I'm really an intern

Chapter 254 The Differences of Powerful Antibiotics

Why do you feel that this patient needs such a super-dominant treatment method from Shanghai Meiping Wangulian?

In fact, Zhang Tianyang himself couldn't tell.

It can only be said that it is "intuition".

In fact, clinical practice is often a place that relies on "intuition".

Experienced doctors, relying on their "intuition", can roughly guess your cause after hearing the symptoms, and can even guess the results of the tests you haven't done yet.

This kind of "intuition" may be called "experience" more appropriately.

But in fact, when the diagnosis and treatment are in trouble, and the existing examination methods and instruments cannot help the diagnosis, it is the "intuition" of experienced doctors.

Zhang Tianyang just thinks that this uncle should use it.

Really want to find out why.

"I think the patient's disease is progressing too quickly."

Zhang Tianyang gave an ambiguous answer.

In the system space, he has seen many such patients.

If something goes wrong, there must be a demon, and if the disease progresses too fast, there must be a problem.

He also once misjudged and did not use sufficiently powerful drugs, which caused the disease progression of the patients simulated by the system to be uncontrolled, and even resulted in death.

Based on those patients who "died" in the system, he also had to make his own choice.

In the end, Zhang Tianyang did not give any effective evidence, and the question was thrown back to the attending doctor.

To listen, or not to listen?

The attending doctor frowned, and recalled all the data of the patient's examination in the emergency department.

In addition to the CT two days ago, the patient also underwent almost a full set of blood tests.

Including but not limited to blood routine, infection indicators, liver and kidney function, etc.

The attending doctor pointed to the screen to confirm again.

"Xiao Zhang, you can see that the infection index of this patient is actually not high."

The normal range of ProCT is 0-0.05ng/ml, this patient is 1.5.

The normal range of CRP is 0-5mg/L, and this patient is 12.

Although there are elevated, but does not look serious.

Compared with the index of 78 beds, which often increases hundreds of times and floats high in the sky, it even seems very light.

The doctor in charge explained his point of view, "I don't think there is a need for such powerful antibiotics for this indicator, and the second echelon is more than enough."

But Zhang Tianyang still insisted on his own opinion.

"This is data from two days ago, which does not match the severity of the patient's symptoms now.

I suggest doing an emergency blood test right away and rechecking the relevant indicators. I think he just had another CT before he came, so call him to remind him, and he will see the latest CT results tomorrow morning.

But Meiping Wangu's plan should be used now. "

The voice fell, and there was a strange silence around.

Two big guys fight, horror.jpg.

In fact, the white coats who were onlookers understood.

The doctor's order is based on the patient's existing examination results, which is also the basis for most doctors to judge the condition.

Because the patient's indicators were not too far off the mark, the attending doctor felt that a slightly weaker antibiotic could be used.

The basis for Zhang Tianyang's doctor's order is that he believes that the current patient's performance does not match the examination indicators two days ago, and the disease progresses too rapidly.

So he felt that the most powerful antibiotics should be used.

In fact, in the final analysis, antibiotics are used, and the two achieve the same goal by different routes.

The problem is that the two people disagree on the severity of the patient's disease.

If the patient's condition is indeed critical, but weak antibiotics are used, there may be no way to contain the progress of the disease in time, which may lead to serious consequences.

But in the same way, if the patient's condition is actually just looking scary, but he has used too powerful antibiotics, then he will develop a certain resistance to the powerful antibiotics in vain. It will be much worse.

In both cases, it is possible to have a long-term impact on the patient's later life.

In fact, if you wait until tomorrow, when the blood test results and new CT results come out, it will be clear at a glance who is right and who is wrong.

But the problem is that patients need treatment today.

Where can I wait for tomorrow?

So, who do you listen to?

The white coats always felt that what the two of them said made sense, and they didn't know who to believe for a while.

He simply gave up thinking and turned his eyes to the attending doctor.

In any case, Zhang Tianyang is just an intern doctor. He has no right to prescribe, only to make suggestions.

The final decision rests with the attending physician.

Of course, the responsibility is also his responsibility.

The attending doctor frowned.

According to his usual personality, here he has the highest professional title and the richest experience. When there is a disagreement, he should definitely stick to his own judgment.

but this little Zhang

The performance of these two days made him put Zhang Tianyang in the same level as himself.

An intern jumped out and said, "Teacher, your judgment is wrong", he must have laughed it off.

But a colleague of the same level jumped out and said, "I think there may be a problem with your judgment", and he had to think seriously.

After thinking about it, he still couldn't make up his mind.

"In this way, you first prescribe urgent blood tests, liver and kidney function infection indicators, etc. for the patients, and ask the nurses to draw blood first."

The attending doctor decided to implement the consensus of the two first, and then turned to look at Zhang Tianyang.

"I still insist on my own opinion on this patient's condition, but what you said is also reasonable, why don't we go to the director for instructions?"

A new patient's doctor's order should go to the director's side, and there is no one else.

But Zhang Tianyang could only nod helplessly.

He also didn't want to confront the attending doctor.

However, in line with the attitude of being responsible to patients, if you have an idea, you have to say it.

Especially when there is disagreement.

Otherwise, the word "consultation" would not appear.

Isn't the consultation also a process in which everyone sits together, expresses their opinions on difficult and miscellaneous diseases, is finally convinced by a certain most likely guess, and then unites the front?

The director of the ICU touched his half and pulled the Mediterranean Sea, and listened to the opinions of the two people.

On the computer, I carefully read the results of various examinations of the new patient in the emergency department.

They were asked again about the performance of the two patients who had just been sent up.

Finally, I patted my head.

"As for the intracranial infection caused by this patient's lung infection, I agree with you."

"As for the specific antibiotics to be used, what Xiao Zhang said makes sense."

Director ICU's words made Zhang Tianyang feel relieved, but in the next second, the plot reversed.

The director of the ICU changed his tone, "However, there are guidelines for the use of antibiotics in our Dongfang Hospital. Xiao Zhang, you have also prescribed strong antibiotics, right?"

He even clicked on the doctor's order entry interface on the computer.

"You see, the background color of a normal doctor's order is light blue, but for a slightly stronger antibiotic, the background color will turn bright red."

"And after clicking OK, you need to check the conditions of use and enter the patient's inspection indicators."

"The country has strict requirements on the use of antibiotics, and all usage records will be reported. If you need to check in the future, you can find them at any time, so"

The director of the icu dragged out the ending and didn't say anything further.

But Zhang Tianyang already understood what he meant.

The current index of this patient is not enough to use the combination plan of Meping and Vanco.

In this case, if you don’t use it, even if the patient’s condition is worse than expected, or even dies in the end, and you have to file a lawsuit, it will not be judged that the medication was wrong.

Because it is indeed not enough to use the conditions.

But if it is used, even if the bet is right, the prognosis of the patient is good, but if the family members have impure thoughts, want to rely on medical expenses, and have to file a lawsuit, then the hospital can only suffer in vain.

Because although you have used the right medicine, you have no evidence to prove that patients need to take this medicine now.

After all, powerful antibiotics are still expensive.

From the perspective of the hospital, or even from the perspective of doctors protecting their own safety, they should choose the plan of the attending doctor and choose conservative medication.

What's more, the title of the attending doctor is more than 01:30 points higher than that of Zhang Tianyang.

On the surface, his experience far exceeds that of Zhang Tianyang.

Therefore, due to emotion and reason, the director of ICU should not stand by Zhang Tianyang, an intern.

Do you really want to continue to persist because of your "intuition" that you can't produce evidence?

Zhang Tianyang frowned, and was about to speak.

Over there, the ICU director spoke first.

"but"

(End of this chapter)