Back in 2002 as a doctor

Chapter 0115 Discuss Director Wang's Mistakes ([-])

"Xiao Zhou, it shouldn't be considered a difficult medical record." The head nurse forced a smile to smooth things over between Wang Chengfa and Zhou Congwen.

"Director Wang said——are you questioning my doctor's order? If you have the ability to be the director yourself, or shut up.

Finally, Director Wang said in front of the patient's family - didn't you always say to write a record of the course of the disease?Remember every word I said, it was I who decided to extubate. "

Holding the medical record in his hand, Zhou Congwen read it word by word.

"..." The head nurse was as if she had fallen into an ice cave, with her head lowered like a quail, not daring to say a word of nonsense.

This is not a medical record discussion, it is almost the same as Wang Chengfa held the head of the old director decades ago and threw them to the farm to feed the rabbits.

Retribution, this is all retribution.

"The head nurse's question is a good question. Let me share my thoughts." Zhou Congwen said lightly, holding the medical records in his hand, "First of all, according to the results of various tests, the extubation should not be extubated. This is my perception. Wang If the director has a different opinion, we can discuss it."

Zhou Congwen looked directly into Wang Chengfa's eyes and issued a heads-up invitation.

Wang Chengfa looked at the ground and said nothing.

A few seconds seemed embarrassingly years had passed.

"Facts have also confirmed this. The patient developed acute respiratory and circulatory failure 2 hours and 32 minutes after extubation." Seeing that Wang Chengfa did not answer, Zhou Congwen continued.

"Secondly, I don't think Director Wang Chengfa deliberately put patients in a dangerous situation. The director is simply not good enough."

"..." The head nurse almost didn't cry.

"..." Shen Lang almost didn't cry.

"..." Liu Di began to regret that he shouldn't be transferred to the thoracic surgery department at all.

A little doctor pointed to his nose and said that the director's level is not enough...

Wang Chengfa's face had already turned green faintly, what Zhou Congwen said was veiled in Yangqiu's heart, and every word was murderous.

And it's not the kind of killing that doesn't see blood, but an open fire, and the smell of blood has already spread in the office.

"Director Wang is the person in charge of the department, and even the person in charge is not qualified enough. I think this medical record is a difficult one. I'm done with the head nurse. Do you have anything to add?"

"Is democracy centralized? If you have a different opinion, just say it."

Zhou Congwen looked at the head nurse like a senior director.

The head nurse was silent, not daring to say a single unnecessary nonsense.

The depression in the office was severe, even worse than the day when Zhou Congwen slapped the textbook in front of Wang Chengfa and questioned him face to face.

Ten seconds later, Zhou Congwen took the medical records and began to report the medical history.

This is a normal process. First, the doctor in charge of the bed reports the medical history, and then everyone has to speak up step by step.

There are standard death discussions and preoperative discussions in the drawer of the case cart in the department, as long as they are copied according to the format.Face-to-face discussion, including Wang Chengfa, is the first time we have met.

This is not a hospital-wide consultation, but a discussion, criticism and self-criticism within the department, seeking technical improvement and avoiding similar mistakes.

Everyone understands the truth, but in fact Wang Chengfa's face turned red and then white, and finally turned green.

Zhou Congwen's every word is invisible... No, he pointed to Wang Chengfa's nose and said, you are not good enough!

"To sum up, extubation at 16:12 p.m. on the day of the patient's operation is debatable. Our future work must be more detailed to avoid irreversible damage to the patient."

After Zhou Congwen finished speaking, he raised his head, glanced at everyone in the office, smiled and remained silent.

Wang Chengfa's face was green, as if full of vitality.

Next...

No one in the office spoke.

Zhou Congwen was not in a hurry, he raised his legs, and was ready to record with a pen and paper in his hand.

He didn't urge anyone to speak out at this time, it's not good, Wang Chengfa has already been pushed to the edge of the cliff, and today he can only do it himself.

The awkward and suffocating silence in the office had no effect on Zhou Congwen, the more this happened the happier he was.

Doctors are essentially a technical job. Since we want to talk about technology, it is bound to be useful to crush on all aspects of technology.This day will come sooner or later, Zhou Congwen enjoys watching Wang Chengfa's expression with a smile.

The embarrassing discussion didn't last long, and the head nurse stammered a few words of irrigation.Seeing Liu Di and Shen Lang hiding aside, Wang Chengfa could only take a deep breath and began to speak.

Criticism and self-criticism, who can be criticized?

I had a great time swearing at people yesterday, but Zhou Congwen caught me and wrote every sentence in the medical record!Wang Chengfa was helpless, and could not walk away.

If he really left in a huff, if Zhou Congwen didn't add a note to the medical record, and then publicized in the hospital that everyone knew that his surname was not Wang.

He complained endlessly, and secretly scolded Wang Qiang for causing trouble.

If it wasn't because he wanted to protect Wang Qiang, he wouldn't have offended so many people for no reason, so that the matter of sending the old directors to feed the rabbits decades ago was also remembered.

As a director myself, I can't do anything with the little doctor...

This is incredible.

But no matter how unbelievable, I have to hurry up to deal with this matter, Wang Chengfa gritted his molars, and said falteringly, "This... the patient's handling is indeed a bit sloppy... I..."

"Ring ring ring~~~" the ringtone of the mobile phone interrupted Wang Chengfa's words.

If it was normal, Wang Chengfa would definitely look in the direction of the ringtone with a cold face, and scare the doctors and nurses whose phones were not muted to death with murderous eyes.

But today he felt a little rejoiced, and really hoped that it would be so vague.Sooner or later, I will find this place.

He looked gratefully at the ringtone, only to realize that it was Zhou Congwen's cell phone.

Zhou Congwen frowned, he was happily admiring Wang Cheng's embarrassment, why did he call.

He took out his phone and took a look, it was Chen Houkun calling.

"Director Wang, may I answer Professor Chen's call first?" Zhou Congwen "asked" Wang Chengfa for instructions.

"Go." Wang Chengfa waved his hand.

Zhou Congwen picked up his mobile phone to answer the call, and walked out while talking.Wang Chengfa was relieved to see Zhou Congwen's back leaving.

"Professor Chen, what's wrong?" Zhou Congwen asked.

"Doctor Xiao Zhou, we are consulting with the whole hospital. Director Zhang has just performed a right lung cancer resection, sleeve resection, and the patient's condition is stable after the operation..."

Chen Houkun began to tell the patient's situation.

Director Zhang Youzhang just performed a lung cancer sleeve resection operation. The full name of sleeve resection is bronchial sleeve resection, which is relatively difficult in thoracic surgery.

Generally speaking, when the tumor or stenosis is in the carina and extends to some bronchi on both sides, one lobe of the lung and a section of the bronchus with disease can be resected, and then the bronchus of the remaining lung can be used for reanastomosis. This operation is called sleeve surgery. Lobectomy.

When taking the supine position to suck sputum before removing the endotracheal tube after the operation, the patient coughed violently, and the blood pressure dropped directly to 60/30 mmHg.

The anesthesia thought it had nothing to do with me, so everyone was wondering whether to open the chest for a consultation on the stage.

Chapter 0116 heart...... Hernia?

The patient's blood pressure suddenly dropped to 5/60mmHg within 30 minutes, and the heart rate suddenly stopped. After dropping to 40 beats/min, it continued to rise and remained at about 120 beats/min. The central venous pressure suddenly increased to 21mmHg, and the blood oxygen saturation decreased progressively. .

But after all, in the operating room, there were many people, and the rescue was timely. At that time, aggressive fluid replacement, volume expansion, and vasoactive drugs were given.

However, the patient's condition did not improve after taking the medicine, so there was an emergency consultation on the stage.

Hearing that the patient in Corey had an accident, Chen Houkun also changed his clothes and went on stage to have a look.He has been bored recently, doing nothing every day.

Even most of the time, Chen Houkun came to change clothes every day to change shifts. After finishing work, he watched his colleagues go to surgery, and he changed his clothes and went home from get off work lonely.

Does it make sense in a hospital?It is an indisputable fact that he has been hung up.

Today, a manufacturer was going to visit Chen Houkun to promote Olida thoracoscopy equipment, so Chen Houkun didn't leave so early, and when he heard that there was an accident in the operation, he followed up and took a look.

In the operating room, the director of the anesthesiology department and Zhang You had a very fierce dispute. The director of the anesthesiology department said that it was a problem with the operation, but he couldn't come up with a solution. Director Zhang You made it very clear and insisted that it was a matter of the anesthesiology department. .

The root of the dispute is whether the patient should stay in the operating room or go down for rescue.

There are a lot of things to say here, Chen Houkun understands what Zhang You and Director Cui of the anesthesia department mean - both of them are throwing the blame, and it depends on who is stronger at this time.

Generally speaking, the director of anesthesiology department will have some advantages.

It is said that the sleeve cutting will not cause sudden changes in the patient's vital signs. In theory, Chen Houkun also agrees with Zhang You's point of view-it must be a problem with the anesthesiology medication.

Especially now that the patient's symptoms have not been relieved after taking the appropriate medicine, these all prove Chen Houkun's guess in his heart.

Seeing Zhang You arguing with the director of the anesthesiology department in some embarrassment, Chen Houkun felt no joy in his heart, but began to think about the complications of sleeve surgery.

Alas, it would be great if I could do the surgery myself.

Unfortunately, only thoracoscopy can be done now.By the way, can thoracoscopic sleeve resection be performed?Chen Houkun was thinking about the thoracoscopy in his mind, and suddenly thought of Zhou Congwen.

Give Dr. Zhou a call and ask.

After visiting Zhou Congwen's home, Chen Houkun's inner Zhou Congwen became a little mysterious.

It is definitely not easy for a small doctor who can casually put a device worth 50 yuan in a rental house.

It is indeed biased to measure a person with money, but it is also too generous for Zhou Congwen.

This is different from driving a million-dollar sports car whizzing by in the sea of ​​cars. Zhou Congwen didn't show off, but practiced his skills like a night walk in brocade clothes.

You can spend 50 casually... Thinking of this figure, Chen Houkun's head gets a little big.

I am a professor at the Second Hospital of Medical University who has accumulated many years of accumulation and cannot afford it.Although he was very greedy, he hesitated for a long time after he came back, and he still didn't borrow money, but directly gave up the idea.

50 is enough to buy two large flats by the river in the provincial capital, which are pure river view houses.Standing by the window and looking out every day, I feel happy.If you really bought a grinding drill and brought it home, would your wife have to kill herself?

So every time he thought of this, Chen Houkun would feel that Zhou Congwen was very mysterious.

He couldn't be someone's illegitimate son living in Jianghai City.

After calling Zhou Congwen, Professor Chen told him everything he knew, "Dr. Zhou, do you think it is possible to perform sleeve surgery with thoracoscopic surgery?"

The scope of thoracoscopic surgery is what Chen Houkun cares most about.

It was all gossip before, when it came to Zhang You's embarrassment, Professor Chen subconsciously said a few more words, even he himself didn't notice.

"Of course, the damage is much smaller than that of ordinary thoracotomy." Zhou Congwen gave a definite answer, but before Professor Chen could continue to ask, Zhou Congwen asked instead, "Brother Chen, is the patient still on the operating table? Are you going down?" ?”

"No. Director Zhang said it was an anesthesia problem, and the anesthesiology department said it was an operation problem. Director Zhang didn't dare to do it. He has to wait until the patient's condition is stable."

"Don't do it." Zhou Congwen suddenly raised his voice, interrupting Professor Chen's words.

"Huh?" Chen Houkun was taken aback.

"Have you thought about opening it and taking a look?"

"..." Chen Houkun frowned, "What's the problem with sleeve surgery? Even if there is a problem, the patient's blood pressure and heart rate will not change when he coughs up sputum."

"I think it might be a heart hernia." Zhou Congwen gave the answer directly.

Heart hernia?

This term refers to an emergency in which cardiac tissue herniates out of the pericardium through a pericardial defect, resulting in cardiac incarceration or torsion leading to haemodynamic disturbances.

As long as the pericardium is moved, there is a possibility of heart hernia, but the probability is too low. Chen Houkun has worked for decades but has never encountered it.

"Xiao Zhou, are you overthinking it? Uh, I just want to ask if laparoscopy can do cuff cutting." Chen Houkun said helplessly.

This Xiaozhou is really meddling with mice.

He couldn't even participate in the dispute in the operating room. He, a little doctor from the Third Hospital of Jianghai City, turned out to be talkative.

"Professor Chen, once a cardiac hernia occurs, the patient's mortality rate may reach more than 35%!" Zhou Congwen ignored Chen Houkun's words at all. After thinking clearly about the possibility based on the patient's symptoms, he immediately became stricter, "Re-open the chest and check immediately."

"..." Chen Houkun was speechless.

It's not your own patient, can Director Zhang You listen to him?

What a joke.

There was silence on the other side of the phone, Zhou Congwen frowned, "Brother Chen, do you and Zhang You both think it's a problem with the anesthesiology department?"

"Ah."

"Anyway, the patient won't be able to go down. I would like to make a suggestion. There is no secondary damage to the patient. It is better than wasting time on the operating table."

"Tell me." Chen Houkun was puzzled, is there such a good thing?

"Enter endoscopic equipment in the mouth of closed thoracic drainage, one-lung ventilation, and use an endoscope to look at the situation in the chest cavity. If there is a heart hernia, open the chest directly, and hurry up to rescue. If there is no problem, then it must be an anesthesiologist About medication."

Chen Houkun was taken aback for a moment, what Zhou Congwen said was indeed serious.