waited for a while before realizing what he had just said.He didn't care about the leaders of the hospital who were present, patted his head, and said with a little chagrin: "Alas!
How did I forget that the craniotomy had to be done by Lao Chen and Li Min together. ”Then he pulled back the words and explained in a self-deprecating tone: "Sure enough, I am not a person who can do two things, nor am I a person who can think carefully and think through everything.My thoughts today are focused on the order in which I consider my defence. ”Secretary Tang smiled and said, "It doesn't matter if Li Min is the first.Then this year's defense will start with surgery, what do you think?
”In previous years, the order was internal and external gynecology and children, then the clinical small department, and then the auxiliary department.When Secretary Tang said this, he also gave Director Qin a round, so as not to make Chen Wenqiang feel that Director Qin was targeting him.Director Qin also instantly figured out what Secretary Tang meant, and he immediately smiled gratefully at Secretary Tang.Dean Shu agreed: "Then let's do surgery first." ”*When Chen Wenqiang returned to Corey, Director Shi had just brought the patient back, and he was talking to Li Min about the brain CT examination.Chen Wenqiang watched the CT film while listening to Li Min's medical history report."
Teacher, the current diagnosis of the relevant neurosurgery is occipital hematoma and cerebral edema secondary to frontal lobe cerebral contusion.""
Have you done the pre-op preparations?""
The surgical consent form, the preoperative summary, the temporary doctor's order, etc., are all prepared.I just gave a 25% 125ml mannitol. ”Director Shi also said, "I asked the escort to inform the patient's parents.If they can't get there in time, we'll have to sign it off with the medical department. ”Chen Wenqiang nodded and said to Li Min: "The preoperative doctor's order will be handed over to the nurse for execution."
Where are the patients now?
”Director Shi immediately said, "I took him to our department and put him in the custody room."
Transfer procedures or something, and then make up for it. ”"That's fine.Lu Qing, you called the operating room and asked Zhang Zhengjie and Yang Weiguo to get out of the operation and hurry over. ”Lu Qing heard Chen Wenqiang's tone was not good, and immediately went to call.Director Shi sighed: "This is a trouble.It's a shame that Xiao Li didn't have a vacation today.Otherwise, if you have a brain herniation at night, you will be in big trouble.Dean, let's go see the patient first?
”"Let's go."
Chen Wenqiang raised his feet and left.Li Min took the CT film off the reader and followed it to see the patient.Chen Wenqiang asked Li Min as he walked: "How are you going to have surgery?"
”"Bilateral deboning flap decompression.Survive the cerebral edema phase first to avoid brainstem compression and foramen magnum herniation. ”Chen Wenqiang went to the intensive care unit, and when the patient heard that he was the dean and an expert in neurosurgery, he was ecstatic and a little scared at the same time."
That Dean Chen, I'm okay with my head, right?"
After carefully examining the patient, Chen Wenqiang said, "Something's wrong."
It's a big deal.How far do you live?
When will your parents arrive?
”The escort immediately said, "I've already called, and they came over after taking the money."
It's only an hour and a half at most.Dean Chen, what's wrong with my eldest brother?
”"Broke my brain."
Seeing their ignorant appearance, Chen Wenqiang kindly explained to the two of them: "The human head is like a watermelon, the skin on the outside is quite thick and firm.But in case of a fall, although it looks good on the surface, the watermelon inside is gone.Do you understand?
”The escort nodded stupidly, without the slightest ferocity towards Li Min and other interns.The patient was lying on his side on the bed and timidly asked, "Is this surgery easy for me?"
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”"It's ok.Craniotomy is not simple.Later, when we finish the preoperative preparations, we will push you to the operating room. ”"Did you do it with him?"
The patients refer to Chen Wenqiang and Director Shi.Director Shi immediately waved his hand: "I won't open my head."
I happened to be in the CT room for something, so I brought you back.It was Dean Chen and Dr.
Li who did it. ”Chen Wenqiang relied on the questions that the patient might ask if Li Min would have surgery, and turned around and left with a group of doctors and interns."
Head nurse, call the medical department and ask Director Qin to come over and sign for the family.Well, you can call the hospital. ”*Zhang Zhengjie and Dr.
Yang arrived a few minutes before Director Qin.Both of them had seen the CT films of the patients, and they were both a little stupid.When Director Qin came to the director's office, he happened to hear Chen Wenqiang's roar trying to lower his voice."
You two, ah, what did you check on this morning?
Zhang Zhengjie, what did you check for the No. 2 round?
If Xiao Li hadn't taken the intern to the ward rounds today, and happened to catch up with the patient complaining about the headache for two days, would you have to wait for the patient's brain herniation to know?
Yes?
”Chen Wenqiang reprimanded Zhang Zhengjie and Dr.
Yang like three grandsons.But he immediately stopped after seeing Director Qin."
Lao Qin, the patient's parents haven't come yet, you sign first, and I will immediately push the patient to the operating room."
Director Qin was willing to sign without understanding his condition, but when he understood the reason for the matter, he looked at Dr.
Yang and didn't know what to say.Dr.
Yang is responsible for this morning's rounds; Can you make a big round on the 2nd?
Zhang Zhengjie's neck has always been up, and this time it is a little less stalked.Although he asked all the patients during the ward rounds the day before yesterday, the patient did not say that he had a headache or a hematoma in the occipital region.It is impossible for him to do a comprehensive and detailed physical examination of all the newly hospitalized patients, right?
Now something is wrong, aggrieved?
- It's useless.The bonus of the department director is a coefficient of 2.0, the attending doctor is a coefficient of 1.2, and those who are more are worried about the fee.Not to mention the three-bedroom and one-living room and the installed telephone according to the treatment of the section director.usually enjoys the treatment of the level of section director, and at this time he has to take on the responsibility of the section director......
He was ashamed to say to Chen Wenqiang and Director Qin: "On the 2nd, the patient did not say that he had symptoms of occipital hematoma and headache.But the responsibility for this matter is mine, and I will not shirk it. ”Dr.
Yang was so embarrassed that he couldn't find a crack in the ground to get into.He also admitted his mistake with honor: "I worked the night shift last night, and I took over to see the patient, and the patient didn't say anything about the headache."
This morning, I was too sloppy on my ward rounds, and I specifically asked about the fractures and trauma of the patients, and did not ask if there were any other uncomfortable places. ”Chen Wenqiang waved his hand and said, "I don't have time to listen to you two say this now."
Zhang Zhengjie, you hurry back and carefully check all the patients in the department, and don't have such missed patients.Doctor Yang, this patient is fine, let's settle the account if there is something. ”Director Qin accompanied him and asked carefully: "The patient has no brain herniation or coma, so it shouldn't be life-threatening, right?"
”"God knows!
Go for a decompression surgery first, and then come back and watch it again. ”Chen Wenqiang knew that Director Qin was careful about protecting Dr.
Yang, waved his hand disdainfully, grabbed the medical records and checked Director Qin's signature.Li Min knocked on the door with Fu Yunxiang: "Dean Chen, are you sending patients now?"
”Chen Wenqiang closed the medical records, nodded to the wilting servants in the room, and said, "I'll go to the operating room."
Something to come back and say.Lao Shi, you should also carefully examine these patients in our department. ”Director Shi hurriedly replied and pushed Zhang Zhengjie with his hand."
Director Zhang, you're busy.Come up and chat when you have time. ”woke up Zhang Zhengjie, who was a little stunned.Zhang Zhengjie immediately said goodbye, Director Qin nodded to Director Shi and Dr.
Yang, and followed Chen Wenqiang to the operating room.Dr.
Yang sighed and sat down in his office chair."
Old Shi, I'm done.""
I just went to see the bedside card.The occipital hematoma headache is waiting to be identified, and you didn't notice it during your morning rounds?
”"What?"
Dr.
Yang's eyes widened and his mouth wide enough to fit an egg."
I didn't do it when I was doing my rounds, and the nurse on the night shift last night didn't mention it when I was on duty this morning.It must have been filled in by the nurse on the day shift today. ”"Then you hurry up and chase Zhang Zhengjie and tell him about it.""
Hmm.Thank you, old stone. ”"Don't thank me.If you have time, you can go to Xie Xiaoli.If she had walked around the patients who were fighting, she might have to wait for symptoms such as brain herniation and coma to appear today, and we would not know until she had symptoms. ”Dr.
Yang grinned and left in a hurry.() The distance is a bit far