Li Min arrived at the department before half past seven and asked Xiao Wu, the nurse on duty, who said that Director Li's eldest daughter-in-law gave birth to a girl at 1 o'clock in the night."
Dean Chen said she looked like an aunt.""
That's good.Growing up to be a beautiful girl again. ”After asking if the night shift was okay, Li Min went to the obstetrics department and found that there were quite a lot of people in the Sun family, and after the small 4-person room was changed to a 5-person room, the people of the Sun family surrounded the hospital bed.Li Min looked at the pregnant woman who was sweating because of the airtight air, and retreated after taking a look.The family that watched other people's little grandchildren give birth to children was completely different from Liu Na at that time.Li Min sighed with emotion and slowly climbed the stairs back to the 11th floor.She returned to Corey, and this time Chen Wenqiang got up from the duty room.He went to the obstetrics department last night, and waited outside the delivery room with Administrator Sun and the eldest of the Li family.Seeing Li Min coming back, Chen Wenqiang asked her, "Looking at the child?"
”"Nope.The child is taken care of by the newborn.It will be picked up after the shift at 8 o'clock. ”"Oh."
Chen Wenqiang regrets Li Min.But he still said happily: "Looks like her grandmother and aunt."
The contours of the facial features are similar everywhere. ”"It's going to be beautiful when it grows up."
While talking, Dr.
Ma and the others, who had gone to eat in the cafeteria, came back.Chen Wenqiang nodded and said, "Let's go, go to the ward round." ”Chen Wenqiang is very satisfied with Dr.
Ma and the doctors who are waiting to live in the department for 24 hours and are to be transferred to the provincial hospital.Lu Kaiwen can also stick to Corey 24 hours a day like the two of them, and Chen Wenqiang is also very satisfied.So every time he makes a round, he reminds them of the issues they should pay attention to from different angles.But for the three interns, today was supposed to be their last day in neurosurgery, but except for the one brought by Li Min, the other two didn't show up."
What the hell."
After checking, Chen Wenqiang shook his head, and his disapproval was very obvious."
Usually I don't work hard enough.Knotting has not been practiced yet. ”Li Min comforted him and said, "Teacher, among the 40 interns in the Department of Surgery, at most 10 should be left."
It's definitely time to stay, and it's not yet our turn to turn around. ”"Hopefully.Anyway, I don't think it's as good overall as last year. ”After Chen Wenqiang muttered this sentence dissatisfied, he said to Li Min: "I'm going to my parents today, if you have to come over for something, you call me." ”"I'll stick to the standards.""
Hmm."
Li Min knew that Chen Wenqiang's mother had not been in good health since she entered the summer, and she was in and out of the hospital several times.But nothing went wrong with it.Director Zhao once said to Chen Wenqiang: "It's just old."
You're prepared. ”Therefore, Chen Wenqiang usually goes back to his parents' house whenever possible.And the standard of grasp that Li Min said is also to emphasize that he will not use unnecessary things to find him to come to the hospital.Chen Wenqiang left after the night shift, and Li Min took Lu Kaiwen and the interns to the 12th floor to make rounds.The two departments combined to have 8 doctors on duty, and Li Min thought that instead of waiting for something to happen and going to see the medical records in a hurry, it was better to prepare first when he was idle.I didn't go to the 12th floor for rounds for 6 days, and a few familiar old patients were discharged, and a few new patients were admitted to the hospital.Li Min focused on the serious patients last Sunday, as well as the two who were newly admitted to the hospital and had surgery.After checking around, Li Min said to Lu Kaiwen: "Xiaolu, if you go to the 11th floor, you won't go to the 12th floor in general."
You take the time to grasp the diseases on the 12th floor, and what treatment measures should be taken under what circumstances, first copy the notebook, and then take the time to memorize them.In the future, you may be able to use it when you work the night shift or go out of the emergency room. ”"Yes.Mr.
Li, I went to the 12th floor in the morning to see the medical records. ”"Okay."
The intern who followed Li Min asked her, "Teacher Li, what about me?"
”"You come back to the 11th floor with me."
Li Min took the intern downstairs.As she walked, she said, "You're going to move to the 12th floor tomorrow to continue your internship."
If you don't want to do neurosurgery in the future, this two-week internship will be the only opportunity you will have in your life to get involved in neurosurgery.Have you memorized all the medical records and work notes I asked you to copy?
”"Remember.""
Then you can take a look at Corey's treatment for those traumatic brain injuries today.Write down what you can't call in a notebook, and you may need it in your future work. ”"Yes."
Li Min returned to the 11th floor, where Mu Jie was already waiting for her.* handed over Mu Jie to Director Hu, and didn't wait for Li Min to see Mu Jie on the machine for inspection.The nurse on duty in the radiology department came to look for her."
Director Li, the nurse in your department called and said that there is a female patient with impaired consciousness in the emergency department, so please hurry over.""
Good.I'll go over it.Director Hu," Director Hu immediately said: "You can rest assured to go to the emergency department, and I will carefully check your Mu Jie." ”Li Min beckoned to Mu Jie and turned to go to the emergency room.The female patient was emaciated and did not look very good.There are red and swollen marks of bruising on the forehead, but the person is awake.When she saw that Li Min was young, she said to Dr.
Liu, who was on duty in the emergency department, "I'm fine, I'm going home." ”Dr.
Liu said to her, "Don't look at her young.You look at her badge, she's the deputy director of neurosurgery. ”Then Dr.
Liu said to the patient's husband: "It's not the first time she has been knocked down, so it's better to do a careful examination."
No one can be unconscious for no reason.Isn't it?
If there is something in the head, it can be treated in time if it is detected early. ”The patient's husband rubbed his hands and replied, "We have been hospitalized here, and Director Tan diagnosed that it was renal insufficiency caused by polycystic kidney disease.I did a lot of examinations, CT and imaging, took a lot of medicine, and spent a lot of money, and now I don't have blood in my urine, but I have a headache. ”Li Min interjected and asked him, "Did you bring the discharge diagnosis?"
”The man pointed to Dr.
Liu's right hand, crumpled a roll and said, "Bring it."
It's in the outpatient medical record. ”Dr.
Liu unfolded the outpatient medical record, and while flipping, erasing, and trying to smooth out the medical record, he said to Li Min: "There have been no patients in the emergency department this morning, and I heard just now that I was injured because I suddenly lost consciousness and fell, so I asked the nurse to call you." ”Li Min sat down at the desk opposite Dr.
Liu and stretched out his hand to ask for the outpatient medical records.But looking at what Dr.
Liu meant, he wanted to read it himself and then give it to Li Min, so Li Min didn't insist on it.It's not bad for a while.Li Min turned back to ask the woman who was sitting up on the treatment bed."
Did you have any unusual sensations before you lost consciousness?""
Hmmm—headache.Suddenly," the woman touched the back of her head with her hand, and said, "Suddenly it hurts like a pinprick inside."
I didn't sleep well last night. ”"How many times have you been in pain?""
It's only three times this time, it seems like four times.""
How long does each one last?
I mean head pain. ”"The first time it seemed like a moment.But after the second headache, it was faintly painful.However, you should take painkillers in succession.As soon as I stopped taking the medicine, my head hurt. ”The man interjected on the side: "How can you rely on painkillers?"
”Makes sense.Li Min saw that the man ignored him and continued to ask for a consultation."
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Then how many times have you had a headache, how many times have you lost consciousness?""
Except for the first time, I was in a trance, and I fell down the next few times.But this time I knocked my head. ”The woman moved uneasily and said to her man, "Go buy me a bottle of soda, I'm so thirsty." ”Li Min saw that she wanted to break away from the man, so she followed and said, "I'm here to accompany her, and I may not be able to finish the inspection when you come back." ”The man looked at Li Min's protruding belly and said politely, "That's bothering you." ”He went out in a brisk.Li Min stood up, walked to the diagnosis and treatment bed, and asked her in a low voice, "Is there urinary incontinence?"
”The woman blushed and nodded silently.Then he bit his lip and thought for a while, and when he saw that Li Min looked like he wanted to ask the end of his concern, he said in embarrassment: "It's been getting more and more frequent since the summer vacation."
At first, I thought it was because I was tired of teaching small classes at home.Because I'm angry and anxious, I can't control myself.I now have to pad sanitary napkins every day, otherwise I will pee my pants once I am in a trance.I don't want to let him know. ”The woman didn't want her husband to know her true condition, and Li Min nodded in understanding."
And when did you start experiencing this?""
It was there before the last hospitalization.Director Li, do you think I'm showing symptoms?
”Without waiting for Li Min to answer, Dr.
Liu called her."
Doctor Li, look at this medical record, what Professor Tan writes behind is in English."
Li Min took the medical records, and the discharge diagnosis was all in confusing English except for one "renal insufficiency caused by polycystic kidney".Even if you are careful to distinguish what is written, it is difficult to recognize what is written.It can even be said that the entire discharge summary is scribbled and has a tendency to drive people crazy."
You're an English teacher?"
In this case, unless the patient himself asks for it, Director Tan of the Department of Urology will not do this."
Yes.I teach English in the second year of junior high school. ”Li Min carefully spelled out the word a few times before she caught Bourneville, she slowly spelled out the word, and asked the woman, "Did Director Tan say it was this disease?"
”The woman nodded and said, "I did a brain CT, chest and abdomen CT, and an MRI examination." ”"Do you know what disease you have?
Do you understand what Bourneville, or tuberoussclerosis, means?
”"I know.Director Tan told me everything. ”Li Min took out a pen and wrote down the woman's name, the medical record number of the hospitalization, the date of hospitalization, and the number of CT, MRI and other examination films.Then he said to her, "Then you should go to neurology now for regular anti-epileptic treatment."
Otherwise, the risk of falling at home is smaller, and if you are outside, it will be difficult to say. ”The woman smiled bitterly and said, "I want to take medicine every day."
But I don't want to let anyone know I'm sick. ”"You go and buy a few bottles of vitamin C, or vitamin E, you want a whole bottle.You put the anti-epileptic drugs in it.But you have to put it away and don't get eaten by the children. ”"Okay.""
Do you know the outcome of this disease?""
I know.I checked the information and there is no treatment yet.My daughter has just started junior high school, and I have to hold on until she goes to college, preferably college. ”"Your daughter doesn't have any symptoms?"
Li Min asked worriedly."
She's fine now.I also got sick after the Spring Festival this year.If it weren't for the blood in the urine and being hospitalized, I wouldn't have known I had this disease.I knew I wouldn't get married and have children. ”"But your daughter is fine at the moment, you're in luck.""
yes.A blessing in misfortune. ”The woman stopped talking and reached out to the door.Li Min turned around and saw the man coming back with a few bottles of wet Coke.He was breathing a little hard because he was walking too fast."
Frozen.Director Li and Dr.
Liu, you two also drink a bottle to cool off. ”Dr.
Liu took the Coke bottle and pried it open in the corner of his desk.Li Min refused: "I don't dare to drink Coke."
I'm afraid of eating cold and uncomfortable. ”The man was not reluctant.He asked Li Mindao, "Director Li, do you think my daughter-in-law is sick?"
”Li Min grabbed the outpatient medical records, turned a blank page, and wrote them in flower-style letters."
Director Li, what is her illness?"
“autosomalrecessivedisorder。
Bourneville。
Epilepsy。
”The man's performance obviously didn't understand, but he saw that Li Min was writing with his head bored and didn't want to explain to himself, so he asked Dr.
Liu: "What do you mean?"
”Dr.
Liu had already guessed from the words anti-epileptic drugs Li Min said that this woman's illness was not simple, so he said: "I am an orthopedic major, and I don't know anything about what is going on in my head, otherwise why would I ask Director Li to come over."
Just listen to it. ”Li Min only wrote a few lines, then handed the medical record to the woman and told her: "There is no outpatient doctor in the neurology department today.Tomorrow morning, remember to take your medical records to the neurology department, because our neurosurgery department generally only accepts patients who have to do craniotomy. ”"Dr.
Liu, I prescribed her a one-day dose of diazepam, 40mg orally.You cover the poke. ”Li Min pushed his signed prescription to Dr.
Liu."
Okay."
Dr.
Liu took out his red rubber print."
Thank you then."
Li Min took the prescription back and handed it to the patient."
You go home and take your medicine and go to sleep.Anyone who doesn't sleep well can have a headache. ”The man asked Li Min suspiciously, "You can't prescribe medicine?"
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”Li Min poked himself on the button of his white coat and pulled it out for the man to see.Explained to him: "I am the doctor in the ward, not the time when I go out of the clinic, and the outpatient pharmacy does not recognize it."
You look at the emergency department, you have to be prescribed by the emergency department. ”The woman thanked her repeatedly, and she dragged the man out of the consultation room.The man took the soda bottle that Dr.
Liu had drunk back, and said with a smile: "There is a deposit." ”"Uh-huh, I know."
Dr.
Liu answered and said casually, "Thank you." ”When the two of them walked away, he asked Li Min: "What is her disease?"
”"Tuberous sclerosis, also known as tuberous sclerosis."
Li Min saw that he didn't seem to know about this disease, so he said, "It's an everchromosome dominant disease."
But some people will be asymptomatic for life.It mainly affects the central nervous system, skin, and kidneys.Onset may occur as early as two or three years of age, and seizures are usually accompanied by intellectual disability.You see that she can be a foreign language teacher, and she only got sick when she was 40 years old, which is obviously very lucky. ”"Then her daughter said it was fine......
"Maybe it's really fine."
After all, there are a few people who do not get sick for life. ”Li Min smiled and said to Dr.
Liu, "I'll go back to the ward." ”Dr.
Liu followed Li Min to the corridor of the emergency department."
What's wrong with you?""
Where are you driving at the North Gate this morning?""
yes.What's wrong?
”"Nothing.I just listen to other people, just ask you.Did you drive it back?
”"Hmm.""
The first copy of our provincial court.""
He fought for his life in Laoshan, and he was also the only one in the provincial court."
Li Min replied simply, turned around and left the emergency department.* Li Min walked back to the ward or to the fork in the radiology department, and without waiting for her to make a choice, Xie Xun walked over from the ward with the rotating newcomers and interns.He beckoned Li Min and said, "Senior sister, go, go to the emergency room." ”Li Min had no choice but to turn around and follow his footsteps and ask, "What's the matter?"
”"A patient in the Department of Internal Medicine.At around 2 or 3 o'clock in the night, I had persistent pain in my upper abdomen, and I called an ambulance at 5 a.m.After the acute abdomen is ruled out on the outpatient basis, anti-inflammatory treatment is given according to gastroenteritis. ”Xie Xun slowed down and waited for Li Min to catch up with him before he continued: "Do you know omeprazole?"
”"Yes.Proton pump inhibitors.A medical representative came to Cory to deliver the information.This medicine hasn't come into our hospital yet, has it?
”"Didn't officially come in.But a trial was granted.The patient took omeprazole orally. ”Xie Xun's eyes were full of excitement."
The pain in my abdomen went away after taking it, but it got worse again after two hours.""
Is it a probationary application from the Department of Gastroenterology?""
Hmm.Director Qian and Director Xiang jointly proposed it.So the emergency department is also used. ”Li Min understood Xie Xun's excitement.The new drug is advertised as having a strong and long-lasting inhibitory effect on histamine, gastrin, acetylcholine, food, and gastric acid secretion caused by the vagus nerve.The key is that the product is advertised as having no side effects, and the phase 3 and 4 clinical trials have shown that users are well tolerated.Double-blind controlled trials have shown significant efficacy in gastric and duodenal ulcers and reflux esophagitis.This medicine is not only used by patients with ulcer disease in gastroenterology, but also in gastric and duodenal ulcer surgery in general surgery to prevent ulcer recurrence; Other major surgeries also deal with stress ulcers.On the 11th floor, after craniotomy, patients are routinely given intravenous gastric acid suppressants during the period of fasting with water.If this drug can achieve the effect of product promotion, even if it can only reach 80%, Li Min is willing to try it for half a year.If omeprazole is more effective than cimetidine, Li Min is willing to change the drug to the patient.But when a new drug enters the provincial hospital, there are strict procedures to go.The director or deputy director of the relevant department shall submit a new drug trial application report, and the Pharmaceutical Affairs Committee shall discuss and approve it, and then the clinical trial shall be conducted for 3 to 6 months in the department where the application is made.If the feedback is good during the probationary period, you can officially enter the provincial hospital and allow other departments to use it normally.If the feedback effect is not good, it is basically impossible for the drug that failed the trial to officially enter the provincial hospital.Feedback is collected by the Pharmacy Department on a prescription from the patient.It may be asked during hospitalization, before discharge, or more likely after discharge.Director Fan personally grasped this part and has been grasping it very tightly.This is also the fundamental reason why the provincial hospital has not seen new drugs continue to enter the hospital in recent years, but there have been no adverse reactions of new drugs in clinical practice.In order to enter the provincial hospital to test the drug, Xu Qiang deliberately told Li Min the background of this drug.Although the drug has not yet received the official approval of the ministry, it has been allowed to select several tertiary hospitals in China as test sites.The provincial institute was selected as one of the test sites, which was facilitated by Xu Qiang's finding and facilitation by Astra's agent in China."
Senior sister, the cost of this test is very high.It's more expensive than all the drugs I've represented in the past.It's really worth your involvement. ”Xu Qiang told Li Min the data."
Multinationals are willing to spend money on this.Moreover, the drugs provided in the trial are free of charge, and the hospital can charge at a temporary price.But for clinical doctors, there is no shortage at all. ”Seeing that Xu Qiang had confessed to himself, Li Min also told Xu Qiang: "Don't point to Dean Chen to apply for this medicine." ”"Senior Brother Xu, no matter how good the manufacturer's promotional materials are, they are not clear about the side effects and contraindications of the yellow race.The specific dosage can only be used as a reference, because the test data obtained from Caucasian people may not be suitable for us yellow people.This racial difference leads to a difference in the dosage of the drug, and you know that exists.Once something happens to this drug during the clinical trial, what I tell you is that once someone else applies for the drug, there will be nothing wrong.But if Dean Chen mentions it, it will definitely not be easy to pass.If Dean Chen is implicated, a large number of people in the surgery department will eat you raw.If you are in the provincial court, there will be no market at all.You might as well wait for the results of the test feedback, and when the medicine is discussed, please ask Dean Chen to vote in favor.He was the medical director, and that vote was decisive. ”Xu Qiang may know better than Li Min about the composition of the various surgeries in the provincial hospital.He understood that Li Min's words were defending Chen Wenqiang, but at the same time, it was also for his Xu Qiang's good.He turned his attention to gastroenterology with kindness.The trouble is a little troublesome, but Director Qian is easy to overcome, Director Fan used money to open the way, and he made the provincial hospital one of the new drug test sites as he wished.Li Min didn't know that he could still convince Director Xiang.Xu Qiang is really not ordinary.* Li Min followed Xie Xun back to the emergency room.In the observation room of the internal medicine department, I saw the middle-aged man with a painful face.The emergency medical record is too sloppy and too simple, almost as Xie Xun introduced, well, there is an extra past history: cervical spondylosis.However, under the questioning of the new rotation doctor this year, the patient's past history was more than half a year ago, no obvious trigger for breath-holding, no chest tightness, chest pain, no cough, sputum production, infusion treatment in the district hospital for a week, improved and discharged, the specific medication is unknown.If you ask more carefully, the patient does not start to have epigastric pain at two or three o'clock in the morning.Instead, three days ago, the symptoms of breathlessness worsened, accompanied by fatigue, unable to lie flat at night, abdominal distention, abdominal pain, intermittent cough, coughing up a small amount of white sputum, pain and chills in the left lower limb.After asking about the medical history, Xie Xun looked at Li Min: "Senior sister, what do you think?"
”Li Min pointed to the patient's left lower limb, but asked, "I'm here for a physical examination?"
”Xie Xun shook his head: "Let the intern check." ”Patient resistance.Xie Xun "persuaded" him with a stiff face and could not refuse: "The provincial hospital is a teaching hospital and has teaching tasks.Don't look at me and Director Li both wearing deputy director badges, but we are also interns.Any doctor in the provincial hospital is an intern.If you don't agree to have your intern checked, you should go to a non-teaching hospital. ”The person who accompanied him immediately played a round and said, "Director Xie, don't be angry, he just feels uncomfortable, and the pain is unbearable." ”"Hmm.I'm not angry.You have a careful and careful examination. ”The intern stepped forward and reported while checking: "Heart rate 105 beats, rough breath sounds in both lungs, no dry and wet rales, flat and soft abdomen, positive subxiphoid tenderness, no rebound tenderness, no renal percussion pain."
The skin temperature of the left calf is slightly lower than that of the right, and there is no puffiness in both lower limbs. ”This is also the result of the rotation student's re-examination.A positive sign is a subxiphoid tenderness.Xie Xun said, "Let's go, go back to the office." ”The emergency physician who followed showed the existing examination results to Xie Xun and Li Min.Chest x-ray: patchy opacities in both lungs and thickening of bilateral pleural adhesions.CT of the lungs is recommended."
Did you do a lung CT?""
I did.The film didn't come, but the phone call gave the result, which was consistent with the chest X-ray. ”The test sheets were passed from Xie Xun to Li Min, and then passed to the two young men.The electrocardiogram was normal, and there was no abnormality on abdominal ultrasound."
Senior sister, what do you think?""
I recommend rechecking the ECG, blood and urine routine, biochemistry, cardiac enzymes, blood urine amylase, lipase, liver and kidney function.It's been a few hours, and maybe after the window, these biochemical indicators will change.There is also no D-dimer in the morning, and coagulation is three things to be checked.Because the patient has pain and chills in the left lower limb, there is no explanation.If there is a vein thrombosis in the left lower extremity......
"Director Li, what do you suspect?"
”The emergency doctor asked."
Pulmonary embolism.""
How is that possible?""
How could it be.The first diagnosis of acute gastroenteritis is definitely wrong.Heart rate 105, how do you explain it?
The left lower extremity complained of pain, and the examination did not have an accurate tender point, but the skin temperature was lower than that of the contralateral side, which could not be explained. ”※※※※※※※※※※※※※※※※※※※※ suddenly found that it was written like this, and it would ...... () The distance is a bit far