A day in the life of an internist
A day in the life of an internist
Every day, they are trying their best to save the lives of patients who are in critical condition, and to bring the patients back from the hands of the God of Death, and these are the angels in the front line of the battle. This edition features the diary of a young doctor from the Municipal People's Hospital, which records their lesser-known working conditions, in order to give readers a deeper understanding of this special group's silent dedication and persistence in waiting for life?
July 24, 2013
8:00
A Little Bit of Progress Every Day
The Department of Intensive Care Unit (ICU) is a clinical department set up to improve the safety of patients with acute and severe illnesses. The ICU is a clinical unit that houses state-of-the-art medical equipment, experienced specialists and specially trained nurses. The Department of Critical Care Medicine is equipped with advanced equipments, which are first-class in China. The medical staff can not only monitor the vital signs of patients 24 hours a day, but also carry out invasive and non-invasive hemodynamic monitoring, blood purification and blood gas analysis at the bedside, so as to fight for valuable rescue time for patients. As a member of the Department of Critical Care Medicine at City Hospital, I am proud that the hospital can have such a level of medical care. Today is the day of our weekly routine study. After the morning shift check, we began to study the latest diagnosis and treatment guidelines for various diseases. Just then, the nurse on duty hurriedly pushed the door in:?Patient in bed 7 has sudden coma! The oxygen saturation level has dropped!
9:30
No danger! Resuscitation of intractable heart failure
All personnel are rapidly engaged in resuscitation! Critical care director Zheng Zhigang instructed: acute left heart failure! The patient's life is in danger! The first thing you need to do is to get on a ventilator. The family was notified of the critical condition! This 72-year-old patient from Gaokeng Town was diagnosed with coronary heart disease and diabetes 17 years ago. Recently, the patient's condition suddenly worsened, large acute myocardial infarction, cardiogenic shock, the local hospital could not save. The cardiovascular department received the diagnosis, after obtaining the consent of the family decisively decided to implement interventional surgery for the elderly rescue.
After being admitted to the operating room, the old man suddenly lost consciousness, his blood pressure could not be maintained, and he fell into a coma. We immediately performed emergency tracheal intubation and coronary stenting for the patient. After the operation, the patient was sent to ICU with tracheal intubation, and in ICU, the old man repeatedly developed intractable heart failure and acute renal failure, and his life was in danger! So the patient was urgently placed in a deep vein tube, hemofiltration, and two hours later, the old man's vital signs gradually returned to normal, and the resuscitation was successful! The ICU ward at this time, in the medical staff patiently explained in detail, the elderly family members of the mood is gradually eased.
13:30
Lunch interrupted many times
After a long time of resuscitation, I have no appetite. When I had just picked up my bowl of rice, I heard the doorbell ring again. It turned out that two more critically ill patients were transferred. In the ICU, it is not uncommon for lunch to be interrupted many times like this. This also reflects the tension and busyness of the medical staff. Take nursing as an example, some nurses have counted the work content of a day: 20 times of scrubbing, 20 times of oral care, 25 times of oral rinsing, several times of removing oral secretions at any time, 20 times of perineal scrubbing, more than a hundred times of feeding and watering, 35 times of placing tubes and changing medicines, countless times of sputum suctioning, more than 100 times of turning and patting the back, nearly a hundred times of cleaning up the urinary bag, dealing with the alarms of all kinds of instruments for a hundred times, and monitoring and recording vital signs such as blood pressure, respiration, pulse and pupil for more than a hundred times. The company's main goal is to provide the best possible service to its customers.
15:00
The life and death of a man who has been saved? Don's dad?
2 beds? The patient is a longtime patient of ours. The patient is our old patient, he is kind and friendly, we affectionately call him "Papa Tang". The patient's father, Mr. Tang, has been in a coma since 3:00 p.m. At 3:00 pm, Papa Tang was in a coma, shortness of breath, his life hanging in the balance, and was urgently admitted to ICU. Prof. Liu Deqing, Director Zheng Zhigang, and emergency consulting physicians from the Department of Respiratory Medicine arrived at the scene quickly and began to resuscitate him! The patient's words were slurred, his consciousness was blurred, and he was staring straight at his daughter who was guarding beside him. At this moment, I am accustomed to seeing life and death, but also blurred vision.
Director Zheng made a snap decision: severe pneumonia combined with acute respiratory failure, emergency tracheal intubation, ventilator-assisted respiration! Fortunately, after 30 minutes the old man's blood oxygen gradually returned to normal. However, because the patient was bedridden for a long time, multiple infections, coupled with the critical and repeated condition, resulting in multiple organ failure, causing serious difficulties in treatment. We closely observed the condition, continued hemofiltration, and at the same time took a variety of therapeutic measures such as anti-shock and anti-infection. Finally, Tang's father is temporarily out of danger, and gradually improved.
Rescue until 7:00 pm, at this time the guys have been tired and sweaty, but the heavy face finally showed a smile. At this time, has been involved in the rescue of Professor Liu Deqing appeared hypoglycemic symptoms, I immediately find bread, milk. This is the emergency food available in the department. Dry food? Because for us, overtime is the norm. Many medical staff have developed the ability to eat within two minutes. The company's website is a great source of information about the company's products and services.
I ate a few bites in a hurry, then walked to the conference room. There, another hot scene awaited me.
19:00
Fruitful research team
The research study session that was scheduled to start at 6:00pm? The scientific research study session? , was delayed by an hour due to an afternoon resuscitation. Since Dr. Xiao Du joined us, the department has made a breakthrough in research at a stage, and this year we won the provincial natural science (youth) fund. Our `team is getting bigger and bigger, there is already 1 PhD, 6 master's degree holders, 4 master's degree holders, 4 professors and associate professors ****. A dozen or so people sit around and report and discuss the progress of their respective scientific research topics, the difficulties they encountered and their next plans. Last year, the hospital successfully set up a scientific research cooperation platform with Zhejiang University's Department of Medicine, and we also contacted Zhejiang University professors many times, and got a lot of hand-holding guidance, and began to sprint for the National Natural Science Foundation of China.
23:00
Being a happy doctor
It's late at night, and the lights are still on in the ICU ward, where there is no difference between night and day, and it's like a frontline field hospital, where there's no idle time. Medical work is the need to pay the humanistic feelings, wards and diseases fighting the living life, wards outside the anxious eyes of loved ones, when I continue to inspire me to think and keep moving forward. Walking on the way home, only to feel that this day is really very tired. My mom in addition to work is to go home and sleep this is my son wrote a sentence in the essay, see my heartache, but also very helpless. Being a doctor is my childhood wish, I hope that no matter what the conditions, as a doctor has the ability to feel happy, in the busy work and ordinary life to enjoy every moment.
Doctor's Diary of a Day's Work:
Today, a follow-up patient told me that I had prescribed a gastric ulcer capsule, and after taking the medicine, the condition has improved greatly, and the original is the symptoms of heartburn are basically gone, and there is no symptom of recurrence after stopping the medicine. This is a patient with reflux esophagitis who came to me 3 months ago. When he came to me, he had epigastric pain, abdominal distension, vomiting, heartburn, early satiety, nausea and other symptoms, which had lasted for almost half a month. At that time, gastroscopy examined the esophageal mucous membrane damage, and there were reflux symptoms, and thus he was diagnosed with reflux esophagitis. This patient usually smoked and drank too much, because the main component of alcohol is ethanol, which not only stimulates the secretion of gastric acid, but also relaxes the lower esophageal sphincter, which is one of the causes of gastroesophageal reflux. In the clinic because of socializing more, the gastrointestinal diseases caused by too much alcohol and tobacco is really a lot of see.
In fact, the patient has chronic superficial gastritis for a long time, due to irregular work and rest, usually too much alcohol and tobacco, the disease has been repeated. This visit was due to the symptoms of burning pain and acid reflux behind the sternum some time ago. This is a relatively obvious clinical feature of reflux esophagitis. Many patients are due to gastric ulcer, peptic ulcer and gastritis after the aggravation of the condition, caused by the gastric, duodenal contents of the esophagus back into the esophagus caused by inflammatory lesions of the esophagus.
For reflux esophagitis, I used to prescribe omeprazole and cisapride, which can relieve the symptoms faster, but after stopping the medication has been very easy to relapse, and if the use of ppI as a maintenance treatment, long-term use of the patient will produce some side effects. I remembered that I had given some patients with peptic ulcer ppI and antibiotics (2 weeks' dosage), and then added a Xinjiang Quanan Pharmaceuticals An Gastric Ulcer Capsules. Considering the safety of botanicals and their ability to repair the gastric mucosa, I instructed the patients to take An Gastric Ulcer Capsules every day to maintain the treatment after ppI and antibiotics were finished, and lasted for 8 weeks. Later, the patients responded well, saying that once they stopped taking the medication, their gastric problems came back, but now, after stopping the medication, they feel a little bit uncomfortable occasionally, but basically there is no obvious recurrence. This time, I also apply the previous medication experience to this patient with reflux esophagitis, for one thing, because the main active ingredient of An Gastric Ulcer Capsules is licorice flavonoids, which can inhibit the secretion of gastric acid and reduce the concentration of gastric acid, and secondly, considering the relationship between the reflux esophagitis caused by this time and the patient's chronic superficial gastritis, the licorice flavonoids have a significant role in protecting and repairing the gastric mucosa, therefore, I prescribed 8 weeks of An Gastric Ulcer Capsules. , I prescribed 8 weeks of An Gastric Ulcer Capsules as maintenance therapy. The patient's response was favorable, which greatly enhanced my confidence in prescribing proprietary Chinese medicines.
For many years, prescribing chemotherapy has been a habit, and in recent years, I have started to prescribe chemotherapy and pCms together, and the results are also gratifying. The new version of the base drug catalog, the base drug catalog greatly expanded, new varieties of 218, the proportion of pCms compared to the 09 version of the increase in a lot of, found that the stomach ulcer capsule is also in the base drug directory, the base drug expansion of the pharmaceutical market, especially for the patients is a good thing, it seems that in the future in the prescription medication with more choices.
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