The road to the rise of great doctors

Chapter 15
Upon hearing Song Wei's words, Liu Dong made a gesture of cupping his hands and shouted, "I obey."

The song ends.

Liu Dong and Zhu Guoliang inspected a circle of patients before leaving get off work. There were no abnormalities or emergencies. The ward gave people a sense of orderliness.

Opposite the hospital, after a simple bowl of sliced ​​noodles, Liu Dong returned to the ward.

He took out "Urology" and carefully read the disease knowledge chapters of the two new patients he read today, and took notes in his own way in his notebook, especially the key points of diagnosis and preoperative preparation. .

Then, I closed my eyes and meditated on the knowledge I just read and the examples I saw today. I felt that I had mastered them all, and then I put away the books.

Liu Dong walked out of the office, went to say hello to the doctor and nurse on duty today, and said: "I will stay in the ward until 11pm today. If you need help, call me anytime."

Seeing that there was nothing going on in the ward for the time being, I went back to the office.

I picked up a book called "Urological Surgery" and read it with great interest on perioperative preparation.The principle of preventive anti-infection, the scope and time of skin preparation, the range of preoperative general indicators such as blood pressure, hemoglobin, etc., when blood transfusion is needed, and when blood components are needed, etc.
After reading about 1/3 of the content, Zhang Bin, the doctor on duty, walked to the office and said to Liu Dong, "Are you free?"

Liu Dong nodded in response and listened to Dr. Zhang say: "Follow me."

Zhang Bin turned around and started walking quickly, and Liu Dong followed quickly.

Five minutes later, they arrived at the emergency department.

"There are several emergency clinics here. Usually at this point, we may have to come here every time we are on duty." Zhang Bin's tone was slow and steady, as if he was confident.

There are not many emergencies in the urology department. For example, the combined organ injury last time may not happen once a month.

Most of them are simple small operations, such as urinary catheterization, changing urinary catheters or fistula tubes; or those who have no time during the day and can only come to the emergency room at night.For emergencies with a relatively single type like this, sometimes doctors in the undergraduate department will create a few "little tips" for novices to draw lots to see if they will win.

Liu Dong heard from a senior in breast surgery that they would first register at the hospital after obtaining the qualification certificate, and then be assigned to be on duty alone. If they could not solve the problem, they would call the class for instructions.They only have one tip when they are on duty, and there may not be a single consultation in a week. One possibility is that disease-acute mastitis.Just follow the tips and write your treatment opinions.
After Zhang Bin and the nurse confirmed which observation beds had been consulted, they took Liu Dong to see them one by one. On the way, Zhang Bin smiled and said: "Liu Dong, you will follow my instructions later."

Liu Dong nodded.

Now let him get a urinary catheter, suture something, etc., and he is absolutely confident.However, the patient's problems do not follow the textbooks. Sometimes they are bizarre and without corresponding experience, it is easy to get into trouble.

Some jobs, if messed up a little, may not make a difference.But if the doctor makes a mistake in handling the matter, or even says something wrong sometimes, the consequences may be irreversible.

This is like what was reported in the news, where one person’s cancer diagnosis was mistakenly told to another person, and the result was so many episodes of the story.

Every patient is unique and can be called a limited edition.
Liu Dong stood behind Zhang Bin and followed him to check on the patient.

The first consultation was with a 65-year-old man. He drank some wine at night and couldn't pee.
"Prostatic hyperplasia is a benign disease that occurs with age. Symptoms will appear when you reach your age, and the symptoms will be more serious if the position is not good. Drinking alcohol will aggravate the consequences of prostate hyperplasia. No, you are Urinary retention has occurred. You have to get a urinary catheter to solve the problem of urination first, and then I will prescribe some medicine for you to take for a few days, and then come to the hospital to evaluate whether to treat the disease. There are two ways: medicine and surgery. , we will talk about it in detail at the outpatient clinic later.

"Xiao Liu, go prepare a catheter bag and put a urinary catheter on this old man later." Zhang Bin and Liu Dong said.

It was resolved smoothly.

The second consultation was with a patient with prostatic hyperplasia, but he did not want surgery or cystostomy. He still had difficulty urinating, so he had to wear a urinary catheter for a long time and come to the hospital regularly for replacement.Zhang Bin looked at the medical record, then handed it to Liu Dong and said, "Go and prepare the catheterization bag and get the F16 urinary catheter."

Liu Dong first looked at the medical records and found that the F1 could not be replaced when the urinary catheter was changed one month ago, and he was considering urethral stricture.Bringing your past medical records with you every time you see a doctor can save you some detours, as both old patients and doctors know.

After Liu Dong was ready, he first used a syringe to evacuate the original bladder of the urinary catheter.

The normal function of this air bag is to prevent the urethra from slipping. However, the air bag must be pumped out when pulling it out. The air bag has a certain size. If such a large thing is not pumped out, it will scrape all the mucous membranes on the narrow urethra, which will not only cause blood in the urine. , scarring may appear in the future, making the urethra narrower.

Then re-sterilize, drape, put on sterile gloves, pick up the urinary catheter to lubricate it, and follow the steps to start lowering the urinary catheter.About halfway in, it kept slipping and couldn't be put in.At this time, you cannot easily inflate the air bag, because if the position is wrong, inflating the air bag will damage the urethra.And the inability to put it in just shows how narrow the urethra is in the prostate area.

Zhang Bin said to the patient's family members: "Look, the posterior urethral stricture caused by prostatic hyperplasia is sometimes easy to replace, but sometimes it is difficult to replace. Do you want to consider hospitalization for surgery?"

The patient's family members waved their hands and said: "As he gets older, he has a stubborn temper. We can't convince him to change it this time. We come here every time. You are high-level and you must have a way. We believe in you. Wait until you go back. Later, we will try to persuade him."

Zhang Bin watched Liu Dong try twice and failed.I put on sterile gloves and started trying. I tried twice and still failed.

Zhang Bin was worried that excessive force would cause the formation of a false urethra, so he decided not to try this again.

He asked the nurse to help open the sterilized guidewire and hand it to him.Then he said to Liu Dong: "This is the secret weapon of urology surgery, the first choice equipment for unsuccessful urinary catheterization!"

"However, you have to be familiar with the anatomy of the urethra and have a sense of feeling in your hands before you can do it. If you are a novice, you can't use it. If your hands don't count, you'll be done with one poke."

He inserted the guide wire down the urinary catheter and then lubricated the urinary catheter again.Holding this equipment in one hand, lift the patient's urinary organ with the other hand. After putting the urethra in, press down to keep the front and rear urethras at the same level.Liu Dong was asked to hold the guide wire without letting go, and he told her not to move forward with force, and then gradually pushed the urinary catheter in.

After pushing out the guide wire, Liu Dong said: "Success, the urine came out." Only yellow urine flowed out along the urinary tube.Quickly fix the urinary catheter and inflate the air bag.

Liu Dong and Zhang Bin looked at each other and breathed a sigh of relief.

If it cannot be inserted and the patient cannot urinate, a cystostomy may be necessary.Fortunately, with the help of this equipment, I succeeded again.

I saw two more consultations for kidney stone pain, and it was already 2pm.

Liu Dong said: "It should be over tonight, right? It's so late, so there should be fewer people coming out."

Zhang Bin quickly said: "Bah, you can't say these things casually. The duty is very evil."

Liu Dong smiled awkwardly.

As soon as they left the door of the emergency room, they saw the nurse running out and shouted: "Doctor Zhang, wait a minute, there is another one I want you to take a look at."

Zhang Bin smiled helplessly and knocked Liu Dong on the back.

When I entered the emergency department again, I saw a young woman lying on the transfer bed with a look of pain on her face.
(End of this chapter)