My Medical Skills Give Me Experiences

Zhou Can bowed his head in thought.

After working in the hospital for so long, whether it is an internship or eight months of regular training, his understanding of ICU is actually very limited. Regarding Tuya's intensive care medicine department, I believe that most doctors will think that it is a mysterious place.

Vice President Ye personally greeted him and asked him to train in the Department of Critical Care Medicine for three months, which must have deep meaning.

"Perhaps many people don't know about intensive care medicine yet, so I will introduce it to you first."

The person in charge did not urge Zhou Can.

"The Department of Intensive Care Medicine is currently in Tuya General Hospital, and this is the only department that is serious about children. The Department of Respiratory and Critical Care Medicine can only be regarded as a sub-department, and it is not very different from the ICUs of neurosurgery, cardiology, and obstetrics. There is a big difference. I believe that you may have been lucky enough to see it in the ICU during the specialist training and internship. But I want to tell you that there is a big difference between the real intensive care medicine department and the subdivided specialist ICU.”

Everyone is listening carefully.

Tuya Hospital is like a complex big city, with various functional departments.

Even if you are a doctor in this hospital without certain qualifications, you may know little about other departments in this hospital.

"The specialized ICU you see, more precisely, can only be regarded as an intensive care unit. It is quite different from the real comprehensive ward of intensive care medicine. The construction of a specialized ICU is carried out according to the needs of each department. In terms of technology, Management, equipment, etc. can only be described as 'immature'. The main thing is to monitor the patient's ECG, blood oxygen, etc., to observe changes in the condition at any time, and the rescue measures are very limited."

This is said more cryptically.

The meaning is to tell everyone sitting here that the specialized ICU ward belongs to the amateur level, and only the intensive care medicine department is professional.

Zhou Can couldn't help thinking of the goal Qiao Yu mentioned.

She said that after working for a period of time, she will work hard to pass the assessment of the Department of Critical Care Medicine and go in for a period of experience.

It seems that she has already had a deep understanding of Tuya's intensive care medicine department.

At that time, Zhou Can secretly wondered that there was an ICU ward in the emergency department, and he had never heard that it was particularly difficult to work in it!

Thinking about it now, what she wanted to enter should be this real intensive care medicine department.

"To apply for the regular training of the intensive care medicine department, in principle, each regular trainee has only one chance to apply, and the regular training period is one month. If you become the elite of the specialty in the future, you may have the opportunity to apply for further study here. Or you will be transferred in directly. Work in the intensive care medicine department. But the probability of this is very small. So, cherish this one-month training time! Learn as much intensive care medicine nursing, rescue knowledge, and techniques as possible.”

Hearing what he said, ordinary regular trainees only have one month of regular training in the Department of Critical Care Medicine, but Zhou Can has two months more than them. This is a special treatment.

It's **** if you don't take advantage of the advantages.

Zhou Can already had calculations in his heart.

Isn't it more stressful and tiring? Three months is only three months, when the time comes to learn the rescue and nursing of critical illness, it will have unimaginable benefits to practice medicine in the future.

He faintly felt that the competition among various departments in the hospital was everywhere.

Specialist departments do not want to see the emergency department become stronger, and hope that the emergency department will always be just a transfer station for guidance.

There is also competition between the intensive care medicine department and the specialized ICU ward.

Each department is striving to embody its unique value.

Otherwise, it will soon be replaced and eliminated.

Cruel workplace rules are everywhere, forcing everyone, every department, and every company to strive to improve their competitiveness.

This is actually a manifestation of social progress.

"Zhou Can, how are you thinking?"

After the person in charge introduced the difference between the intensive care unit and the specialized ICU ward, his eyes fell on Zhou Can's face again.

This is not clear, is the introduction just now a disguised form of doing ideological work for Zhou Can?

"I am willing to train in the Department of Critical Care Medicine for three months. I would like to thank Vice President Ye and all the leaders for their cultivation."

After Zhou Can understood clearly, he agreed decisively.

The planned training time in the intensive care medicine department has been extended by two months, which also means that his regular training time in other departments has to be shortened.

If it is replaced by ordinary Pearson, it will hardly have much impact.

But he is different. Not only does he have to train in multiple surgical departments, but he also has to go to the internal medicine department for training.

At present, 8 months of his 36-month regular training time have been used up, and with the addition of three months in the intensive care medicine department, nearly one-third of the time is gone.

"Okay, great! Years from now, you'll find that the choices you made today were very wise."

Seeing that Zhou Can agreed, the person in charge showed a happy smile of relief.

After Zhou Can thought for a while, he understood the mystery.

If Vice President Ye's personal account was not completed, he, the person in charge, would definitely lose points in Vice President Ye's mind.

"Let me introduce to you the sources of patients in the Department of Critical Care Medicine. They can be roughly divided into four categories: first, patients with acute reversible diseases. Such as various types of shock, after major surgery, severe trauma, severe infection, acute poisoning, cardiopulmonary After resuscitation, etc. There is a prerequisite for such patients to be admitted to the ICU, and it is clear that it can effectively reduce the mortality rate and the curative effect is certain.”

Such patients should account for the majority.

During Zhou Can's regular training in Shenwai, he found that there are many patients who have just completed major operations. The surgeon will give special instructions and must be sent to the ICU for monitoring.

As for patients with acute heart poisoning and serious infections, there are very few patients treated by God.

"The second type is high-risk patients. These patients have potentially dangerous underlying diseases and may be preparing for invasive surgeries with higher risks. Such as severe pancreatitis, severe asthma, organ failure, severe obstetric diseases, etc. The principles of treating such patients can effectively prevent and treat their complications, reduce medical expenses, and shorten the length of hospital stay."

There are many patients who do not stay in the ICU while waiting for the operation, and may never meet the standard for being on the operating table.

At this time, it is a good choice to decisively choose to live in the ICU, first to save life, and then to elective surgery.

Many people think that staying in the ICU ward is a waste of money, but it is actually the opposite.

Sometimes it may actually save medical expenses.

Just imagine, when various complications break out, the rescue cost is very staggering.

And it will greatly prolong the discharge time.

"The third type is patients with acute exacerbation of some chronic diseases. The intensive care unit can help them pass the acute stage and strive to help patients return to the original state of chronic diseases. For example, patients with exacerbation of chronic respiratory diseases are in this category."

Such patients are very common.

Money can buy life, often refers to this kind of patients.

They live in the ICU, and they can really escape the king of Hades.

After getting over it, they can live well again.

"The fourth type is patients with irreversible deterioration of the disease. For example, hemorrhage that cannot be effectively stopped, or patients with malignant tumors that are dying. There are also patients who are old and waiting for natural death. The greater significance of treating such patients is to show respect for life. , reverence for life."

The last kind of patients are mostly rich people who have too much money and no place to spend it.

Generally speaking, as long as the family members do not allow extubation, such patients can live in the ICU for a long period of time.

Basically, as long as there is no brain death, they can live forever.

It is worth mentioning that after the fourth type of patients are admitted to the ICU, very few of them can survive.

Before they entered the ICU, they already knew this ending.

Purely just to make life last longer, nothing more.

Of course, it must also be realized that the relatives of such patients are willing to pay expensive medical expenses, which is difficult to part with family affection.

For example, as a child, you don’t want to watch the parents who raised you die, and you are willing to give everything you have, even if it’s just to let your parents stay in this world for a second.

"The sources of patients in the intensive care medicine department generally fall into these four categories. The purpose of giving you such a detailed introduction is to let you know what to expect when you go to work. Clarify the direction and purpose of treatment for each type of patient."

The person in charge said loudly.

There are four types of patients, each with a different focus of treatment.

To prepare for surgery, we must find ways to reduce complications and provide patients with better nutritional support as much as possible.

In order to prolong life, then try every means to ensure that the patient does not die.

After Zhou Can finished listening, he had initially felt the tense atmosphere in the Department of Critical Care Medicine.

"When admitting patients in the intensive care medicine department, in addition to the four criteria given above, there is another very important indicator, that is, the mortality score. For example, take the acute physiology and chronic health scoring system as an example. According to the patient's various The physiological index score is used to predict the mortality rate. The score ranges from 15 to 35 points, that is, the mortality rate is higher than 15% and lower than 85%, and it is most suitable for admission to the ICU ward.”

This scoring standard is basically the gold standard for admission to ICUs.

The mortality rate is less than 15%, and they are generally treated in specialized ICUs or general wards.

The mortality rate is higher than 85%. Unless the family members really have mines at home, the doctor will suggest that the patient spend the last days of his life in the emergency room out of conscience.

Of course, this standard cannot be dogmatic.

The mortality rate of some patients is predicted to be higher than 85%, but the attending physician believes that admission to the intensive care unit can be rescued. As long as they survive the most difficult period, they may improve, so they must be admitted for treatment.

Reducing the mortality rate of patients in this hospital is the fundamental purpose of the establishment of the Department of Critical Care Medicine.

"Next, let's talk about the grouping. The clinical medical group is divided into three groups, with three shifts and an eight-hour system. There are five groups in the nursing group, and the working hours are 12 hours. The intensive care department is a high-intensity job. You must do it well. Prepare mentally."

The ratio of doctors to nurses is about one to three.

One doctor and three nurses.

Patients in each bed enjoy one-on-one service.

A doctor can manage up to three hospital beds.

This is like a battlefield, wherever there is a need, you can charge there.

"Okay, the basic introduction of the introduction is over. If you don't understand, you can find an opportunity to ask the superior doctor. But I must tell you that when working in the intensive care unit, it is best to talk less and do more. Your superior doctor needs to concentrate Pay attention to every sudden situation, if you ask questions at any time and interrupt their thinking, you will be scolded at least, or sent to me at worst, and let me teach you the rules."

The person in charge first explained the rules to the thirty-two regular trainees.

It is completely two concepts with ordinary departments.

In specialist wards, doctors are more relaxed. Not to mention asking questions, even small talk is a common occurrence.

"I'll start assigning you senior doctors who will teach you. At present, you can only arrange residents to take care of you. Those who perform well will get the chance to treat the flop."

The flop is which concubine the emperor chooses to sleep with at night.

The meaning here is probably that after being appreciated by the attending physician, it is possible to take you personally.

Following the indications, you will definitely learn more advanced knowledge.

"Zhou Can, your teacher is Hu Yiba, the attending physician."

Zhou Can was the first to announce.

Everyone could see that this regular trainee named Zhou Can received intensive cultivation everywhere, and his treatment was completely different from theirs.

The few Gui Peisheng who came from outside the gods together with Zhou Can are lucky. Knowing that Zhou Can's strength and talent are far higher than ordinary Gui Peisheng, it is not unusual to have this treatment.

People who don't know him have already cursed in their hearts.

Damn, this is a hard-wired accountant who came here to beat people.

Under normal circumstances, how could a Gui Peisheng get the special care of the vice president? For many Gui Peisheng, they have not even seen whether the vice president is fat or thin, male or female.

"Jin Mingxi, lead teacher Yuan Kun. Chen Hao, lead teacher Luo Sanzhang..."

Different from the regular training in other departments, the treatment here seems to be one-on-one guidance.

Everyone felt a lot more psychologically balanced.

It is also very good to have one-on-one guidance from a resident physician.

It's only one level behind Zhou Can.

Soon, all the teachers were in place. Except for Zhou Can, who is taught by an attending doctor himself, the others are all taught by residents.

"Have you seen this roster? You can find your teaching doctor on it. If the teaching doctor is not working now, you can familiarize yourself with the regulations in the office first, or you can go home and sleep directly, and adjust the working hours to be in line with your teaching doctor. Teach physicians to agree."

No one took it, and it is estimated that they would not be able to enter the gate of the intensive care unit.

Zhou Can took a look at the schedule of Hu Yiba's attending shift, which was from 8:00 am to 4:00 pm.

The schedule here is very similar to the emergency department.

It is also on a 24-hour shift.

"I'm optimistic about it? Students who are scheduled for the morning shift, I will take you into the ICU ward. Remember, after entering, wash your hands first, and then change the isolation suit. The inside is under sterile management. In principle, you are not allowed to enter and exit at will. The toilet needs to drink water, so let’s deal with it now. Students who are scheduled for the evening shift or night shift can go home and rest, and come back at that time.”

Many people who were scheduled for the morning shift ran to the toilet or drank water.

Zhou Can secretly counted, including himself, there are nine people in the morning shift.

When he came back after using the toilet, some of Gui Peisheng had already left.

Those in charge of Gui Peisheng are still waiting patiently for them.

"Is everyone here? Come with me!"

The person in charge gave an order, and everyone followed him out of the doctor's office.

"It is divided into multiple wards. If the superior doctor asks you to go over to support the rescue of a certain bed, you must do it immediately. Even if you are asked to wipe the patient's excrement, urine and phlegm, don't hesitate. When you get here, first What you have to put away is your squeamishness. Also, you can see farewell almost every day inside, so you must learn to control your emotions. You are not allowed to cry inside, no matter how uncomfortable you have to hold back for me."

This should be said to the two female doctors.

When a male doctor sees a patient die, he usually retches, feels sad, and seldom sheds tears.

Girls have very rich emotional cells. When they encounter sad things, they can cry for you at any time~www.readwn.com~ The person in charge took them to the corridor outside. Ke five **** characters.

There is a sign of a nutrient infusion demonstration ward hanging below.

The spacious automatic metal door was tightly closed, and there was a more eye-catching reminder sign on the wall next to the door.

"If you can't answer your doorbell in time, please understand, we are busy with rescue. Please go to the side door of the **** waiting area!"

I have long heard that there are several entrances and exits in the intensive care unit.

Doctors and nurses usually go through this main entrance. Family visits require an application and are usually entered through the side door.

There is no man on duty 24 hours a day.

If the family members have something to give to the patient, or have made a nutritious meal, and want the nurse to feed it to the patient, they can give it to the nurse on duty here.

However, it must be reminded that the family members want to let the patient eat better and recover faster, which is understandable.

In fact, a lot of food is given, and the nurse may not necessarily feed it to the patient after receiving it.

It was only accepted to avoid doctor-patient disputes.

Sometimes patients can't eat anything.

For example, patients who are scheduled for surgery, or patients with tracheal incision, or other patients who need to fast, cannot eat.

There is really no need to ask where the food I received went.

If you ask, it is poured out or fed to the patient to eat.

Just to clarify, the ICU does not require family members to accompany it, and everything is done by doctors, nurses, and professional nurses.

In addition to the main entrance and the side entrance for accompanying people to enter, there is also a well-known gate called the Corpse Transport Gate.

Dead patients are not transported through the main gate.

One is that the effect is not good, and the other is easy to spread the germs.

There is a special back door to transport the corpses out.