After New Year's Day, heavy snowfall after snow, soon dressed up the provincial city in silver.And even the winter days that do not shine and do not see the sun, the overcast sky has become extraordinarily cold.The number of patients visiting the outpatient department for colds has skyrocketed, the emergency room is full of patients who are not up to hospital standards and are dripping, and the pediatric inpatient has begun to add beds in the corridors.Director Wu, who had just gotten up from the hospital bed, was brought in for emergency rescue in the second half of the night yesterday, and now he is not only with his eyes rickety, but also his whole appearance is simply unsightly.But after the morning meeting, watching the head nurse instruct the nurses to add temporary extra beds in the corridor, he couldn't help but sigh: "The beds in our pediatric department have doubled compared to last year, but they are still not enough."
I have to add someone to the extra bed early. ”Director Qi's inner anxiety is not lower than that of Director Wu, and she also has an extra layer of worry for her wife, Dean Fu.Worried about whether the relocation on the west side of the provincial hospital can go smoothly and whether the construction plan of the branch hospital can be carried out in the end, it must be known that President Fu has fully transferred the actions of the provincial hospital and changed him to the president of the branch hospital to be responsible for the medical work of the branch.If the movement to the west is blocked......
Let's think about it.Director Qi routinely comforts himself every day.Now I see Director Wu tired but still hopes that pediatrics can be expanded.She hid her anxiety for days and calmly comforted Director Wu: "It would be good to wait for the women's and children's center to be built." ”"That plan, I don't know when I can finish supplementing the information and then send it up, so I have to wait for approval."
A few years ago, Director Wu learned from Director Fan's mouth that he was going to build a women's and children's center, and the whole person became excited, so that Director Fan had to stay up late with him, and he couldn't rest well for several days.After the news of the construction of the women's and children's center spread in the provincial hospital, during the day, he pulled Director Qi and Director Liu in the pediatric department to plan how many beds there should be, what the pediatric ward should look like, and whether there would be no pediatric graduates in the summer, and ten or eight more clinical medicine graduates like Fu Yunxiang who were interested in becoming pediatricians.How many people to need and how to train them, so that they can be used by this time next year, he slowly perfected his set of ideas that are very in line with the reality of pediatrics and are more than ten years ahead of his time in the excited discussion.When he returned home, he first discussed with Leng Xiaofeng the specific placement of the pediatric floor and disease types at the dinner table, and then dragged Director Fan to continue to look forward to the bright future of the pediatric center after eating.Then the plan was beaten back.Director Wu immediately fell ill.- The whole person lost his vitality as if he had been drained of his vitality, and then he began to have a fever, and after a day and a night, his body temperature once rose to 41 °C.The little old man, who was originally chubby, suddenly deflated like a potato that had been drained of water.Frightened, Director Fan hurriedly called Dean Shu, Director Guan and others for consultation.All the examinations were done, and Director Sun of the pathology department was afraid of some kind of malignant blood disease, so he pulled Director Chai and the doctor to watch the film together.But it's a bad cold!
But Director Wu felt that his time was running out.He took Dean Shu's hand and said with tears in his eyes: "Old Shu, I watched the provincial hospital from the outpatient clinic of the bungalow to the building, the provincial hospital from the five-story inpatient building to the seventeenth floor, and the internal medicine department with a twelve-story central building, but I didn't see the pediatric center, I didn't see the pediatric department have its own exclusive inpatient building, and I didn't look blind when I died." ”Director Guan persuaded Director Fan: "This is his reaction to an attempt and a blow, you don't have to worry too much." ”Seeing him like this, Dean Shu comforted him and said, "We are continuing to supplement the information, and if it goes well, we will be able to apply for the plan again soon."
The ideas you have for pediatric centers can be realized one by one in the future. ”This did not serve any comforting effect, but Director Fei came to see him and said that he was in contact with the municipal government, and that there was only one purpose: to properly arrange the residents to the west of the hospital, so that the women's and children's center could be built a little bigger.After that, Director Wu miraculously subsided his fever and rested at home for almost a week, and Director Qi took the newly rotated interns and the number of inpatients who couldn't stop choking, so he reluctantly got up and struggled to come to work.* But on his first day on the job, Li Min brought him from home in the second half of the night.It was an emergency patient in his pediatric department, and he, the director, had to preside over the rescue.Onset is simple.The 4-year-old girl, who vomited due to food and drink, was treated at a clinic in the town, and one day after it became paroxysmal convulsions, she was sent to the emergency department of the provincial hospital in the second half of the night.The one on duty in the ward was Leng Xiaofeng.She looked at the child in a coma and convulsions, pinched the examination list of brain CT, and hesitated to call Li Min: "Minmin, come and have a look." ”Li Min hurried over to the pediatric consultation in the second half of the night.The child had just stopped convulsions, and Leng Xiaofeng had already started low-flow oxygen inhalation for the child.However, the child's face is gray, comatose, and the breathing rhythm is irregular, with nodding breathing and double inhalation, and bilateral pupils are unequal.Leng Xiaofeng asked Li Min to come over for consultation because the child's bilateral pupils were unequal and he was in a coma and convulsions.The child's parents introduced on the side: "This child ate the pig-killing dish the day before yesterday morning and noon at home with his grandparents, and his grandparents were fine."
She started throwing up after lunch.Her grandparents took her to the town's health clinic and gave her anti-emetic injections. ”The child's parents said it once in the emergency department, once in the ward, and Li Min came over and said it for the third time."
What antiemetic injections did the clinic give her?"
Li Min asked.Leng Xiaofeng asked, "Why didn't you say that you had an antiemetic injection just now?"
”The child's father rubbed his hands, looked at Li Min's badge and then looked at Leng Xiaofeng's badge.The implication didn't need to be said by him, and Leng Xiaofeng, who guessed it, changed his face.This is because he sees himself as a resident doctor, so he looks down on himself, so he refuses to even tell the medical history completely?
Li Min couldn't cry or laugh.In the past, I was mistaken for a nurse by patients and family members because I was a woman, and even after learning that I was a surgeon, I doubted whether the female doctor would perform surgery.Now on the badge of an attending physician, in pediatrics received extra blue eyes.It's also too dramatic.The child's father took out a carefully folded letter from the inner pocket of the down jacket, and the paper was still carrying his body temperature when Li Min took it.She hurriedly unfolded it to see that it was ordinary red-checked letterhead, and the handwriting was scribbled.Only a few simple lines were written on this page of letterhead, which can be regarded as a description of the child's condition and medication, which can barely be regarded as a summary of the transfer.It reads: "Vomiting one hour after meals, non-ejection, stomach contents."
metoclopramide 5 mg orally 2 times at half-hour intervals; Intramusclopramide 10 mg twice at an interval of 1 hour.Heal, go home. ”There is also a note below - the oral medicine is fed by the child's grandfather at home, and the antiemetic effect is not good, so it is required to be administered intramuscularly.There was no mention of the child's convulsions or coma on this piece of paper."
When did the child have coma and convulsions?"
The child's mother wiped her tears and said, "The two of us work in the county, thinking about earning more for the New Year."
It was someone from the town who brought us a letter saying that the child was sick.When we got home, the child was like this. ”Li Min repeated the question just now.The child's father said, "Probably after dinner." ”"Your mother said at first that she had an antiemetic injection, and it didn't take long to come back, and that's it."
When the mother's head is turned to choose someone to eat.The child's father tried to argue, but he only pouted and made no sound.The parents didn't pay attention to their granddaughter, and they looked at the child without a ride, and sent someone to the county tonight to carry a letter, but they didn't want their children to die at home during the New Year.He understands.He also understood his wife's sadness, he reached out to hug the woman's shoulder, looked at the little daughter on the bed, and stretched out his fingers to wipe the dampness from his eye sockets.Li Min was helpless, and looked down at his watch It was 3 o'clock in the morning.It has been 14 hours since the child took 10mg of metoclopramide at home.She rubbed her hands together and began to examine the child.Occasionally, the child's mother will be asked, "How long does she have each convulsion?"
How often do you have a convulsion?
How many convulsions have you had since the onset of the disease?
”"Her grandmother said she smoked twice."
But she didn't believe it herself, and when she finished speaking, she covered her mouth and whimpered.The child's father continued: "We arrived home in the middle of the night, and the child's convulsions lasted about five or six minutes each time.I smoked twice along the way. ”The child's mother said, "I just smoked it in the office. ”After speaking, she glared at Leng Xiaofeng.Li Min guessed that she was because Leng Xiaofeng was dissatisfied with the treatment of the convulsive child."
Body temperature 37.5°C, heart rate 70 beats per minute.The heart rhythm is uniform, and there are phlegm sounds in both lungs. ”Li Min examined the unconscious child, and Leng Xiaofeng reported the physical examination just now by her side.Li Min wanted her to "shut up", but considering that there were parents and interns of the affected children, she finally pretended not to hear and endured it.After an examination, it was found that the child's heart sounds were low and dull, and the tension of the lower limbs was slightly stronger, and other pathological reflexes were not elicited."
Did the biochemical test come out?""
Not yet.The emergency department took blood to test K, Na, CL, Ca and other ions, and the blood and urine routine did not come out, and the child came first. ”Leng Xiaofeng was complaining, and she brought the child in the hospital without anything, how could she diagnose and treat herself......
"Then let's go back to the office first." ”Li Min comforted the child's parents with her eyes, and when the child's parents could watch her speak, she said, "The nurse will come over to give the child medicine soon." ”After returning to the office, Li Min asked the nurse, "Do you have metoclopramide injections in your department?"
Give me a note. ”"What are you considering?"
Leng Xiaofeng asked.Li Min quietly dragged Xiaofeng aside and said, "Metoclopramide is effective as an antiemetic when it is in acute head injury.But I haven't used it for children.If you look at this dose, isn't it a bit big?
”Leng Xiaofeng took the letter and looked at it, and immediately broke out in a cold sweat, and the parents of the child did not give her this at first.Adult surgery is less sensitive to the dosage of drugs, but she is in pediatrics."
This dose, this dose" Leng Xiaofeng's hand trembled."
It's not something we can solve.Let your department head come. ”Li Min reminded her.Leng Xiaofeng turned around and asked Li Min while making a call."
How, what should I do first?"
She panicked."
You've been given low-flow oxygen.Give 654-2 intramuscularly, no, you have to give scopolamine, you calculate the dose. ”"There is no scopolamine in pediatrics."
The nurse replied to Li Min.At this time, the phone was connected, and Leng Xiaofeng hurriedly said to the phone: "Dad, I just received a serious patient, I took 20mg of metoclopramide intramuscularly and 10mg orally within an hour, and I was 4 years old and was already in a coma."
You've got to give it a try. ”"Then give atropine first, you remember to calculate the dose."
Li Min corrected his identity."
I'll talk about it later, when Director Wu comes.It is best to use scopolamine, which can penetrate the blood-brain barrier and work. ”"Good.Atropine, 0.01~0.02mg/kg each time. ”Leng Xiaofeng muttered about the dosage of atropine, and said to the nurse who came back with the instructions while giving the doctor's instructions: "Give the child 0.3mg of atropine intramuscularly just now." ”She directly gave the maximum amount according to the child's weight of about 15KG."
First open the fluid access and hang the saline."
Li Min saw that the nurses in the pediatric department tonight were all young, so he hurriedly chased after him and gave an order."
Give another 50ml of 20% mannitol intravenously.Do you have 20ml of 50% glucose in your department?
”"No mannitol."
The nurse replied."
Call the twelfth floor and ask them to send them down quickly.Just say what I said.Xiaofeng, remember to ask your head nurse to return the medicine tomorrow. ”"Okay."
There were three nurses on duty at night, and the three of them were busy after a while.When the nurses went to carry out the doctor's orders, Xiaofeng also calmed down.She watched the intern pass through the instructions for metoclopramide injections, and asked for a reinforcement.I saw that it was written: children, under 6 years old, 0.1mg/kg each time.The child received two consecutive adult doses of 10 mg......
No, she also took two doses of 5mg orally at home."
Is it too late for us to give her dialysis?
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She should still have it in her body. ”Leng Xiaofeng asked Li Min with expectation.Leng Xiaofeng's medication has always been calculated according to the kilogram body weight, and she has never encountered an overdose of metoclopramide.No, she had never given it to a child at all."
It's too late."
Li Min replied to her with pity and sorrow: "The half-life of metoclopramide is 4~6h.It's been more than 12 hours. ”"And what is her convulsion?"
The intern asked."
Extrapyramidal reactions caused by metoclopramide poisoning.There is one in the manual.Wait for the director of pediatrics to come and preside over the rescue. ”Li Min has been taught many times by Chen Wenqiang, and remembers that cross-disciplinary things cannot be strong.Especially for this child, after the medicine that should be given is given, the rest of the things should be done by the pediatric director.The pediatric intern was also in the nurse's medicine cabinet at this time and found the oral instructions for metoclopramide.He took it and passed it on.What is commonly used in children?
5-14 years old, 2.5-5 mg (0.5-1 tablet) each time, 3 times a day, 30 minutes before meals, preferably for a short period of time.The total pediatric dose should not exceed 0.1 mg/kg/day."
Teacher Li, there is no reference for children under the age of 5."
The corridor sounded the greetings between the nurse and Director Wu, and Li Min took the intern out and said, "Director Wu, you are here."
Xiaofeng said that you are just sick, but this patient is too serious, so I still have to trouble you to come. ”Leng Xiaofeng stopped the first journey he was writing, and reported the child's medical history and the treatment just now to Director Wu.Director Wu saw that Li Min's handling of the child was decent, and there was no impropriety or fault.I tried my best to cheer up and said with a smile: "Xiaofeng vomited a lot a year ago, and I couldn't work the night shift for her because I was sick for a while."
It's up to you to come over and help her. ”"It should.I don't dare not come if I have a consultation order. ”Li Min joked with Director Wu."
Neurology is fine."
Director Wu smiled and said, "But you have a good relationship with Xiaofeng, she must have thought of you first when something happened." ”Li Min smiled and agreed with Director Wu's statement."
Director Wu, I have to go back.The 11th and 12th floors are almost full. ”"Well, then you can go back."
Li Min left with the intern.But as soon as she walked out of the door, she heard Director Wu behind her instructing the nurse: "Move the child to the intensive care unit outside the child."
Be prepared for the rescue. ”The pediatric internal care unit is full.Temporarily occupying the child's custody room, Li Min is not qualified to mention it as an outsider, otherwise he will be suspected of provoking discord inside and outside the child.The inside and outside are not completely separated.Leng Xiaofeng didn't dare to mention it: I was afraid that the child would have an opinion tomorrow, so she asked her to remove the child.The pediatric intensive care unit is full......
But Director Wu can decide this matter.
*Two interns follow Li Min up the stairs."
Teacher Li, is the child still saved?""
Not much hope.If you go back and check the time of metoclopramide metabolism, you will know that dialysis is useless. ”"If you have a convulsion after taking the medicine, you can send it, is it okay?""
Absolutely.At that time, dialysis was completely in time.Even if you send it 6 hours early, you can also fight for it. ”There has never been a shortage of patients in such conditions at the grassroots level.Not to mention small clinics, even larger county hospitals, sometimes similar things happen.The use of metoclopram for patients with renal insufficiency has not been reduced, Li Min had heard it in the experience lecture of the deputy chief physician every Wednesday afternoon, and Leng Xiaofeng was probably absent from that class."
Mecloprapramite is metabolized in the liver, and more than 85% of it is excreted from the kidneys in the form of a prototype bound to glucuronic acid.Therefore, for drugs that are not commonly used, even if they are commonly used, you can read more instructions for the use of drugs when you have time.In particular, it is necessary to pay attention to the side effects and contraindications of the drug, as well as how to rescue in case of toxic reactions. ”"Then what kind of medicine should this child give for vomiting?"
Chen Wenqiang's intern asked."
Vomiting caused by improper eating and drinking, causing the child to vomit.That's self-protection and gastric lavage if necessary. ”Li Min replied a little indifferently."
But parents will have opinions."
The intern whispered skepticism."
Communicate well with parents.It is an instinctive reaction for the child to spit out food that he is not comfortable with, and it is not beneficial for the child to forcibly stop vomiting. ”Li Min took the two interns up the stairs."
Between vomiting and dying, parents will make choices that benefit their children.If you vomit a lot, let's pay attention to replenishing water and electrolytes, and don't have other problems caused by ion imbalance.Other anti-inflammatory treatments should be used according to the blood routine. ”In fact, Li Min didn't understand such a treatment idea.Give painkillers for pain, and antiemetics for vomiting.It's not an advanced stage of malignancy......
If you don't address the cause of the disease, is that a treatment?
It can temporarily mask the symptoms, but once it erupts, it is often an uncontrollable consequence.The two interns sent Li Min to the nurse's office on the twelfth floor, and then transferred back to the duty room on the eleventh floor to sleep.When Xiao Zhai saw Li Min coming back, he asked, "What does the pediatric department want you to consult?"
”The patients on the twelfth floor are almost full, and the night nurses are basically sleepless all night now.So Xiao Zhai was wearing a military coat on duty, and he didn't even spread out the cover.Otherwise, it would be better to get up in a while, and it would be better to stay like this until dawn."
There was a 4-year-old child who had taken metoclopramide too much, fell into a coma and had convulsions.""
Gastric lavage or dialysis?""
Medication after lunch.10 mg orally, 20 mg intramuscularly.It's almost metabolized, and it's too late for anything. ”Xiao Zhai has been working for more than three years, and he has seen more life and death, and he can't help but sigh a few words for the 4-year-old child."
It's pathetic.I'm only 4 years old.What did her parents do?
”"Her parents earn money in the county, and the children are handed over to their grandparents."
Li Min grabbed the nurse's night duty record and looked through it.Fortunately, the postoperative patients on the twelfth floor were fine.This night's little things, Xiao Zhai also handled them according to the routine.Li Min signed his name, and then said to Xiao Zhai, "Thank you." ”"You're welcome.Go back and sleep a little longer.You're not like we can sleep on the night shift. ”"Well, then I'll go back and sleep a little longer."
It's not even four o'clock, and the winter is late, Xiaoyan can bring food to herself, and she can sleep for more than two hours."
I just filled this hot water bottle, you can take it."
Xiao Zhai gave the hot water bottle he was holding to Li Min."
You shouldn't have been hot at this point.""
Then give me to you, and you can change the hot water.""
Okay."
Xiao Zhai got up and followed Li Min to the duty room to take away the hot water bottle that had become warm.Li Min hugged the hot water bottle, got back into the quilt and went to sleep.After a long day on duty, it is necessary to exercise the ability to work energetically at any time when you wake up, and to fall asleep when you lie down.So after a while, she fell into a deep sleep.* Intensive care unit for pediatric surgery.Director Wu said calmly: "Prepare the tracheostomy package.Xiaofeng, you go and talk to the parents of the child.Tell them what I just told you. ”"Yes."
Director Wu was distressed that Leng Xiaofeng, who was pregnant, was sensitive to the smell of blood, so he sent her to explain her condition to the parents of the child and do the tracheotomy herself.The Wu family's small life now is very warm and peaceful.In November last year, after Wu Dong came back to participate in the group wedding, he delayed at home until mid-October, and Leng Xiaofeng was about to go to work after his marriage leave, so he reluctantly went back to school under the urging of Director Fan.For this reason, Director Wu and his wife laughed at their son in private.But no matter what, after Leng Xiaofeng and Wu Dong got married, in the eyes of Director Wu, she became a lot better.For example, Wu Dong got along well with Wu Dong when he was at home; After Wu Dong returned to school, he no longer stimulated people with shopping.Director Wu is very satisfied and gratified.Especially after Leng Xiaofeng returned to school in Wu Dong, he immediately responded to the request of the old couple and moved in with them.So some time ago, when Leng Xiaofeng's pregnancy reaction was relatively serious, Director Wu worked the night shift for her.Director Fan saw it in his eyes and was happy in his heart.That's how life should be.For the sake of Xiaofeng's well-behaved and her wife's lack of nitroglycerin, she privately carried Director Wu to give Xiaofeng good things.So every time Wu Ya goes home, she complains to her parents sourly, and it is not uncommon to have a daughter-in-law who is her daughter.Now that Director Wu saw that Leng Xiaofeng was in trouble, he first asked Li Min to come over for a consultation and sympathize with himself before he got better, and suddenly felt that the hard work he had poured into Leng Xiaofeng was not in vain.sent Leng Xiaofeng away, and Director Wu began to carry out rescue work.The child's condition was not optimistic, and he tried his best to save the life.After the morning meeting, he tiredly handed over the child to Director Qi to take care of, and rushed to the director's duty room to start catching up on sleep.Old minions, old men, it's just a cold, and my legs are shaking when I get up in the middle of the night to do a rescue...... * Leng Xiaofeng got off the night shift, and went home and fell asleep after dealing with a few mouthfuls.She had a more serious pregnancy reaction than Yan Hong and Liu Na, and in the first two months, she ate and vomited.In addition, the number of pediatric patients continues to increase with the seasons, which also makes her feel more difficult.But what can be done?!
Director Wu is a father-in-law, and being able to work the night shift for himself is already the greatest care for himself.Liu Na didn't have to face the patient by herself, and Gong Hai couldn't help anything.Well, only Yan Hong is slightly better, Pan Zhi can go to the operating table for her during the night shift, but she has to bear the matter of the day shift.Alas, it's too hard.Leng Xiaofeng fell asleep with pity for herself and all the female doctors and nurses who were pregnant.※※※※※※※※※※※※※※※※※※※※ metoclopramide is a commonly used antiemetic drug in clinical practice, with a wide range of indications and low price.Children are susceptible to extravertebral reactions.Extravertebral reactions can be summarized into two categories: hypertonia-hypokinesia syndrome and hypotonia-hyperkinesia syndrome.Parkinson's disease and parkinsonism, which we are more familiar with, belong to extrapyramidal diseases manifested by hypertonia-hypokinesia syndrome.() The distance is a bit far