Hearing that the patient died, Chen Wenqiang immediately stood up and asked, "Lao Xiang, what is the cause of death?"
Does the patient have underlying cardiovascular disease?
”Director Xiang shook his head and said: "I did a routine examination before the operation, and the patient's physical condition was acceptable, and the arteriosclerosis was in line with his biological age, and there were no contraindications to surgery and special attention.It was not bad to come back after the surgery.However, yesterday there was a brainstem infarction, and after I gave the patient symptomatic treatment such as mannitol, the patient's urine output did not increase, but in the evening, he had oliguria.Anuria also appeared today.I sent the patient to the emergency room for dialysis in the afternoon, but an hour ago, ......
"Chen Wenqiang's face was condensed, and he was depressed by Director Li's affairs, and after Zhang Zhengjie left, he was thinking about how to talk to the jealous and hateful Director Li.Director Xiang came in not only interrupting his train of thought that he had easily found, but also brought him such a heart-stopping news.M's, this is a house leak that has been rained, press the gourd and scoop it up."
What do you think about the patient's family?""
I don't quite accept it."
This is the reason for asking the director for Chen Wenqiang's help."
You quickly call Director Qin and ask him to calm the patient's family first.Then let's find out the cause of death and ask for a forensic autopsy if necessary. ”"This ......"
Xiang Xiang muttered to the director, his attitude obviously hesitant."
Lao Xiang, I told you that you should understand things at this time, you received the patient's money and did emergency surgery on holidays, and I temporarily agree that your emergency surgery should be done, but it is an indisputable fact that there are not enough staff on duty during the holidays.When you have less urine on the 3rd, how much less?
Is it a low total urine output over a 24-hour period or a low urine output per unit of time?
Have you had a nephrologist consultation?
There is also a brainstem infarction, I don't question your professional ability, you are more familiar with this than neurosurgery, and you are more skilled in how to treat it?
Have you had a neurosurgical consultation?
”Director Xiang felt guilty and embarrassed.Chen Wenqiang's every sentence asks the key point.He muttered, "I'll call you in the morning, and your Corey said you went to surgery."
In the afternoon, it was again the review of surgical promotions. ”"You bastard!
Can the evaluation of job titles be compared to human life?
I went to surgery, can't you follow me to the operating room?
Will Li Qin let you in and find me?
You just don't want to embarrass me in front of people.Is it difficult for you to write a consultation order?
Can I go to see it after surgery?
Even if you write a consultation order for the neurology department, will their director not be able to go" Chen Wenqiang's voice gradually became louder.Several nurses on duty outside also heard it, including the trainee nurses, who were all frightened by Chen Wenqiang's fierce attitude, and they were like quails with shrunken necks, not daring to move or speak loudly.Director Xiang is the same age as Chen Wenqiang, and he was damaged by him like this, and he had to suffer silently, how could the torment in his heart be able to suppress the changing face!"
Hurry up and call Director Qin.What are you doing here?
”Chen Wenqiang's voice was louder."
Let the people from the medical department come over and comfort the patient's family first.The directors of the Department of Neurology and the Department of Nephrology were called to your department for an overnight consultation to discuss the cause of death.Don't tell me you don't have a preoperative consent form!
”"Yes, yes, all of them."
Director Xiang turned around and pushed open the partition door, grabbed the phone and called Director Qin expressionlessly, and told Chen Wenqiang what he meant.Poor Director Qin took a shower and changed his clothes in order to get home in order to get lucky, and then he picked up his job, so he had to rush back to the hospital.This is where the Medical Service comes into play.* Chen Wenqiang's movement alarmed Director Shi, who opened the door of the director's office, and he sent the intern to the nurse's office to ask.After a while, the intern came back and whispered what he had heard.Director Shi thought for a while and said, "Yang Yu, you go and call Dr.
Li and ask her to persuade Dean Chen not to be angry so loudly, it will have a bad impact." ”"Yes."
Yang Yu walked and knocked on the door of the duty room."
Teacher Li, I'm Yang Yu, Director Shi asked me to come to you."
Yang Yu looked for Li Min several times and knew that calling the door in this way was the most effective.Sure enough, Li Min heard his voice and immediately came to open the door."
What's the matter?
Coming to the patient?
”"Well, it's not."
Yang Yu felt weak when he met Li Min's clean eyes, for the sake of his father, Dr.
Yang's medical records.The records of the first course of illness of those who fought in the hospital were written by him and by the doctors.He didn't expect the nurse downstairs to divide the patient to his father.Otherwise, he would definitely take care of that patient across disciplines.Anyway, the eleventh and twelfth floors are not completely separated.Let's just say that Li Min let him take care of it, who will say anything.He carefully explained what the intern asked from the nurse's mouth, and then lowered his voice and said, "Director Shi asked you to persuade Dean Chen, it doesn't have a good impact on being so angry."
Are you going?
”Li Min accepted Yang Yu's kindness, hesitated for a moment and said, "His drinking cup is in the director's office, you go and pour half a cup of hot water, I have to have a reason to go." ”"Okay."
Yang Yu immediately turned back to the director's office."
Dr.
Li has passed?"
Director Shi asked."
Teacher Li asked me to pour half a cup of hot water into Dean Chen's water cup, so that there is a reason to pass."
Yang Yu poured out the residual water in Chen Wenqiang's enamel cup, replaced half a cup of boiling water, covered the lid, and carefully took it out.Li Min was standing in the hallway waiting for him."
Teacher, drink some hot water."
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Li Min went in from the nurse's office, lifted the lid of the cup, and put the steaming half cup of hot water in front of Chen Wenqiang."
Well, let's leave it here for now."
Chen Wenqiang took a deep breath of the hot air on the water glass, and his mood eased a lot."
You go to the orthopedic department with me in a while, listen to a discussion of a death record, and make a record.""
Good.Then I'll go back and talk to Director Shi, take a notebook and come over again. ”Chen Wenqiang waved his hand and asked Li Min to prepare.Outside the nurse's office, the director is dialing in the number.He didn't just have to find Director Qin of the Medical Department.It is also necessary to put Director Tan of the Department of Nephrology and Director Wang of the Department of Neurology.Director Tan said that he had been transferred from the Medical University.But Director Wang is a person who has been loaned to the provincial hospital by the medical school.It was because of this relationship that he did not invite Director Wang to consult Chen Wenqiang during his operation.He called Chen Wen's mandatory appointment of director over and over again, and finally ruthlessly invited Director Guan of the respiratory department and Dean Shu, who is a part-time cardiovascular officer.Anyway, it's a shame, and after losing it once, you can save yourself from encountering suspicious and speculative eyes again.* When the hot water was palatable and drinkable, Chen Wenqiang's mood basically calmed down."
Lao Xiang, have you made a good call?"
Director Xiang shook his head and said, "Director Wang has someone to look for it, and it may be a little late."
I invited Dean Shu and Director Guan. ”"It's better to even call Chai Rong."
Director Xiang knew that Chen Wenqiang was annoyed, pretended not to hear this teasing, and naturally asked, "Now go over and look at the medical records?"
”"Okay, let's go."
The two of them went out of the office and met Li Min, who locked the door."
Director Xiang."
Li Min greeted him respectfully.Xiang looked at Chen Wenqiang's face and nodded reluctantly.Because he noticed the notebook in Li Min's hand, four big red characters in a black circle: death case.Li Min found that Director Xiang was looking at the book in his hand, so he silently dropped the book, but the back cover of the book made Director Xiang feel even more panicked.A large black skull shelf, which occupies the back cover, is filled with different shades of blue and black, large or small, normal, or twisted skulls.The biggest skull with a grinning mouth that seemed to be laughing, no matter how you look at it, there is a sense of ridicule.Although they are all studying medicine, they are still orthopedics, and their daily work is basically to deal with bone sticks, but such a book, especially Li Min is still a girl, holding a book with a black skeleton, a skull, and a skull in his hand, this hobby is too scary.The three of them took the elevator upstairs together to the director's office.Chen Wenqiang also noticed the notebook in Li Min's hand.So he asked her, "Why did you paint it like this?"
”"Originally, I only drew a human skeleton, and the rest of these heads were scribbled by those classmates who were idle and had nothing to do during the internship."
Li Min turned the front of the notebook back on.When I took a closer look at the director, I found that the black hook was actually made of a small skull."
It's not easy for you to draw this edge."
Li Min smiled mysteriously, his fingertips caressing the tiny skull ornament.Of course it's not easy.It took several pieces of paper for Mu Jie to draw the skull evenly."
With a book like this, don't you have nightmares when you sleep?"
Xiang asked the director with a wicked taste."
I'm okay.When we were learning anatomy, many of us brought back their skulls.At the end of the exam, the dissection room was open for two days, and everyone was left to send the specimens back.The head of the department said that all students who were missing a specimen would be deducted 5 points each. ”"Did you steal it?"
Chen Wenqiang asked."
Mr.
Lu Xun said that the things of the scholar cannot be said to steal."
Li Min's answer to evade Chen Wenqiang's question made Director Xiang forget about the upcoming death discussion for a while.He asked Li Min playfully: "What does it feel like to sleep with your skull in your arms?"
”"If you close your eyes and touch it, you know what is under the tips of your fingers, and you are not afraid of drawing this part of the content in the exam.In fact, you don't need to close your eyes, you can touch it after the lights go out. ”"No wonder you have good anatomy."
Li Min smiled: "The senior sister taught me before." ”"Did the skull specimens finally get all of them?""
It's all.At the end of the reception, the teacher of the department said that all the specimens had been used for at least ten years.He asked us to go back and see if there was an extraoccipital bulge that was gone, the mastoid process was smooth, and the cockscomb was flattened. ”"The boy didn't steal it?""
Boys generally don't carry school bags in class, and they can't take them out if they want to.There's no point in keeping the specimen after the exam. ”Entering the orthopedic ward, the three of them quietly entered Director Xiang's office like thieves.Director Xiang took out the medical records of the deceased patient from the drawer and held them to Chen Wenqiang with both hands."
Dean Chen, take a look first, I read this case record every day, and the record is basically in line with the changes in the patient's condition.Xiao Li, this is the nurse's guardianship record. ”Li Min reached out and took the not thick guardianship record, flipped through it and began to choose to copy it.Director Xiang had the intention to stop it, but looking at Chen Wenqiang's attentive appearance in reading the medical records, he couldn't help but stop and didn't say it.Dean Shu and the others arrived at about the same time.Director Qin led the staff from the medical department to invite the patient's family to the small conference room.The orthopedic ward is finally quiet.Director Xiang sighed and said, "Fortunately, the orthopedic ward is now two floors. ”There were too many people, and Chen Wenqiang didn't taunt Director Xiang anymore, but just pushed the medical records to him and said, "Do you think you should stand here and discuss, or go to the office downstairs of your department to sit?"
”*Dean Fu and Dean Fei only got into the car from the provincial hospital to pick up people at this time.The driver was the husband of Director Wang of the Finance Department.A stocky veteran, he looks taciturn and reliable.He saw that Dean Fei and Dean Fu had drunk a lot, so he helped the two of them into the car and slowly drove back.After the car drove out for a long time, Dean Fu felt that the alcohol had gone down a little before he spoke: "Old Fei, I have done enough of this work."
If you are willing to take over, you and Dean Shu should mention it. ”Dean Fei laughed in his heart: "The infrastructure of the hospital is finished, I will take over?"
Take over logistical maintenance?
”Dean Fu said: "Old Fei, don't think that there is nothing to do after the infrastructure construction in the hospital is completed."
Do you think about the fact that there have been more and more patients in recent years?
Can the Sorting House always be thrown like that?
The land on the side of the branch is not small, and there is no place here, so I think it is indispensable to build a dormitory building on the side of the branch in the future. ”"It's not easy to get the Sorting House up.One has no money and the other has no one. ”"If he had everything, Lao Shu wouldn't let the branch be deserted.Lao Fei, we have been working together for more than 20 years, let me tell you a word from the bottom of your heart, if you can get the branch hospital up, even if you retire in three years, this life will also be recorded in the history of the provincial hospital, how can it be better than staying here. ”"Why don't you go ahead?
After the construction of this internal medicine building, you are very familiar with the bank, and Jiang Yan is also very cooperative. ”"I want to do clinical.I went to the branch hospital to take care of the medical care.There is a lot of information about Lan here in the General Hospital, and I may not be able to beat him when I go back to the respiratory department.If you're interested, we'll join forces.When the time comes, it will take three years and two years to reorganize the branch ......," Dean Fei was said by Dean Fu, and his heart was hot.The head of the branch will retire early next year.The provincial court held several meetings, but no decision was made on who to go."
Old man, you said that we both went over there, what did Lao Shuken do?""
I guess you'll have to take care of the logistics here.But there's not much going on here, and the rest is running in a step-by-step manner. ”"Let me think again.""
There are still two or three months, so there's no hurry."
Who said that he was not in a hurry, Dean Fu himself was in a hurry.The wife and son gave themselves an ultimatum, and if they continue to mess with Jiang Yan like this, something will happen sooner or later.But Dean Fu knew that Jiang Yan, who had thought the provincial court thoroughly and invested a lot of money to come in, would not let go of the fat of the provincial court.If you want to get out, you must be replaced by someone who can cooperate with Jiang Yan and is willing to do more projects.Except for Fei Baode, who was in a hurry to seize power and money, he didn't do what he thought.
*In the orthopedic doctor's office.Li Min and the orthopedic inpatient always sat on a bench by the door, borrowed from the patient's ring.The director did not prosthetically hand the general inpatient of their department, and reported to everyone the medical history, auxiliary examinations, surgeries, and follow-up treatment.Then the death discussion moderated by Chen Wenqiang began."
Xiao Li, you say it first."
In such discussions, the first to speak was the lowest among those present, and there was little exceptionality.Li Min spread out the content he had just recorded and said: "There are a few questions: the first is the operation time, is it necessary to have emergency surgery and emergency surgery during the holiday?"
I'm not orthopedic and don't understand.The second is the diagnosis of brainstem embolism, which I didn't hear from a CT film just now; Clinical symptoms alone are still a bit insufficient.The third is oliguria, which is caused by mannitol or renal artery embolism at the same time, or simply the corresponding intracranial lesion caused by renal blood vessel embolization successively.The fourth is the use of mannitol. ”Li Min said it in an orderly manner according to the record and outline in the notebook he had just made, and 1234.The orthopedic resident sitting next to her always looked at her in surprise and forgot to take notes.Director Xiang said: "The patient is a little thinner, weighing about 60 kilograms, which is a normal weight for his age.When I used mannitol, I also followed the principle of half amount. ”"Xiao Li, you go on."
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Dean Shu supported Li Min after Director Xiang stopped, "Director Xiang, you use mannitol because of cerebral edema, right?"
”"Yes.""
You may rarely use this mannitol, and the common adverse reactions of mannitol are acute kidney damage, electrolyte imbalances, phlebitis, etc.When our neurosurgery uses mannitol to lower intracranial pressure and treat cerebral edema, it is often half a dose, 0.5g per kilogram of body weight, and it is used within 30 minutes.If urine output is not ideal, it is necessary to change the dressing immediately.At the same time, urine routine should be tested to see if the patient has acute kidney damage or even kidney failure. ”Director Xiang took a deep breath and asked, "Do you suspect that mannitol caused acute kidney failure?"
”"What if there is a renal artery infarction at the same time as a brainstem infarction?
It is also possible that mannitol is complicated by acute kidney damage.If it is really an infarction, this is also a common complication after surgery.No, it has to be concluded by autopsy.That's all for my opinions, and if it's right or wrong, I would like to ask the dean and the department heads for advice. ”"Next."
Chen Wenqiang couldn't call the name of the general orthopedic hospital, so he directly signaled to him.The chief resident of the Department of Orthopedics immediately stumbled and said: "Dean Chen, I, I still haven't figured out why patients have oliguria and anuria......"
Director Wang of the Department of Neurology saw that he couldn't tell why he looked like he was, so he said: "Xiao Li just now, right, Xiao Li's proposal to use mannitol, Xiang Director, half a dose of instillation within 1 hour, generally speaking, it does not have the effect of reducing intracranial pressure."
In the neurology department to lower intracranial pressure, I agree with Xiao Liti's usage.If you use mannitol for diuretics, Director Tan, do you use mannitol?
”"I use less mannitol and more furosemide.If mannitol is used for diuresis, the dosage is generally 1-2g/kg, which should be observed at the bedside, and the dose of mannitol injected into the body should be adjusted to keep the urine output at 30-50ml per hour. ”Director Tan said unhurriedly."
So, Director Xiang, your use of mannitol has not achieved the purpose of diuresis and reducing brain cell edema."
Professor Wang said regretfully: "After using mannitol for the first time, I did not achieve the goal and found the symptoms of oliguria, so I should not continue to use it yesterday and today."
Actually, you don't have to use mannitol. ”"I stopped mannitol this morning.""
It is discontinued after the patient has anuria."
Director Tan interjected as he flipped through the temporary doctor's orders and checked the nurse's nursing records."
I had dialysis in the afternoon, which means that even if the deceased had acute kidney failure, it was not the direct cause of his death."
At this point, Director Xiang's face was disgraced, and his improper use of mannitol was certain.But the cause of the patient's death was not caused by mannitol, which also made him look forward to it.Dean Shu asked, "Lao Xiang, what is the cause of your cerebral infarction?"
Is it a fat embolism?
Or is it a postoperative blood clot?
Is it vascular occlusion or volume depletion?
Is your brainstem infarction complicated by cerebral edema that must be treated with mannitol?
Have you ever considered dehydrating with glycerin-fructose?
”Director Xiang muttered that he couldn't answer.These are neurological and surgical matters, and he doesn't pay much attention to them.Yesterday, he felt that he could judge a brainstem infarction, use mannitol antioxidant to remove free radicals, use mannitol to avoid edema of brain cells, dehydration and reduce cranial pressure to reduce nerve root edema, and he has done quite well.Dean Shu continued: "If there is a brainstem infarction caused by blood clots, Xiao Li, how to use mannitol at this time?
”"Use sparingly to avoid large amounts of diuresis, which can increase blood viscosity."
Li Min has put a lot of effort into mannitol, there is no way, Chen Wenqiang likes to use mannitol.Director Wang said: "Brainstem infarction has occurred, and I think it is more likely to be a postoperative thrombosis.If there is a fat embolism, it should be in the pulmonary artery.Of course, in the advanced stage, any organ may be embolized.But at this time, there are obviously high-risk factors for the formation of thrombosis, Professor Tan, whether it is kidney failure caused by mannitol or kidney embolism with the same cause as brainstem embolism can only be determined by waiting for the autopsy report.My opinion is that the medical school should come to the autopsy, and the real cause of the patient's death, I want to know more than the family. ”Director Guan, who has been silent, also said: "My opinion is also an autopsy.Only by clarifying the cause of death can we avoid similar things in the clinical future. ”This is the case with Western medicine, which is to learn from the experience and lessons of the previous cases, summarize the rules for future generations, and avoid the same mistakes of the latecomers.Only an autopsy can find out the root cause of the patient's death.There was no nonsense in this death discussion, and it was quickly agreed that the medical department would do the rest of the work for the patient's family and fight for the "autopsy".When everyone walked out, Dean Shu called Director Xiang."
Lao Xiang, the No. 2 emergency room is operating, you don't have anything to explain to me?
I don't know about surgery, but after 7 days of femoral neck fracture traction, I have to have emergency surgery during the holidays, do you want me to ask Chen Wenqiang if he should do it?
”Director Xiang was ashamed: "It was the patient's family who found someone." ”"This kind of thing, you will follow the medical procedure in the future.There is also the matter of specialist medication, my opinion, you should ask the specialist as well.No one can master everything, whether it is self-knowledge or shameless questioning, we are in this industry, and mentioning the pen is related to the life and death of others.You say, don't you?
”"Yes.""
And there were a lot of people just now, I didn't say you, you had less urine after using mannitol yesterday, and you also made a diagnosis of brainstem infarction before, why didn't you ask the neurosurgeon to come to the consultation immediately?
Why not dialysis right away?
Think about it, call me a report on these problems tomorrow before I go to work. ”"Yes."
Director Xiang was extremely uncomfortable."
Lao Xiang, who entrusted you with surgery, who do you go to.The intermediary must do the work of the family, and the autopsy must be done.Otherwise, if you are passive, the hospital will also be passive.Do you understand?
”"Understood
.
"* At the head nurse's house, Xiao Zeng sat solemnly opposite Wang Jing, staring at his restless wife with a cold face and displeasure.asked her in a deep voice, "Do you want to understand what you are doing wrong?"
”"You don't have to be a dean at home."
The head nurse was upset, "I'm not one of those students at your school. ”"Xiao Jing, don't avoid my questioning.You answer me, do you want to understand what is wrong?
”The head nurse was silent for a long time before reluctantly replying, "I shouldn't have shielded those nurses."
shouldn't quarrel with Zhang Zhengjie. ”"What else?"
Director Zeng's face became heavier and darker, and his expression became more and more serious.The head nurse raised her eyebrows at her husband and asked, "What else?"
Aren't you enough?
Do you want me to submit the disciplinary advice to the nursing department?
”※※※※※※※※※※※※※※※※※※※※ scoop, here a pun on a meaning press the gourd scoop up; Another meaning is piao in colloquial language, the second sound, which has the meaning of incorrect and crooked.If the rim is piao, it needs to be re-plated.() The distance is a bit far