Xue Huan, the boss of the Department of Neurosurgery, said expressionlessly: "He now has a large amount of subdural hematoma!"
"The operation must be performed immediately, otherwise he may be brain-dead on the spot!"
There are only two situations of brain death!
One is complete physiological death, and the other is vegetative state.
"No family members, no payment! Do you want to get the general duty authorization?" the doctor in charge also asked directly.
"Hit him! Call the person who brought him here as soon as possible to contact his family."
"Can't delay."
"At least I have to open a window in my head to decompress my head no matter what."
"Contact the anesthesiology department and ICU and be prepared for anesthesia and tracheostomy at any time." The chief resident of the Department of Neurosurgery just gave his own advice.
"Where is the medical record? I'll write a consultation opinion first."
…
The doctor in the emergency department without a badge finished the call: "The general on duty has authorized it, you go back to the operating room first!"
"I will send the patient here immediately. The first four items of blood transfusion and blood type will be drawn as soon as the patient arrives. The coagulation function is currently meaningless, and it is estimated that it will take some time. We will follow up during the operation."
"I just need to trouble you to arrange for someone to contact the blood bank to prepare blood."
"I'm really too busy here."
Hearing this, only Shenwai Xue Huan, who had already finished writing his opinion, hurried back!
Neither Zhou Cheng nor Chu Lin from the Department of Thoracic Surgery moved a single step.
Just stare at that medical record!
Write your opinions slowly and calmly.
Help is help, you have to complete your own tasks.
In an emergency consultation, there is no consultation opinion. In the end, it is the people who have to be held accountable. It is not Zhou Cheng and Chu Lin who are pretending to be arrogant. This is the hospital's rule.
If the emergency department is overwhelmed, call someone.
Their specialized doctors also need to talk and sign, etc.
When the doctor in charge saw this, he could only say helplessly, "Forget it, classmate, help me make a phone call to the blood bank. They say that a large amount of blood is needed in the emergency! Then contact the anesthesiology department for emergency consultation!"
Wang Huan was pointed out like this.
Wang Huan was a little stunned and looked at his teacher Zhou Cheng.
After saying that, he hurriedly ran out to contact the kind person who brought the patient.
But wait until he goes out!
The good Samaritan is no more.
By sending the patient to the hospital, that person showed his kindness.
You can't ask him to pay money either.
He didn't curse anything, and quickly returned to the computer again to quickly open the doctor's orders and materials with various conversations and signatures...
After Chu Lin finished writing his opinions, he immediately handed the medical record to Zhou Cheng and said, "Brother Cheng, we meet again!"
"You two brothers seem to have a lot of luck together."
In medical institutions, the first-diagnosis responsibility system and the consultation system are both core systems.
Among them, the first-diagnosis responsibility is to avoid pushing the patient to run here and there.
The essence of the consultation system is actually to collaboratively diagnose and treat conditions!
Leave specialist issues to specialist doctors to handle,
It is absolutely correct that this patient needs emergency surgery!
However, if Zhou Cheng and Chu Lin did not write consultation records, except for any related department issues, there would be no consultation records and opinions.
No matter how perfect you are on the operating table, no matter how hard and tiring you are, if you make a mistake in the first step, it is all fake and you are completely responsible for it!
If the program goes wrong, it will be very troublesome.
Basically, people who have been attending consultations for a long time will not make mistakes, but they do not rule out meeting some newcomers and stubborn people.
Or people who are not familiar with the core system are often taken over in this way.
For example, who of them made a phone call just now?
Then something went wrong with the patient.
It can range from being fined and interviewed, to the more severe being revoking the qualification to practice medicine.
This is the biggest difference between being a doctor and being a student.
If you practice alone and are responsible alone, you need to take full responsibility for what you do.
Unlike when you are a follow-up physician or a bedside physician, the senior physician is generally responsible.
These are all aspects of growth on the road to becoming a doctor.
Sometimes you have to be cold-blooded and reject some things in order to survive well. Otherwise, what you are waiting for is the word "suicide".
Therefore, even if their condition is extremely urgent, Zhou Cheng and Chu Lin can only finish writing the medical records first, and then call someone to arrange surgery and other matters.
Zhou Cheng finished writing it quickly and then started to call the doctor on duty in the trauma surgery department!
Ask him to prepare the consent form for emergency surgery. He will go up to get it later. He must prepare it...
Wang Huan was in a daze, so Zhou Cheng asked her to help.
Zhou Cheng only needs to be responsible for conversations related to the Department of Orthopedics. He does not need to take care of other departments at all and cannot control them.
However, since I don’t have any family members now, I can only call the chief on duty for authorization first!
After you step down or your family members arrive, sign in as soon as possible!
Zhou Cheng quickly finished writing the consultation record and handed it to the elder brother in charge of the bed. He said, "Teacher, please send the patient to the emergency operating room. I will prepare the materials. If the family members come later,
Got it!"
"I've already called the blood bank and the anesthesia department."
"Please also ask him to be at the door of the operating room. We will talk to him then."
"Thanks for your hard work."
After Zhou Cheng said this, he ran to print the materials.
The computer is connected to the Internet. If the doctor on duty at the trauma surgery department is ready, he can print directly here.
And just then!
However, there were voices about him coming from the outpatient clinic outside the emergency care unit.
"Another patient with trauma from a car accident came in. He seems to have a dislocated hip joint."
"Calling for an orthopedic emergency consultation. Orthopedics has a resident doctor in our emergency department."
This seems to be what a doctor outside is saying to a subordinate or a nurse!
However, someone outside said: "Dr. Liu, it seems that the general hospital of orthopedics is in our emergency department."
"The patient in bed 3 has multiple injuries all over his body."
"It's quite serious. This?"
Dr. Liu said: "Then go and pull out the film and ask him to take a look."
"This patient has no skin trauma for the time being. I will explain it to the patient first, and then listen to what orthopedic treatment needs to be done. I will then check to see if there are any injuries to his chest, abdomen and head."
"If necessary, call other CEOs of the orthopedics department."
Two overarching principles of emergency medicine.
Save your life first.
The bottom line is to save your life!
"Okay!" The nurse walked in quickly.
After hearing this, Chu Lin smiled and said: "Your orthopedics department is quite popular, here comes another one."
"Brother Cheng, I'm going to go first and go to the operating room in advance."
Zhou Cheng nodded, and before he could say anything more, a nurse from outside the door walked in.
"Are you the chief resident of the Department of Orthopedics? Dr. Liu from the outpatient clinic asked you to take a look at this film. It just came out. The patient's feet are very swollen and he can't move. Do you have time to take a look?" The nurse in green clothes walked up to Zhou Cheng.
!
After speaking quickly, he pointed at the computer at the nurse's station.
The tone was quite polite.
There is a certain time limit for the development and printing of plain films, CT, MRI and other examinations, so each hospital will have an independent reading system. As soon as the examination is completed, the pictures can be read by computer.
However, this kind of film reading is mostly used for emergency patients, so that the doctor can understand the condition at the first time.
Most regular patients have to wait.
Most casual patients appear in outpatient clinics. How can any outpatient doctor have so much time to review the examination system for you?
The nurse just called Mr. Zhou Cheng to the hospital because she was not very familiar with the orthopedic doctor system and to avoid being polite.
She has to take care of at least a dozen emergency patients a day, and each patient even comes to see three or four doctors for consultation!
If every doctor was polite, she would be exhausted.
Over time, chief residents, teachers and doctors were used instead.
It’s not that I disrespect Zhou Cheng.
"Okay, I'll go take a look first. I don't know when I can go on stage yet." Zhou Cheng followed immediately.
When I came to the computer and took a look, a plain film was read out.
Posterior hip dislocation, looking at age, 54 years old, male.
This kind of medical record is very suitable for emergency manual reduction, but Zhou Cheng does not make empirical or operational errors.
One of the charms of orthopedics is manual reduction. There are many patients who are in great pain when they enter the hospital, and they can be restored through manual surgery!
It can immediately relieve the patient's pain, and some patients can even enter the hospital lying down and walk out in ten minutes.
However, empirical mistakes must not be made.
Zhou Cheng continued to look through all the layers of the CT, but found no obvious signs of fracture!
After reading it, he asked: "How is the patient's consciousness now?"
"Do you have a headache, chest pain, or abdominal pain?"
"If not, I will directly print a template for hip dislocation reduction surgery and send it to the operating room."
The nurse shook her head and said, "I don't have any headaches, chest pains, etc., but Dr. Liu and the others are still watching related films."
"I think you can prepare the consent form for the conversation first. If there are no problems with Dr. Liu, I will send you to the emergency operating room first."
"I'll call you after the anesthesia is over."
"Can this patient be sent to the emergency operating room?"
"Yeah! I also have a person here who will incise and explore to stop the bleeding."
"It may take a while. Just send me to the operating room and do spinal anesthesia. Then remember to ask Dr. Liu from the emergency department to tell the anesthesiologist and add some muscle relaxants. Call me later and tell me which operating room you want to go to.
I took the time to go over and do the reset." Zhou Cheng said calmly.
After posterior hip dislocation, muscle relaxants must be added because the pain will cause muscle tension behind the hip.
He was afraid that if he met an inexperienced anesthesiologist, he would lose his temper even if he said a few words.
"Okay!" The nurse in charge didn't ask specifically why, but she just felt that Zhou Cheng was a little pitiful!
Before the last emergency patient started, a new one came.
And it's very late to get to this point. Unless you call your superiors for help, no one will help you.
She was in the emergency room, and she had to ask about every order given by the doctor!
There may be many patients who have died.
Unless she can find a particularly serious mistake.
Of course, the chance of this was very small, so she just went ahead and executed it.
After this, Zhou Chengcheng was really busy. He quickly found a computer and printed out two consent forms for the surgery.
The surgery consent form only states the name of the surgery and the complications and risks!
The patient's basic information must be filled in by hand. Because the patient is not hospitalized, it cannot be uploaded to the medical record system.
One part was debridement and exploration, and the other part was manual reduction.
I originally thought that he and Wang Huan would prepare a patient's talk and signature alone.
After surgical reduction of the hip joint, Wang Huan asked Wang Huan to talk to his family before going to the operating room. What he didn't expect was.
Just when Zhou Cheng finished talking and was about to enter the operating room, another middle-aged couple ran in from outside.
Holding a crying child in his arms.
The child was at most three or four years old. One of his hands was drooped, and his mother was holding his hand. The child's face was crying, his eyes were red, and he was crying and feeling aggrieved.
The nurse immediately asked the man to register first and his wife to take the child to the clinic first.
The woman ran and shouted: "Doctor, doctor, look at my baby quickly!"
"He suddenly couldn't lift his hand. What's going on?" It could be seen that she was very anxious and wanted help impatiently.
There were three doctors in the outpatient clinic, and the one who received him was still the one without a badge.
When he saw the person coming, he looked at Zhou Cheng helplessly and said, "You want to take pictures first! How did you get hurt?"
"I took my baby shopping, so I pulled him!"
"I suddenly started crying and making a fuss."
"No matter how hard I hug or coax, I won't listen or speak. Doctor, what's going on?" She was so anxious that her hands were shaking and she didn't dare to touch her child.
The man could only look in the direction of Zhou Cheng: "Mr. Orthopedics, do you want to come over and have a look? Or should you come back later?"
"I write medical records!"
It’s not that he is lazy or shirking responsibility!
But since Zhou Cheng is here, naturally he has to ask Zhou Cheng's opinion.
Zhou Cheng listened to the medical history and basically had his own diagnosis in mind.
For radial dislocation, photos are useless and can be diagnosed basically through medical history and physical examination.
Zhou Chengcheng immediately put the conversation list on the table, then went up and touched the child's elbow.
The child was crying and hiding at the same time, and at the same time he retracted his right hand!
His fingers still wanted to grab Zhou Cheng, and he cried: "I don't want it, I don't want it. It hurts so much, I don't want it."
In fact, Zhou Cheng's hand had already touched his elbow, and his eyes had confirmed through his finger movements that there was no temporary nerve damage, and his hand could still be retracted, proving that the possibility of a fracture was unlikely.
Just confirm the tenderness at the radius.
And at the same time, just hold your wrist with one hand and your elbow with the other!
Press the radial head with your thumb and rotate the forearm from extension to flexion of the elbow joint to reset the dislocated radial head.
He said: "Kid, let me check again, just for a check, okay?"
The child looked at Zhou Cheng, who seemed to be holding her in a chokehold, making her unable to move at all.
He cried and nodded: "But I'm afraid of pain."
But just as he finished speaking, Zhou Cheng heard a slight click.
Zhou Cheng then bent the child's elbow until the elbow was very close to the upper arm!
He said: "It's already healed. Brother, could you please write a medical order and let the family members pay the fee?"
"I'm really too busy here."
"I performed a reduction of radial head dislocation, took an X-ray, and hung my forearm in a sling for a week."
Zhou Cheng just finished speaking!
The woman said: "Are you feeling better now? Don't hide it from me? Baby, are you still hurting now?"
"Do you want to do it manually?"
The child nodded: "It still hurts, but it's not as painful as before."
He moved his hands while speaking.
It doesn't seem to hurt at all.
The woman then said: "I thought something was wrong, but my baby turns out to be fine!"
"Baby, let's go! Let's go home."
Then she left. She met her husband who was about to come in and left the consulting room.
A minute later, there was an argument with the nurse at the registration desk.
Zhou Cheng frowned slightly when he heard this voice!
Then he sighed and said nothing.
It’s not like he has forgotten the diagnosis and treatment procedures and principles. He has three emergency rooms here at the same time, just because he is a child, and he is acting out of good intentions!
Liu Xuan said: "I rarely encounter such patients' family members in the emergency department."
"My name is Liu Xuan. I just entered the emergency department this year. I haven't been admitted to the general hospital yet. What do you call me the teacher?"
"It's too polite to call me teacher. You can just call me Dr. Zhou or Zhou Cheng." Zhou Cheng replied!
Then he said: "Dr. Liu, let's talk next time when you have time. I'm in the emergency operating room now, and there are two patients waiting for me. I haven't prepared any materials for the conversation yet!"
"Brother Cheng, you go and do your work first." Liu Xuan is the doctor on duty in the emergency department, and he works in shifts with people from other specialties who come to the emergency department.
Before Zhou Cheng went out, he hooked his fingers at Liu Xuan, and Liu Xuan understood the meaning and handed the little girl's medical record to Zhou Cheng.
Zhou Cheng could only quickly complete the emergency medical records.
This little girl actually needs to wear a forearm sling. Pay attention to her. If she is not cared for properly, the couple will come again.
Zhou Cheng had also encountered such a patient in No. 8 Hospital, but that patient was a middle-aged man.
Zhou Cheng really doesn't have time to be a good Samaritan anymore.
I left the emergency department in a hurry and went directly to the operating room. That emergency surgery was really an emergency...