Li Min came out after changing her clothes and followed the flat car that sent the child back to the ward.After she settled the postoperative child, Chen Wenqiang came back."
Xiao Li, you go home and rest, and come back to check the room in the evening.""
Good.Thank you, teacher. ”Li Min was very happy to be able to go home and rest for half an afternoon.…… When she came to Corey again in the evening, she saw that Yang Weihua and her remarried husband were also in the custody room.Yang Weihua introduced him to Chen Wenqiang and Li Min."
Thank you, Dean Chen, and thank you, Director Li.Thank you very much. ”This man, Lao Sun, stretched out his hand very enthusiastically.On his body, Li Min smelled the breath of the boss of the Zhu family very obviously.Even Mu Jie's body has a similar aura.This familiar feeling made Li Min feel good about this person.Chen Wenqiang said to Lao Sun with a hint of reserve: "You're welcome.If there is any problem, you can come to me in the evening, I am working the night shift tonight.Xiao Yang, tell the patient's family that it is best to leave only one person to accompany you to avoid postoperative infection.Warmth, you have to take on the responsibility of special support. ”"Yes.I've told them a few times that I'm only going to keep one chaperone. ”The warm voice was relatively small, if it weren't for the other people in the room who didn't say a word at this time, Chen Wenqiang might not be able to hear it.Lao Sun immediately said: "We'll leave right away." ”He and Yang Weihua had just come in, and they really hadn't heard the nurse say that there was only one person left.There were a lot of people in the room, and the room was almost full of grandparents, parents, and other relatives.But the nurse said warmly several times, but she couldn't get the person out of the care room.Chen Wenqiang led the way out of the care room, followed by a series of doctors, interns, and relatives and friends of the children who came to visit.When they reached the hallway, the child's grandfather stepped forward to thank and apologize.Chen Wenqiang shook his head and took the lead into the next care room.Although the warm temperament was too soft just now, the family's practice of not cooperating with postoperative treatment was also excessive.Looks like I've got to alert the head nurse.But they only finished looking at the postoperative patients in the intensive care unit, and the nurse in charge on the eleventh floor hurriedly came over and shouted to Chen Wenqiang and Li Min: "Dean Chen, Director Li, Director Shi, please hurry upstairs to ward 3." ”Chen Wenqiang agreed and hurried to the twelfth floor, there must be a patient in the 3rd ward.* Chen Wenqiang entered the third ward, but saw that the screen isolated the patient, he pointed to the screen and asked, "Old Shi, what's the matter?"
”Director Shi replied, "There's skin in it." ”Then he motioned for Chen Wenqiang to come up to the corridor."
A 43-year-old female patient with urinary stones was admitted at noon today, and her blood picture supported the infection.Just now I came to this ward to make rounds, and found that she was pale and in cold sweat, so I asked the nurse to take her blood pressure, which was 76/52. ”"Did you do the ultrasound?""
Yes, it is a tertiary hospital that our hospital recognizes the test results.Ultrasound diagnosis is ureteral stones.Because the patients in the hospital were far away from home, they were transferred to our hospital, and all the examinations were from the tertiary hospital.Admitted to Corey at almost half past eleven in the morning, and was given 654-2, anti-infective treatment. ”Dr.
Huang, who hurried back in a hurry, hurriedly replied, and opened the medical record to Chen Wenqiang."
Old Shi, what do you mean?"
Chen Wenqiang did not examine the patient and did not know the specific situation of the patient.But Director Shi just said that the skin is prepared, so it is likely to be explored by laparotomy according to the acute abdomen."
That's what you think.Just now I examined the patient, there is peritoneal irritation, no fluctuations, emergency laparotomy and exploration. ”"Do you have any blood?"
Li Min asked Xiao Huang."
Ready, I just placed an order, ready 2000.I have already called the operating room. ”After a moment of talking, Li Min took a cursory look at the inpatient medical records written by the intern that Chen Wenqiang was looking through.The nurses of the disposal squad have finished preparing the skins.Dr.
Huang took the intern to the bulldozer, and Li Min immediately entered the ward and went to the bedside to ask the female patient about her menstrual history."
Do you have regular periods?
How many days?
How many days at a time?
”"It's okay.29 days and 30 days.It's only 5 days each time. ”"When did April come, remember?""
It seems to be number 1.It ended on the day of the Qingming Festival. ”"Is it coming this month?
Has there been any change in menstrual flow?
”"This month is May Day.The amount seems to be a little less than usual.Well, maybe it's because I'm at home during the holidays, I haven't moved much, and I don't feel like much has changed. ”Probably because Li Min is a woman, she looked at Li Min's badge and answered Li Min's inquiry very cooperatively.But she continued: "I don't feel very comfortable squeezing the bus to and from work these days, and I thought it was because I was lazy at home for three days in a row on May Day."
I tripped when I got out of the car today, and you can see my hands are all scratched.When I got up, I started to have a stomachache.Director Li, what kind of illness am I?
”"It's not clear yet.Did you go to the ring?
”"Up.It used to be an 'O' ring, and every time it bleed, it hurt a lot of blood, and it hurt my stomach.Last fall, it was changed to a 'T' ring. ”In this short moment, according to the menstrual history asked by Li Min, combined with the time of onset of the patient, Chen Wenqiang, Director Shi, Li Min, and Pan Zhi who came over, their thoughts converged: I am afraid that this is not a typical gynecological acute abdomen (ruptured ectopic pregnancy?).
）Xiao Huang took the intern to push the flat cart, and the intern went to lay the quilt.Pan Zhi walked over and took the surgical opinion and said, "Dean Chen, director, the patient's family has signed and agreed to the operation. ”Director Shi took it and took a cursory look at it, and then added it to the medical record folder.Pan Zhi went over to help carry the patient to the car.Li Min stepped out of the way and looked at Xiao Huang with sympathetic eyes.Director Shi instructed: "Xiao Pan, you bring Xiao Huang, Xiao He, and the intern who wrote the medical records to the stage."
I checked the rest of the patients and went over. ”Xiao He is a bachelor's degree graduate who came from last year, and he used to follow Director Bian outside the general public, and now he has come to follow Director Shi.Chen Wenqiang listened to Li Min's menstrual history, and when he saw that Director Shi had made proper arrangements, he naturally understood in his heart that Director Shi came over to report this matter to himself.Therefore, he nodded to Director Shi and took Li Min back to the eleventh floor to continue his rounds.Li Min went to ask about the menstrual history, just because the intern wrote the standard menstrual cycle format on the medical record, but did not write down the date of the last menstrual period.The medical record is written like this, and Li Min suspects that he will not be detailed when he asks for medical history.In addition, she heard Yan Hong muttering not long ago, Director Li of the Department of Obstetrics and Gynecology is currently doing a statistic: after the "O" contraceptive ring is replaced by a "T" ring, the number of women of childbearing age who are pregnant with the ring has increased, and the number of ectopic pregnancy patients has also increased significantly compared with 20 years ago and 10 years ago.Whether it has statistical significance or not has to wait for the final version of the paper.Regarding the contraceptive ring, it really makes women of childbearing age love, hate and fear.Many people do not tolerate oral contraceptives and use "O" ring contraception that works well.However, there are side effects that cannot be ignored, such as heavy menstrual flow, back pain during menstruation, and lower abdominal pain.The side effects of the "T" ring are not as many as those of the "O" ring, but they are not as effective as the "O" ring.This matter, if it weren't for Li Min's attention to obstetrics and gynecology and her close relationship with Yan Hong, she wouldn't have known Director Li's statistics twenty years ago.It is estimated that Xiao Huang and the male intern he brought with him may have seen the B ultrasound in the outer hospital and thought it was a stone, forgetting the abdominal pain of women of childbearing age, the first thing to rule out is the acute abdomen of gynecology.
*After the evening rounds, Chen Wenqiang called the operating room."
Hey, I'm Chen Wenqiang, is Director Shi there?""
Director Shi just brushed his hands on stage.""
How's the patient?""
I heard that there was blood in the belly."
Hearing that Director Shi had come to power, Chen Wenqiang was relieved.But he put down the phone and sighed slightly, this young doctor, although he has obtained a lecturer certificate, he still has to grind if he thinks they can combine theory and practice.How can you just look at the auxiliary tests?
He guessed that Xiao Huang was in charge of the patient because the patient's diagnosis was clear, so he handed over the patient to the intern.Now I don't know if he took the intern to ask for medical history and physical examination, or if he completely handed over the patient to the intern and Chen Wenqiang's idea, which is not only now, but when he looked at the medical records, he had this idea.If Li Min hadn't asked about his menstrual history, he would have wanted to ask Xiao Huang at that time......
"Teacher, I'll go back." ”"Okay, you all go back."
The doctor and interns on the eleventh floor said hello to Chen Wenqiang and left the nurse's office behind Li Min.Chen Wenqiang thought about it, explained his condition to the night nurse and went to the operating room.* "Old Shi, how's it going?"
”Chen Wenqiang did not change his hand clothes, he picked up a surgical gown that was prepared for the visit surgery, and wrapped it around the white coat.But hats and masks are worn in a proper manner.He pushed the door of operating room 4 open a crack, and then asked through the crack in the door."
Interstitial rupture.""
How much blood loss?""
At least 3500."
Chen Wenqiang gasped and asked in surprise, "Why are there so many?"
Make no mistake, right?
”"Just more, no less."
Director Shi handed over the operation to Pan Zhi to continue to be the surgeon, turned around and stepped down from the stage, walked to the door and said to Chen Wenqiang: "2000 whole blood has been transfused."
This life is no problem.But the rest ......
""The rest will come back to that." ”Chen Wenqiang confessed, turned around and left the operating room.* Li Min went up to the third floor and didn't enter her own door, she knocked on Yan Hong's door and told Yan Hong about Pan Zhi taking someone for emergency surgery."
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What kind of surgery is it?"
Yan Hong was full moon, and when she heard that it was Li Min calling the door, she hugged her son and came over to open the door for her."
It is suspected to be a gynaecological acute abdomen.The outpatient clinic was admitted with ureteral stones. ”Li Min stood on the floor mat of Yan Hong's house, closed the outer security door with his hand, but did not change his shoes.Yan Hong didn't wear glasses, narrowed her beautiful eyes slightly and asked, "Is it Pan Zhi's patient?"
”"It's not.It should be yellow.But Director Shi sent Pan Zhi to lead people to the operation, and later Dean Chen called, and the nurse in the operating room said that Director Shi had also come to the stage. ”"That's good."
Hearing that Director Shi had come to power, Yan Hong was relieved."
Why are you standing at the door talking when you come in?""
I'm not going in.I'm just back. ”Li Min beckoned to Pan Jia, who was holding in her arms, and said, "Auntie will go home first, and then come to hold the baby after eating and changing clothes." ”"Then you can go back."
Yan Hong grabbed one of her son's small hands and waved at Li Min: "Baby, goodbye to aunt." ”Yan Hong finally named the child's milk baby.She really couldn't stand Pan Zhi's Pan Jiabao, and after changing "home" to "Jia", she intercepted the word "Bao" as the child's milk name.It can be regarded as saving face for Pan Zhi, who is a father.It's really in vain that her father picked out so many words with beautiful meanings, sounds, and shapes.Li Min went home for dinner.Mujay has now increased the range of indoor activities, and he will find any reason to walk around the house with purpose.Seeing that Li Min was back, he immediately walked to the door."
Don't come here."
Li Min stopped him and put his schoolbag on the bookcase."
Mujay, how long have you been gone today?""
It didn't take long."
Seeing her ask, Mu Jie immediately walked back and sat down at the dinner table.Xiao Fang had already laid out the meal.Listening to Mu Jie's answer, he secretly shook his head at Li Min.Li Min smiled and went to wash his hands.When she washed her hands, she said to Mujay, "You can go now, but not too much."
Otherwise, even if the fracture is basically healed, it may stop or fracture again because you exercise too much and the fracture cannot bear the pressure on the fracture. ”"Good.I'm not leaving tonight.Why are you late today?
”Mujay asked."
When I was about to get off work, I found a patient on the twelfth floor who was in shock and blood pressure."
Li Min told Mu Jie about it.Xiao Fang exclaimed.Muljey asked, "Is it an accident to kill someone like this?"
”"Hmm-if the admission examination is done by the doctor in charge of the bed, it should be that the technical level is not enough, will it be recognized as an accident, and it may have to go through the hospital council and the appraisal committee.I don't know the specifics of this patient either.It's hard to say.But even if there are no dead people, it is estimated that they will be taken to the whole college conference as a model, and at the least, they will be named and criticized by Dean Chen for education.Li Min thought for a while and added: "If he only looks at the diagnosis of the outpatient medical record and pushes the patient to the intern to take care of it, then it is a proper accident."
Interns must be in the sight of the instructor before they can carry out medical activities.The intern listens to the assignment, and the responsibility belongs to the teacher. ”"Is it related to outpatient clinics?
I remember that the patient was admitted to the hospital and diagnosed with stones. ”"Yes, but in outpatient clinics, misdiagnosis is allowed.But I guess this patient didn't ask much in the outpatient department, and directly took her information from another tertiary hospital and used it.I didn't look at the first page of the admission medical record, and I don't know if it was admitted to the emergency department or the outpatient department.But regardless of whether the patient is admitted as an outpatient or in the emergency department, the doctor who is the first to receive the patient will also be criticized.It is estimated that they will say that they should be more serious and try to minimize misdiagnosis. ”Xiao Fang didn't understand.But Mu Jie frowned and asked, "Why is outpatient misdiagnosis allowed?"
”"There is a lot of patient flow in the outpatient clinic, sometimes only 5 minutes per patient, or even less.If you can't have a detailed consultation and physical examination, and you can't have a comprehensive auxiliary examination to support it, it is naturally impossible to give a 100% correct diagnosis right away. ”Mu Jie did not quite accept Li Min's statement."
If you don't believe me, I'll go out of the clinic with Dean Chen next Thursday, and you can go and see our specialist clinic.Then you know.That's all Expert. ”"Can't you have more time?
Like 10 minutes per person on average?
”"Then the number of clinicians would have to at least double.But in that case, the first problem is the establishment.If the above is enough for the provincial hospital, will other hospitals give it?
If you don't give it, it won't take long, because the number of patients who come to the provincial hospital will increase dramatically because the time for each doctor in the provincial hospital to see patients has been extended.Even if the provincial hospital was given the doubling of the staff, in the end it would not be possible to have 10 minutes per patient.But if the number of outpatient doctors is doubled in all the same clinics, it will not be possible.You say, don't you?"
Well, too.Hasn't the medical school expanded for many years?
”"It's an expansion.I heard Director Liang say that in the past, people used to stand up at home when they were sick, and they didn't even go to the commune hospital.Now, not only the suburban peasants around the provincial capitals, but also the remote rural areas, will come to the county hospitals, city hospitals, or large hospitals in the provincial capitals when they are sick. ”"The number of patients has increased."
Li Min nodded.He continued: "In addition to the fact that there are no medical students allocated to hospitals, there is also the issue of financial allocation linked to the establishment.The above will also increase the burden on the hospital, and I heard that the salary allocated according to the establishment is not 100%.The larger the establishment, the greater the share of wages that the hospital fills. ”This is beyond the scope of what Mujay is willing to discuss.He immediately stopped talking and stopped asking, and sandwiched a piece of fish for Li Min: "Eat fish."
This is Haichang I bought today, and it's quite fresh. ”"Hmm
.
"* Chen Wenqiang came to the operating room and then left again soon after, which was expected by Director Shi.Because there is no difficulty in the operation itself, the difficulty of this disease lies in the diagnosis and differential diagnosis.But Director Shi, in order to prevent accidents, still watched Pan Zhi complete the subsequent operation.In fact, when he opened the abdominal cavity and found that the patient's stomach was full of blood without coagulation, Director Shi didn't want to go on stage.With such a level of surgery, Pan Zhi is fully capable of serving as an operator.But he couldn't stand the patient's blood pressure falling too much, and he was still urged to the operating table by the anesthesiologist.Chen Wenqiang came over, which just gave him an excuse to step down.The anesthesiologist watched the nurse on the patrol station and hung another 400ml of blood on the patient, and immediately wrote down a note on the doctor's order sheet during the operation.Then he looked at Shuye and asked, "Doctor Pan, it's almost, right?"
”"Well, wait until I flush my abdomen again, and the next drain will be fine.""2400ml of blood.Your surgery has set a new record for blood transfusion in ectopic pregnancy. ”The anesthesiologist teased Pan Zhi.Pan Zhi smiled and began to talk nonsense: "It was you who set the record, not me."
I HAVE 2000ML OF BLOOD, AND YOU CAN NOT HANG A BAG. ”"Cut!
Dare to do it, but don't dare to do it.I said, why did you find out so late that it was an ectopic pregnancy?
”I was ready to close my abdomen, and the atmosphere in the operating room was relaxed.But Pan Zhi is not easy to answer.He used the excuse of letting Xiao Huang close his abdomen and miss answering the anesthesiologist's question.Then he went on to ask, "What's your blood pressure?"
”“106/70。”
Seeing that Pan Zhi didn't answer himself, the troublesome doctor said with emotion: "Look at the jar of the suction device, there is at least 4000ML of blood."
If I don't give you a blood transfusion, you won't want to step down tonight. ”Pan Zhi smiled and thanked him: "Thanks to your help." ”Then he dragged a piece of wet gauze to wipe the stickiness on the gloves, and in exchange for the instrument nurse's scolding: "Don't grab things on my side." ”Pan Zhi smiled good-naturedly, took a big step back, got out of the way to tie the knot for the intern, and then slipped the wet gauze in his hand and asked, "Do you want more?"
”The instrument nurse was so angry that she was about to jump to her feet, and the patrol nurse pointed to the dirt basin and said, "Throw it in this pile." ”Pan Zhi threw the gauze to grab the medical records and began to give postoperative medical orders.Director Shi saw that everything was fine, turned around and walked out of the operating room.The anesthesiologist said, "Look, this is going to be someone else, it must be the oval forceps waiting." ”The patrol nurse replied, "Are you envious?"
Our Dr.
Pan is good-looking, one of the nine handsome guys in our provincial hospital, so he naturally has some special treatment.Doctor Pan, who does your Pan An look like?
”"Is it really Pan An?""
No, no, no.That's a joke.My son seems to be picking on my strengths and those of his mother, but more like his mother. ”"That grew up to be more handsome than you?"
Pan Zhi replied reservedly: "Hopefully." ”Pan Zhi gave a good doctor's order, then went to the locker room to find Director Shi, and asked, "Director, is this patient going back to the department or sent to the ICU?"
”Director Shi hesitated for a moment and said, "Send it to the ICU."
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Monday morning you remember to pick it up. ”"Yes."
Pan Zhi agreed, he understood that this postoperative patient was going to take over by himself.He turned around and went back to the operating room and said to everyone who was going to cross the patient's bed: "The director said to send this patient to the ICU for a day of transition." ”Xiao Huang took off his surgical gown and followed Pan Zhi to see the patient."
Senior Brother Pan," Xiao Huang was uneasy."
Hmm.Scared?
”Pan Zhi handed over the flat car to the intern to push, and he was two steps behind and followed side by side with Xiao Huang."
Yes.""
You'd better go to Dean Chen as soon as possible and explain this matter to him clearly.You have to tell the truth.Don't be delusional that you can fool the past.In addition to this, there are also seven patients in the third ward, and there are several beds with escorts. ”"Yes, yes, I understand, thank you, Senior Brother Pan."
Xiao Huang thanked Pan Zhi very sincerely and from the bottom of his heart."
You're welcome.Be careful next time.If Director Shi hadn't insisted on going to the ward rounds in order to have a day of rest tomorrow, and you went to the ward rounds yourself, would you find that the patient's state was wrong?
”Xiao Huang shook her head and said, "I may think that she is uncomfortable caused by stones." ”"If you had given her another 654-2 just now, she'd have to give an account tonight."
Pan Zhi stopped and said to Xiao Huang very seriously: "You will suffer if you work like this."
Let's not say that we can be the same as Li Min, but we can't pit ourselves, right?
”Xiao Huang wiped the sweat on his forehead and acquiesced to Pan Zhi's words.* Director Shi went home sullenly, he didn't go upstairs to go home, and called Dr.
Yang out first."
Lao Yang, there is no diagnosis and treatment team on the twelfth floor, and you don't have to worry about the patients in charge of Xiao Huang.But you and he are a specialist, you are the attending doctor, he is a resident doctor, you still have to take care of it.Do you think my words make sense?
”Dr.
Yang was embarrassed.If something happens to this patient today, it is not as Director Shi said, he doesn't have to take care of it, but it is related to him personally.He is Xiao Huang's senior physician."
Yes, yes, I was wrong.I will keep an eye on Xiao Huang's patients in the future. ”"It's not just Xiao Huang's patients.With the three-level ward rounds system, you, as one of the only two attending doctors in the department, should take on the responsibility of making rounds once a week. ”Director Shi was determined to give Dr.
Yang more weight.Let him take his share of responsibility."
This ......," Dr.
Yang stepped back."
Old Shi, I don't dare to do this.Dr.
Zheng was immediately promoted to the main doctor, and Xiao Huang would only be a year or two at most.It's easy to check them now, but in another five, seven, or eight years, they will be promoted to deputy high to check on me, and at that time, at that time, ......
""Lao Yang, can you still have a little bit of interest?"
Why don't you want to be promoted to deputy high school before Xiao Zheng enters the deputy high school?
Let me remind you again, that is, if you don't check them now, when Xiao Huang is promoted to deputy high school and even becomes the director of urology, won't he check you?
”"I, I'm ......"
Dr.
Yang was embarrassed.He has never even been a group leader in his life.He has always been "managed" by others, and has never been "managed" by others.Take the qualification certificate of interns, one is for teaching fees, and the other is for face.This year's interns are the only group he has managed.To care about Xiao Huang, who has a better future than himself, he doesn't dare."
Lao Yang, if you don't want to shoulder this responsibility, I will find Dean Chen tomorrow and ask him to quickly introduce the person in charge of the Department of Urology, or return you and Xiao Huang to the emergency department.No matter what Dean Chen will do in the end, I will not allow you to continue with your current state.Think about it tonight and tell me tomorrow morning at nine o'clock. ”After Director Shi said this, he patted Dr.
Yang on the shoulder and said in a heavy tone: "Old Yang, I have only been here for a year and a month, and I, the director of cardiothoracic surgery who has only been in the department for a long time, cannot afford a medical accident with insufficient sense of responsibility in the department.Alas!
Lao Yang, I have always regarded you as a friend.You also know that when I came to the provincial capital, although I returned to my roots, I also failed to compete for the director of cardiothoracic surgery in the medical school.If there is a liability accident in the department I am in charge of, it will inevitably make people who did not approve of me being the head of the department gossip in the first place.Can you understand me?
”Dr.
Yang nodded."
So, if you are embarrassed, you tell me the truth, we can discuss, but you can't afford not to take on the ward rounds of the attending doctor.At least once a week. ”() The distance is a bit far