Auto chess in the operating room

Chapter 70 Purdue
Tang Lou's handsome and tall body was pacing in the empty room, talking eloquently:

"The initial goal of resuscitation is to keep the patient alive while ameliorating clinical deterioration, and diagnostic-grade treatment for the underlying cause can be delayed. Initial medication or other treatment takes minutes to take effect, so a second assessment requires a wait of several minutes. Do not be anxious."

Tang Lou smiled slightly at the camera: "Of course, while treating patients, we must also pay attention to the safety of the medical staff, and wear gloves and protective clothing."

"In the emergency department, patients who often encounter crisis, if the patient is conscious, ask the patient what is uncomfortable. If the patient has lost consciousness, then shake and shout loudly, what's wrong with you, what's wrong with you. If the patient can only Saying simple sentences means that there is a problem with breathing, and if the patient does not respond to external stimuli, it is very dangerous, and the patient may die at any time."

When Tang Lou was narrating, in the review room, everyone thought of the fainting patient on foot in the eighth room. If he had known the procedure in the first scene, he would not have panicked.

Combining the cases in each room, everyone suddenly discovered that Tang Lou's grasp of the emergency procedure is very practical and has reference value.

"I admire that after just a few wards, we were able to come up with such a systematic, detailed and rigorous emergency procedure. Tanglou is really amazing!"

Among the judges, another one put up a 10-point sign.

"If the patient is unconscious, unresponsive to external stimuli, and breathing abnormally, touch the patient's pulse. If there is no respiratory pulse, perform cardiopulmonary resuscitation immediately."

"Early detection of vital signs, fast connection of finger oxygen, ECG monitoring, non-invasive blood pressure monitoring, establishment of venous access as soon as possible, and blood samples for related examinations at the same time."

After finishing the overview, Tang Lou began to introduce each step separately:
Airway, airway is life.

Airway obstruction is very urgent and requires professional treatment. If it is not treated in time, airway obstruction will cause hypoxemia secondary to brain damage, kidney and heart damage, cardiac arrest, and even death.

Airway obstruction manifests as paradoxical movements of the chest and abdomen.
The airway is completely obstructed, and there is no breath sound from the mouth and nose.

Partial obstruction, decreased breath sounds and often marked inspiratory stridor.

Some simple means can reopen the airway, such as pressing the jaw and lifting the chin to relieve the tongue from falling back, suctioning the airway secretions, and establishing an oropharyngeal or nasopharyngeal artificial airway, such as an oropharyngeal ventilation tube and a laryngeal mask.

Endotracheal intubation is mandatory after the above measures fail
Listening to Tang Lou's various countermeasures, the eliminated contestants in the review room were all blushing and yearning for it.

It turns out that when judging a patient's condition in the early stage, there are so many indicators and steps.

If they could master these, how could they be eliminated early? In their minds, they recalled the scenes in the previous rooms. If they knew these steps, how could they not even know where to lose points.

"To be able to stand in the ninth room is really due to a deep background and a calm mind. Tang Lou is so amazing, I am convinced!"

Wu Qian also admired Tang Lou a little bit, he deserved this ranking.

In the front row, Diao Xiwen touched his chin and suddenly said:
"After sorting out this paragraph of Tang Lou's discussion, I think I can publish a paper on the clinical promotion and application of the ABCDE emergency procedure. It is very instructive for emergency physicians."

"Yes, the level of this discussion is very high. It would be a pity if it was only placed in this training camp."

"The thesis belongs to the thesis. I think Tanglou's summary can be recorded in our training camp. After we make further supplements, we can publish it as a guide book for the training camp."

Yang Xiaodong touched the gold-rimmed glasses. This process really fits the tone of the training camp.

"Great!"

Niu Bolin also nodded: "I'm going to copy the performance video of this room in the Tang Building and show it to the young interns in our courtyard."

"Director Leng, what do you think?"

Cheng Jian looked at Calm beside him. The latter sniffed and didn't speak. He reached out and flipped the scoreboard on the table to 10 points.

After calming down, he turned his head and looked at Cheng Jian: "So far, it is the best performance I have seen in the emergency training camp, and it can even be recorded in the memorabilia of the emergency training camp. The ABCDE emergency treatment process is very good! Before I take it back Comments, this young man from Tanglou deserves full praise!”

In the following time, Tang Lou discussed in detail:
Circulation (C) cycle
For most medical and surgical emergencies presenting with shock, priority is given to hypovolemia as the most common cause until other causes of shock are identified.

In any patient with a cold extremity and a fast heart rate, give a crystalloid bolus immediately.

For patients with surgical shock, quickly determine whether there is active or occult bleeding
Observe the color of the patient's palms and toes: cyanotic, pink, pale, or mottled
Palpate the skin temperature of the patient’s hands: cold or warm
Firmly compress the patient's fingertips at or above the heart level for 5 seconds to make the skin or nails pale.

After the pressure is released, observe the time for the pressed part of the skin to return to the color of the non-pressed side. The normal CRT time is less than 2s. Prolonged CRT suggests peripheral hypoperfusion.

Under the condition of inhaling air, oxygen can be given when the pulse oxygen is lower than 94%.

Morphine analgesia, slow intravenous injection, to avoid excessive sedation and respiratory depression.

For every minute Tang Lou said, everyone in the venue agreed with him by one more point, and all the judges in the audience have scored 1 points!
As for this score, no one was in the mood to be surprised, and everyone listened intently to Tang Lou's explanation.

All players who have been through the ward and been eliminated have learned a lot from this discussion.

"If I had obtained such a document earlier, I think I would have survived the first eight rounds."

"Yeah, it's an encyclopedia of emergency department coping."

"I have turned on the recording on my mobile phone. From now on, my good night god will change from Guo Degang to Tang Lou!"

Tang Lou lost the will to win the game as he talked, because this is the perfect response process organized by the emergency department (three stars, 9) system, which covers almost all the situations that the emergency department can encounter.

Tang Lou hopes that his discourse can really go out of this ward, so that more doctors can hear, learn, and benefit from it.

It is hoped that more patients will benefit from it.

Disability (D)Disorder of consciousness
Common causes of disturbance of consciousness include: hypoxemia, hypercapnia, cerebral hypoperfusion, recent use of sedatives, narcotics, etc.

Check pupil size, whether both sides are equal in size and circle, and light reflex.

Rapid assessment of the patient's level of consciousness using the AVPU method:
States of alertness to the outside world, such as mutism, apathy, lethargy, delirium, mania, agitation;
Response to speech; no response to painful stimuli or all stimuli.

GCS scoring and Glasgow scoring can also be used.

For patients with impaired consciousness who have a tongue drop or oral secretions, the patient should be kept in a lateral position to open the airway and allow the secretions to flow out.

While Tang Lou continued to output, the interns in this room were all deeply imprinted in their minds, and many of them would never forget it throughout their careers.

The directors in the front row have also confirmed their years of experience, and they are also thinking about how to integrate years of clinical experience into this emergency procedure.

Especially Diao Xiwen and Niu Bolin, two veterans from the emergency department, took out their reading glasses and started writing and scribbling in their notebooks.

"What Xiao Tang said is very good, but I need to add some examples. The interns I supervised made real mistakes back then."

"It is most appropriate to put the previous cases in Xiazhou City here, so that they can be more impressive."

Exposure (E) Adequate exposure during physical examination
Fully expose the patient for a comprehensive physical examination while respecting patient privacy and minimizing skin heat loss

Tanglou finally finished the last paragraph of his argument. His mouth was dry, but he was very satisfied and didn't care at all how many points he got on this question.

Is there anything more wonderful in the world than sharing knowledge that may benefit one party to others who understand?

Tang Lou thought in his heart that one day, he would be able to redeem the treatment methods for cancer, diabetes, and tumors, and be able to share them with practitioners in this way. That might be the meaning of his Tang Lou's existence.

This is also the mission given to him by the system.

"System, I will work hard."

[It is detected that the hearts of doctors who are selflessly contributing to medicine are detected, and the reward is: Purdue once. After using it, all the open-minded and studious people present can better understand and remember this content, which will be unforgettable for a lifetime.Whether the host uses rewards. 】

"use."

ps: I wanted to simplify the boring first aid process, but some items are really useful.It should also popularize science, and everyone should also know the previous Zhejiang Satellite TV Gao Yixiang incident.So I bit the bullet and added it.

The above content is collected and organized from foreign journals, and the content is authentic and credible.

Alright, Mr. Reader, I’m asking for tickets~
Hehe hehe

(End of this chapter)