Besides, Li Min was poured a stomach full of white porridge and hot water, and Lu Qing took blood from her for examination under the command of Chen Wenqiang, all of which she took care of with Xiaoyan's help, and passively responded in a daze.And Chen Wenqiang did not dare to give her medicine to cool down because of Li Min's drug allergy history as told by Yan Hong.Seeing that she had no pathological reflexes in addition to fever and drowsiness, the physical examination did not cause any pathological reflexes, so she told Xiaoyan to look carefully and go to the office to find someone if there was anything.Xiaoyan circled around Li Min, feeding water and measuring body temperature regularly according to Chen Wenqiang's instructions.The rest was left to let Li Min fall asleep until almost noon when he was awakened.Li Min woke up and lifted the quilt to get out of bed, and when she saw it, she found Xiaoyan lying on the desk practicing calligraphy."
Aunt Min, you're awake."
The sound of her sitting up alarmed Xiao Yan."
Hmm.Why are you here?
”Li Min felt that her throat was very painful and she had to speak hard, but this did not prevent her from getting up."
Aunt Hong asked me to take care of you here.What are you going to do, I'll come. ”Li Min smiled: "Toilet." ”"Put on the coat.Aunt Hong, I also brought you a sanitary napkin. ”With Xiaoyan's help, Li Min wrapped herself tightly and went to the bathroom.When she came back, Xiaoyan got hot water for her to wash up, cleaned herself up, and poured in most of the cup of hot water, Li Min felt that she was not so dizzy when she stepped on the cotton floor.She cleared her throat, but it still hurt, so she said in a dumb voice, "Xiaoyan, I'm fine."
You don't have to stay with me here, you can go back and make lunch. ”"I don't cook at noon today, Aunt Hong said to cook dumplings for lunch and let me buy food in the canteen cart.Aunt Min, you were burned and confused when I came in the morning, so take your temperature again. ”Xiao Yan took out the prepared thermometer."
Dean Chen asked me to take your temperature and feed you water every hour, and I did the same.""
Mm-hmm, thank you, little Yan'er.I've just finished drinking hot water, and now I'm not allowed to take my temperature. ”Li Min took off her clothes and got back into the quilt."
I'll just get some more sleep, you don't have to wake me up, and you don't have to take my temperature.""
Aunt Min, what do you want to eat at noon?"
Xiao Yan saw that she didn't want to take her temperature, so she had to put the thermometer away again."
If you don't want to eat it, you eat it yourself.You let me sleep a little longer. ”Li Min spoke, curled up in the quilt, her whole body bent into a semicircle, and soon fell asleep again.Xiaoyan stepped forward to fold the quilt for her, and pressed the military coat on duty to the quilt for her.Then he took Li Min's keychain and went out to pour water with a basin.She cautiously followed Yan Hong's request, and remembered to lock the door when she came out and went in.* Pan Zhi, who led the young doctor and a few interns to the custody room, happened to see Xiaoyan's cautious action of locking the door.He came to see yesterday's chest and abdomen wound, the most serious of the first wave of wounded.Yesterday's operation was performed by Pan Zhi and Xiao Chen with Director Shi.After today's morning meeting, there were few patients outside the general public, and Director Liang quickly ended the ward round, and Pan Zhi discussed with Xiao Chen: "You have a lot of things, I'll follow the postoperative patients on the twelfth floor." ”Xiao Chen hurriedly thanked him.He wanted to take care of it himself, but he didn't have the skills.Because Xiao Chen is responsible for managing all interns outside the general public, the interns and doctors who have returned to work during the Spring Festival holiday have returned to work today, even if they have their own teachers, Xiao Chen still has to gather these people together according to Director Liang's requirements.The way to do it was for him to give these people exams.At this time, Pan Zhi, the nominal teaching secretary, took the initiative to go to see the serious injury of the chest and abdomen on the twelfth floor for him, and he wanted to thank him.In fact, for surgeons, postoperative management of serious patients is a very headache, egg pain, and pain everywhere in the body.The reason, to say a familiar analogy, those surgeries that can be called serious patients are successful, and they are really only the first step in the long march.Then it's time to test whether you are a qualified surgeon.And this test is basically in internal medicine.Because a qualified surgeon is actually a qualified internal medicine doctor + a scalpel.Therefore, if you want to become a qualified surgeon, especially when you are young, you have to do the work of an internal medicine doctor half of the time - writing medical records and circling around patients before and after surgery; The other half of the time is to sell nerds on the operating table, saying that it sounds good is to observe the operation, and the popular point is to watch the operation, and then pull the hook→ cut the thread→ slowly escalate to knotting→ and was allowed by the senior doctor to stop the bleeding with forceps......
It is the norm to work step by step for five or six years to reach the current level of Pan Zhi.In Xiao Chen's state, hehe, a little unlucky.Those who are as sharp as Xie Xun and Li Min can't be compared, because there is also Xiao Jin of orthopedics as a reference on the other side of the spindle.In fact, it is not an exaggeration to require a surgeon to be a qualified internal medicine doctor first.For example, if the patient's basic condition is not good and he wants to go to the operating table reluctantly, he will not be able to pass the anesthesiology department.As long as the anesthesiologist needs to get started, people will see the patient before the operation; At the very least, before administering anesthesia, check the patient and look at the medical records to see if the anesthesia can be tolerated.If you don't adjust the patient's basic state to the level that you can withstand anesthesia before surgery, you don't want to have surgery.For example, if the patient has a fever after surgery, if it is a fever within 24 hours after surgery, you should analyze the patient's body temperature in combination with the specific situation of the operation: what does 38° and 39°C mean respectively, is this a normal postoperative heat of absorption or a hint of infection?
Plasma detection is back, high Na, K, Cl, Ca, Mg, P or low, timely adjustment is due, but what is the cause?
If the PH is not in the normal range, is it acidosis or alkalosis?
Is it respiratory or metabolic?
Is it primary or secondary?
Is it compensated or decompensated?
Even acidosis must be judged clearly before sodium carbohydrogen can be given, otherwise it will aggravate intracellular acidosis, which will push the patient to death.When there were no interns and Director Cheng was outside the general public, Director Cheng didn't ask, and everyone vaguely took the symptomatic medication.If it really doesn't work, I ask for an internal medicine consultation and only ask what medicine to give, not why.However, from hanging the card of the teaching hospital to Director Liang at the helm of the general hospital, even if it is a patient of Director Bian and Director Xu, he will still ask interns and doctors during ward rounds, and then let the teacher give the correct answer.Wrong answer, blushing, no?
Shame on you?
Another example is the auscultation of the lungs, can't hear rough breath sounds and crackles?
Send a patient with a lung infection to the operating room, hum, the anesthesiologist will anesthetize such an elective surgery patient?
Dream on.At this time, do you want to consult with an internal medicine department?
Don't say that Director Liang doesn't give face, then you have to let the doctor laugh at him to death - go back to the senior year and retake it.There is also a heart sound that is not clear, the room is early, the room is early, and I can't hear the rhythm of the horse, go back and rebuild!
Heart sounds that are normal and abnormal should be completely distinguishable within 30 seconds.Electrocardiogram, this requirement is not high, the abnormality cannot be seen, but what is normal must be distinguished from the abnormality at a glance.Then ask for an internal medicine consultation – help.But how do you fill in the consultation form?
You can't just write on the list or in the medical record: listen to the irregular heartbeat, so please consult the internal medicine.It's not enough for the internal medicine doctor to get the wine on the dinner table.And yesterday's patient with a combined chest and abdomen injury has a lot of basic problems.If you have an underlying disease with high blood pressure and high blood sugar, and you learn that you have stomach problems after surgery, whether you will have stress ulcers is something that you need to pay close attention to after surgery.This patient should be sent to the ICU.Pan Zhi concluded so in his heart.He guessed that Director Shi left the patient in the Department of Thoracic Surgery because he wanted to use the patient as a teaching case.So he wanted to take advantage of the fact that there were not many patients outside the general world and directly manage this patient, and the actual idea in his heart was to force himself not to throw away all the internal medicine things.There is another reason why Pan Zhi is staring at this case, that is, Director Shi has been in the affiliated hospital for a long time and has always been responsible for teaching, and it has become a natural habit for him to ask questions during diagnosis and treatment.There are only "tricky" questions from various angles that you can't think of, and there is nothing he can't ask.But he is a little good, he does not ask questions to anyone, he does not designate anyone to answer, when no one knows the answer, he will save everyone's face, and he will naturally say the answer himself.In front of him, Pan Zhi was not alone with the notepad.On the day of his ward rounds, the little surgeon who was okay was willing to come over and follow.Pan Zhi is pulling himself into the ranks of the little doctors today, thinking that the Spring Festival holiday is five days, and Director Shi should come to a big round today.* But Pan Zhi didn't expect him to bring Xiao Wang over today, and after checking the postoperative patient and changing the dressing for the patient who had just operated yesterday, not only did he not wait for Director Shi's big rounds, but only Yang Yu, who followed Director Shi, watched himself and Xiao Wang do their work with a wilt.He thought that Yang Yu was tired yesterday and didn't get over, but Qin Zhang, who was at home during the holiday yesterday and didn't come back to the hospital in time, was very enthusiastic, followed Zhang Luo, helped hold the gauze bucket, and pushed the disposal cart."
Yang Yu, where is Director Shi?"
Pan Zhi came here to listen to Director Shi's questions."
It's in the director's office.He said that you and Dr.
Chen will come to one, and let me follow. ”Yang Yu beat the spirit.Yesterday's surgery was physically tired, but it was mainly the mother who was provoked by her aunt, and the unreasonable noise made people upset and unable to rest.Pan Zhi saw that Yang Yu was not in high interest in speaking, so he asked Qin Zhang, who was helping to clean up the dressing bowl: "Qin Zhang, why didn't you come yesterday?"
Yesterday there were more than 20 surgeries. ”"Yesterday was the Spring Festival holiday, so I went home."
Qin Zhang felt that he was quite wronged.This morning, Director Li criticized him without naming him.After the shift, he learned about the "tradition" of the provincial hospital from Yang Yu, but Director Li didn't listen to his opportunity to explain, asked him to reflect, and asked him to go to the operating room to ask what the intern nurses thought.It's the same that there is no car, how can people walk all morning to the hospital.Qin Zhang felt quite breathless."
Those who don't know are not to blame.It would be nice to know next time. ”Xiao Wang, who followed Pan Zhi, persuaded Qin Zhang lightly.He used to envy Qin Zhang for following Director Li, but after half a year, there are two or three weeks left before he will be transferred, and he doesn't envy Qin Zhang.At this time, Director Li did not wait to see Qin Zhang, and the thoracic surgery department would definitely not keep him.Pan Zhi sighed, his temperament, this little king he brought with him was just like that.While washing his hands, he said to Qin Zhang, who was about to leave after helping to clean up the dressing bowl: "The city government also has a rule that within one hour after the heavy snow stops, each unit should start clearing the snow and clean its own sharing area within two hours.We've swept the snow more than a dozen times this winter. ”Qin Zhang was stunned for a moment, and defended himself: "I see that the snow is so big, I can't stop for a while."
When the snow stopped, I couldn't wait for the bus to come.I waited at the bus stop for an hour, freezing cold, and the bus came late. ”Yang Yu felt that Qin Zhang was pretending to be confused.He helped Pan Zhi and said, "Qin Zhang, the bus can't come out until the road is cleared."
Otherwise, once such a big car skidds and has an accident, the hospital will be even busier.We had at least three or four surgeries per person yesterday.The surgery department has not yet arrived with a doctor, so Director Li is annoyed, you should understand. ”Qin Zhang nodded: "Yang Yu, thank you." ”After a pause, he said, "Thank you, Mr.
Pan." ”"You're welcome."
The two spoke in unison.Qin Zhang went out, and Xiao Wang, who Pan Zhi took with him, said: "Qin Zhang is very active in college, he didn't want to come to clear the snow yesterday."
Teacher Pan, is he pretending to be confused?
”Pan Zhi smiled and said: "We have done our best.Then you go back and see what Dr.
Chen has to say, and I'll go back in a while. ”* Pan Zhi knocked on the door of the duty room and saw Li Minren asleep.Ask Xiaoyan if she knows that Li Min has woken up once and can drink water and go to the toilet on her own, that is, she is conscious and has no problem exercising.He took Xiaoyan's body temperature record, and saw that it continued to be above 39 °C, and felt that this body temperature was a little too high.He called Director Chai of the pathology room."
Director Chai, I'm Puwai Pan Zhi.Li Min had a fever.Mmmm, I started to have a fever this morning, and our Xiaoyan is here to nurse. ”Pan Zhi probably recounted what he heard from Yan Hong.Then he said, "It's not a problem that the temperature is so high that it burns like this."
Do you want to ask the internal medicine department to take a look?
”......, "Okay, then I'll wait here for a while." ”Director Chai didn't arrive, but Director Liu, who was anesthetized, arrived first.Director Liu smiled before speaking: "Senior Brother Pan, let me take a look at my old chai first." ”Pan Zhi replied with a smile: "Senior sister is the same.I'll go find Director Shimoishi. ”He saw that Director Liu was going to dig Li Min out of the quilt for auscultation, but Li Min was reluctant to come out, so he avoided going out.Director Chai counted the time and pulled Director Guan from the respiratory department, and when he came in, he happened to see Li Min shrinking into the quilt and their Director Liu receiving a stethoscope."
Xiuyu, how is my junior sister?""
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It's okay, both lungs and heart sounds are quite normal.If you don't check it again, you're more professional. ”Director Liu smiled and wanted to dig Li Min out of the quilt again.Director Guan waved his hand and said, "You can check it."
Did she have a blood test?
”Xiao Yan immediately replied: "I had a blood draw in the morning." ”"Then I'll ask the head nurse, and the result should be given to Corey at this point."
Director Liu walked out as he spoke.Pushing open the door, I saw Pan Zhi who wanted to knock on the door.He had a few checksheets in his hand."
Senior sister, this is Li Min's test sheet, this morning.Director Shi said that if you have time, go to the office to discuss. ”Director Liu took the test sheet and took two steps back to let Pan Zhi in.Director Chai and Director Guan also came to look at the test sheets."
It's all normal."
Director Guan frowned: "Then how can it be such a high body temperature?"
”He didn't believe it, so he asked for the test form again, read it again and called the laboratory department."
Director Sun, I'm Guan Lan from the Department of Internal Medicine.My junior sister Li Min has no cause for fever, yes, yes, neurosurgery, blood samples sent in the morning.Uh-huh, good. ”Director Guan put down the phone and said, "Dean Chen called him, and he did all these tests, and he did the liver function." ”Director Chai rubbed his hands and frowned.He went to pathology after graduation and had little experience in clinical treatment.Director Liu went to anesthesia, and the couple was half a catty and eight taels."
Senior Brother Pan, what did you say Director Shi wanted me to discuss?"
Director Liu turned his head and asked Pan Zhi.Pan Zhi saw that Director Guan and Director Chai were coming, so he replied, "Go to the director's office and talk about it." ”Pan Zhi gave way, Director Guan and Director Chai went out first, Director Liu told Xiao Yan a few words, and went out of the duty room first under Pan Zhi's humility.
*Zhang Zhengjie is angry in the director's office.He snorted angrily and said to Director Li and the others: "I think you are idle."
If you're still on the eleventh floor, you won't have time to fix this. ”Director Li was unhappy: "You and Director Qin shouldn't take Xiao Li to see the autopsy."
She's a big girl, why is she looking at that thing, and she can't dissect it. ”When it comes to this, Zhang Zhengjie's confidence is insufficient.Without waiting for him to speak, Director Guan and the others came in.Director Shi smiled and said, "Oh, rare guest."
None of us were embarrassed to place a consultation order. ”Director Guan smiled and said, "What is the use of the consultation form, you can make a phone call and I will come over." ”"Have you read those test sheets?""
Look, it's all within the normal range.But the more this high fever that can't be detected by anything, the more difficult it is in internal medicine.With that, I know how to get here. ”Director Guan answered Director Li's question very seriously."
Besides, this is my junior sister, Lao Chai's brother and daughter-in-law, how dare I not come over immediately when he looks for me.Director Li, Director Shi, and Director Zhang are also there.It seems that everyone is worried about my junior sister. ”Director Chai and his wife greeted everyone again.Lu Qing walked up to Director Liu and told him about the second and third years of junior high school, and Li Min stayed downstairs for several hours last night."
We've been talking about it for a while.I want to find someone to see if it's good to exorcise evil spirits.It must have been something. ”Zhang Zhengjie saw that Director Liu was pulled over by Lu Qing's few words, and he asked Director Guan and Director Chai for support."
Isn't that ridiculous, you two say?
When we encounter unprovoked fever as doctors, we can't find out that the reason is that our level is not enough, and we make those crooked ways are not a joke. ”As for Pan Zhi, he is the director on this occasion, is there room for him to speak, Pan Zhi was ignored by him."
Then how is it crooked."
Lu Qing was not convinced.She urged Director Shi: "You hurry up and call Director Qin, see if he has finished the meeting, and ask him who he is looking for." ”* At this time, at the faculty meeting presided over by Chen Wenqiang, after fierce debate about proposing Guan Lan to be the assistant to the dean, the result was about to be announced.Secretary Tang was annoyed by Dean Fei: "What about Dean Chen, from the perspective of medical safety of the whole hospital, Director Guan was chosen as an assistant, and it was also because Dean Shu was busy with you in the west, and there was no way to take care of clinical reasons." ”Dean Fei was very unhappy, but he was still able to control himself in the face of the conclusion that had tended to take shape.The face of the director of the hospital office was colorful, and he no longer thought that he had missed the assistant to the dean again.At today's meeting, Director Liao was the happiest, although during the discussion, she closed her lips and did not express any opinions.But she sat there, even Dean Fei, and it was not easy to say anything.Director Zhang wanted to ask her to recuse herself, but seeing Dean Fei's attitude of actively fighting for Director Qin, he didn't mention it.At the critical moment, Director Fan voted for Guan Lan and did Dean Fei's work."
I think so, all of you to see if what I said makes sense.In the past two years, with the joint efforts of President Fei and President Chen, the development of surgery has been very smooth.It's not just surgery, it's just a provincial medical school that has just been upgraded, and they also want to hang the brand of a teaching hospital here this year.This shows that they also recognize our current level of medical care and the quality of teaching. ”Dean Fei knew in his heart that the development of the Provincial Institute in the past two years had little to do with him, but Director Fan's words still made him feel ironed in his heart by putting him in front of Chen Wenqiang.Chen Wenqiang pouted in his heart, the development of surgery and the listing of teaching hospitals, what efforts did he Fei Baode have?!
However, Director Fan's words cooled down the tense and blazing atmosphere, and Chen Wenqiang did not raise objections under the instructions of Dean Shu.He followed Director Fan's words and continued to chatter."
After the internal medicine center was built last year, the rat strong incident that occurred in winter, and the experts in our provincial capital basically arrived, including the professors of the Medical University, and they all recognized Guan Lan.You don't deny this, right?
”The dozen or so people who participated in the academy meeting had different ideas in their hearts, but no one came forward to refute Chen Wenqiang's words.To put it bluntly, the "recognition" has no gold content and no meaning.Because among the experts who came to the consultation, everyone knew the department directors and associate professors introduced by the provincial hospital.Among the directors of the Department of Internal Medicine who can participate in the consultation, Guan Lan is a junior who went to college after 77 years, who do you not praise him?
Age, haha, he's older than Director Luo, but he's a junior.If this is also an endorsement, let's be an endorsement!
Director Fan got the help of Chen Wenqiang and continued: "If the internal medicine department of our provincial hospital wants to obtain the professional status of departments such as laboratory department, neurosurgery, and otolaryngology department in the province in the near future, I agree with the opinions of Dean Shu and Dean Chen, and choose an assistant to the dean of the internal medicine department, just like Dean Chen gave Dean Fei as an assistant at the beginning, not to assist Dean Fei in the surgery."
Let's try the ready-made template in internal medicine.With the support of those associate professors who were 'introduced' from the Affiliated Hospital of the Medical University, it is quite promising to get our university internal medicine up. ”The technical strength of these departments mentioned by Director Fan has gained a certain status and recognition in the province.It is nonsense to say that Guan Lan has such potential in internal medicine and is stronger than other directors.Among the associate professors introduced by the Affiliated Hospital of Medical University, which of them is ahead of him in academic status, but the problem lies in what Director Fan emphasized - those people are the "introduced" department heads.And only Guan Lan has been cultivated by themselves for eleven years, well, it is eleven years since they arrived in the provincial court.Dean Fei knew in his heart that Shu Wenchen's proposal was based on public intentions, and held a morning meeting, and it was indeed the most suitable for Guan Lan to consider comprehensively.This, for the sake of Guan Lan, is not inclined to anyone at the moment......
Forget it, he disarmed in his heart.And after Director Fan persuaded Dean Fei not to insist, she stopped talking.She ignored Director Zhang's gaze.From the perspective of public heart, Guan Lan is the most suitable.Selfish, she doesn't think Director Zhang is competent.After all, this is not the time to shout slogans and frame people with rules and regulations.The leaders of the hospital that are needed now must be able to handle the business and have a certain degree of flexibility.Choosing the assistant to the dean, he is more suitable than Director Zhang.But I just don't have that idea.As for Director Zhang, his one-by-one way of doing things is suitable for going to the provincial courtyard to watch the gate and guard the elevator.() The distance is a bit far