A patient with pneumonia who coughs and sputum, coming to the hospital is nothing more than perfecting physical examinations and laboratory examinations. First, it is roughly distinguished from lymphocytes, neutrophils and eosinophils whether it is a bacterial or viral infection. Next, it is to provide diagnostic anti-infection treatment.

If the previous diagnostic treatment goes well, the patient will get significantly better within one week. If the patient is not lucky and the diagnostic treatment fails, you can wait for the results of the throat swab and blood culture, and then targeted treatment will be performed according to the drug sensitivity experiment.

When Song Yao heard the sudden symptoms, she was confused at first, but after calming down, she found that this was just a case and she didn't need to face real patients.

Perhaps this is her only advantage in the entire case. She has just been in clinical practice and has not even mastered the medical records. Even if Qi Jing makes things difficult for her, she will not let her contact the serious patient alone.

Song Yao did not lie. She learned the theory of diagnostics very well, at least her thinking was clear.

Once she calmed down, her brain began to get on track and disassembled several symptoms Qi Jing said. It is not difficult to understand that some severe pneumonia will indeed affect lung function and thus cause breathing difficulties. The heart and lungs are not separated, and the problem can be seen from the breathing rate and heart rate. The symptoms of breathing will make the patient very nervous, and cold sweats will follow.

But what's going on?

Is it a problem with the tongue? A problem with the vocal cords? Or is it aphasia caused by a brain problem?

Song Yao racked her brains and couldn't understand why the patient couldn't speak. It seemed that there was no disease in the textbook that covered aphasia and lung symptoms. But no matter what the cause was, the most important thing now is to master more information and then try to prolong the patient's life as much as possible on this basis.

This is the basis of all first aid. No matter what happens, we must start from these two aspects.

"First go to ECG monitoring." She stayed anxiously for a few days and had basically understood the process of taking over serious patients, "and then open the venous pathway."

Qi Jing nodded: "The nurse rushed over and immediately went to ECG monitoring, with blood oxygen of 91%. The pathway on the arm has been opened. Are you going to have deep vein pathway?"

Song Yao nodded: "Yes, deep vein."

"That's called anesthesiology department."

"Ah? There's no time."

"The deep vein puncture catheterization is done by anesthesiologists. Do you think ordinary doctors and nurses can do it?" Qi Jing continued, "This case does not require deep vein puncture, and it is not shock. Just say what to do next?"

"91% of blood oxygen means that the patient is hypoxia, so he must immediately give a mask to inhale oxygen." Looking at Qi Jing's affirmative eyes, Song Yao re-established her confidence, "and then take blood for testing."

"Take blood, I have to give me a rough test item." Qi Jing asked, "Blood routine? liver function? kidney function? or..."

Blood routine has been left in the patient's medical record record book for a long time. It was just done in the morning. The white blood cells and neutrophils are high, and it should be bacterial infection pneumonia. Liver and kidney function have nothing to do with the heart and lungs, and it is not needed for the time being. The most urgent and useful one should be blood qi analysis.

Blood gas analysis can detect blood oxygen and blood carbon dioxide partial pressure, and can also test the acid-base balance of the blood, and can determine whether the patient has any...

"Wrong, blood qi analysis needs to be done, but not the most important thing." Qi Jing said, "Think about it again, as an intern who has just entered the clinical field, you still have many opportunities to fail."

Not a blood qi analysis?

So what are you doing now?

Song Yao's head was filled with the key points to say, but when she really wanted to say it, she was associated with the actual situation of the patient, but found that it was all wrong.

Thinking continues, and the pressure given by Qi Jing is also continuing.

He couldn't let the intern think without limit, otherwise wouldn't it be too unfair to the patient: "Don't be stupid, what's next, and say something."

Song Yao looked at Qi Jing and seemed very embarrassed: "Senior Qi, your face is so scary and affects my thinking."

"This is not a written test," Qi Jing said, "This is saving people. When saving people, you have to face the patients and the family members. Do you think the family members of a serious patient will have a better face than me?"

This sentence entered Song Yao's ears and immediately made her feel the noisy sound like a tide.

If I really met this patient, there would probably be many people around me, nurses, family members, other patients and family members watching. The family member who accompanied the patient to the hospital would definitely chase her and ask about the patient's condition. If she couldn't tell anything, the result could be imagined.

Thinking of this, Song Yao suddenly thought of a trick: "Senior Qi, I am a resident doctor. Can such a patient be reported to his superiors?"

"You can report to your superiors." Qi Jing said, "Who do you want to report to?"

"It must be the main treatment of the bed," Song Yao said.

"The others have gone to the annual meeting, and you are the only resident in the ward on duty." Qi Jing is a small clinical scene, so you can change whatever you want. "You are a little transparent person who just came here. Of course, you have to stay on the front line of medical care for the annual meeting."

"Then let's report today's hospitalization duty." Song Yao did not give up, "The hospitalization chief of internal medicine will be the consultation for the entire internal medicine."

"The hospitalization always went to the surgical building for consultation, and I couldn't leave for less than half an hour." Qi Jing rejected her request again and began to put pressure on her only clinically. "Just when you were hesitating who to look for, the patient's oxygen saturation has dropped to 89%.

"No matter what, there should be a preparatory class in the ward." Song Yao said, "I'll look for a preparatory class in my department."

"I went to the cafeteria for dinner during the preparation shift, and I didn't bring Xiao Lingtong's phone, so you can't find him." Qi Jing smiled and immediately added, "The patient's blood oxygen saturation reached 85%.

Reduced again?

I really want to find someone to reduce a few percentage points.

"Senior Qi, you clearly don't let me find a superior."

As Qi Jing said, he closed his smile again and said, "You should know why I asked for a higher-level doctor?"

Song Yao suddenly realized that she had been panicked by the case and had forgotten her original purpose.

The whole thing was the one she took, and she wanted to follow Qi Jing. Qi Jing had no choice but to take out the cases under the box and test her abilities. It was not a solution to avoid them blindly.

After picking up the first aid again, looking at the overall situation, Song Yao knew she was doing well. The patient had difficulty breathing, so she gave electrocardiogram monitoring and then gave a mask oxygen. According to convention, the mask oxygen inhalation can basically restore the patient to a certain degree of oxygen saturation.

The next aspect of the symptoms should be...

"First give you a blood pressure reduction, and then... because the patient is now having difficulty breathing and sweating profusely, sedatives should be given to stabilize his mood." Song Yao felt that she was right, but she only got a combination of Qi Jing's eyes rolling and sighing, "Senior Qi, am I wrong?"

"I don't know how your diagnosis is, but respiratory medicine and pharmacology are definitely bad."

Since everyone else agreed to Qi Jing for the exam, he agreed that the other party could withstand this kind of poisonous tongue, so it was impossible to take care of the other party's feelings. As for the sudden change of a senior who made people love, he couldn't control how much spiritual trauma it would cause to the young junior girl.

"Can't use antihypertensive drugs and tranquilizers?"

“There is no problem with blood pressure reduction, but the sedative…”

Qi Jing was about to explain, but a young doctor walked into the door. He just put on a white coat and had the cheapest stethoscope hanging on his shoulder. He took Qi Jing's words and continued: "Before you understand the causes and extent of breathing, taking sedatives casually may aggravate breathing difficulties by inhibiting the respiratory center."

It was Hu Dongsheng who came. He was in the middle of the shift today and it was time to take over.

"You came pretty early."

Since being joined in the emergency team, Hu Dongsheng has almost always reached half an hour earlier in order to be familiar with the changes in the patient's condition as soon as possible.

Of course, he is also a part of the teaching staff now, and is very dissatisfied with Song Yao’s answer just now: “The sedative agent is originally used to achieve calming effects by inhibiting the center. The pharmacological description is very clear. Why did he return the basic medical school things to the teacher after just one and a half years of here?”

Song Yao lowered her head helplessly.

Internal medicine is boring, but there are standards for both diagnosis and medication. Even if Ji Qing has been in clinical practice for several years, he sometimes can't remember the list and usage of the drugs. An intern would be arrogant and say that there is no challenge in internal medicine, which really makes Qi Jing a little speechless.

"Senior Qi..." Song Yao shook her head.

"So don't be arrogant." Qi Jing warned, "We doctors are sometimes very good, but sometimes they don't have 1 ml of adrenaline yet."

She didn't even know what examination the patient needed, what medicines needed for first aid, and what dosage was, so she could only choose to lose. However, she still did not give up pursuing the truth about the patient's final diagnosis, because the superior doctor who was not in the medical scene created by Qi Jing has now appeared in reality.

"Teacher Hu, come and try it."

"Case?" Hu Dongsheng looked at Qi Jing, "What strange cases did Brother Qi say again? Take them to me to see."

Qi Jing smiled and looked at them: "Why, do you want to change someone?"

Hu Dongsheng scratched his scalp barely: "I am still more interested in the patient with repeated pneumonia that I just got."

"No, this is quite interesting." Qi Jing smiled and changed the number he said before, and then said, "Since the person has changed, the patient's condition must also change. As the superior doctor who Song Yao called, you have been delaying a lot of time on the road."

Hu Dongsheng faced the medical record wall, put his hands on his hips and imitated Xu's bald head in the urination and touched his scalp, "What I mean, I will do as you said."

Since returning from Shangjing, the pills have become warmer.

Hu Dongsheng, with a bald head, noticed the benefits of bald head. It was easy to take care of it in the morning and it was cool enough in summer. Anyway, he usually runs three times in the library and dormitory of Dan Medical University, and he has no time to do anything else, so he used bald head.

But unexpectedly, I learned Xu Huasheng's small movements.

"The patient still has difficulty breathing, sweating profusely, and the oxygen saturation must be changed." Qi Jing said with a smile, "to 70%.

This number exceeds the perception of the two interns.

Clinically, if an oxygen saturation is less than 95%, is the patient with an oxygen saturation of 70% still alive? Then, the heart rate of 160 and the respiratory rate of more than 50 make them feel even more terrifying, and they can't find a place to start.

For Hu Dongsheng, first aid is not difficult, but the difficulty lies in the final diagnosis.

"Let the nurse test the lard sugar first, and then draw a tube of blood for accelerated blood biochemistry and blood qi analysis." Hu Dongsheng is obviously much stronger than Song Yao. He said that everything is necessary for first aid, and there is a strict ranking order. "A nurse draws blood, and as a doctor, he must diagnose and treat it."

"How to diagnose and treat?"

"You should auscultate the blood while drawing." Hu Dongsheng asked, "What is the patient's lungs?"

"The breathing sound of both lungs weakens, the expiration phase is prolonged, and there are dry rales in both lungs." Qi Jing considered the entire diagnosis and treatment operation time and gave the first examination result, "The raw sugar has been tested, it is 10.7, not hypoglycemia."

After getting the answer to the examination, Hu Dongsheng immediately gave his next plan without hesitation: "The patient suddenly started to get sick, and the rapid drop in oxygen saturation was not very suitable for cardiogenic dyspnea. Consider more reasons for the lungs. First inhale the albutamol, then 100 mg of hydrocortisone, and then take a bottle of aminophylline and drip slowly."

After saying that, he thought about it and added: "Of course, the possibility of cardiogenic factors cannot be ruled out, so he still needs to push 20 mg of furosemide."

The treatment method was completed in one go, and neither intern could help but dictate all these processes.

Qi Jing nodded repeatedly. The extensive training over the past year has made him progress very quickly. The first aid technique has already had a hint of royal court style. It can not only attack the key points of the disease, but also cover everything, so as to try not to miss it.

But it's just trying.

"There are all medicines in the nurses' ambulance, so the treatment is done in less than five minutes." Qi Jing asked, "What's next?"

Next?

Hu Dongsheng was a little surprised and immediately noticed something was wrong.

Even if you don’t understand medicine, you will understand that after the treatment is finished, you must review the patient’s various indicators to see if the treatment is effective. It is even more natural for the doctor. Qi Jing should have just told the results directly, but he asked again, and there must be a problem.

The patient is not simple, but Hu Dongsheng can't think of what is not simple: "Did the patient not improve?"

"It's all like this and haven't improved yet?" Song Yao couldn't believe it.

"You have a very accurate intuition, you guessed it right." Qi Jing nodded, "You checked the lung auscultation, and the rales on both lungs did not decrease but increased. Then look at the oxygen saturation of the electrocardiogram monitoring, now it is only 65%.

Still falling!

The medicine just now was completely ineffective!

Albutamol is an antiasthma drug that can relieve bronchospasm; hydrocortisone is a glucocorticoid that can relieve various inflammations; aminophylline can relax smooth muscles and increase cardiac displacement. If these three medicines are used in conjunction, ordinary breathing difficulties cannot be completely corrected, at least they can have a significant relief effect.

But this patient...

Now Hu Dongsheng has been immersed in this case, and the patient is in front of him, lying on the hospital bed and sucking the oxygen in his mask in pain. Because of the lack of oxygen, his lips and fingers began to cyanate and could not wait any longer.

"Go on the ventilator." Hu Dongsheng said.

Qi Jing laughed and heard a middle-aged man's voice outside the door, with a little cough and complaining: "Every time you go on the ventilator, is it so fun to get on the ventilator? Cough cough, what should I do if I can't get up or down?"
Chapter completed!