What will happen to a doctor on duty in the emergency room late at night? Dr. Yang Wen, from the Emergency Department of the Civil Aviation General Hospital of Chaoyang District, Beijing, fell on the sharp knife of the patient’s family on Christmas Eve 2019. This heinous tragedy has aroused everyone’s attention to the doctor community and the relationship between doctors and patients.
The author of this article, Honger, is a doctor and an old friend of the Daily Book. Late night duty is a daily routine for her. In many cases, her daily book is on duty. Write it down. In the “Adventure Class” in December, Honger recorded the recent emergency room stories that occurred on the edge of life and death, suicide, myocardial infarction, epilepsy … These stories include the thrilling race against death, and the warmth and coldness of people who have been magnified in crisis .
Honger said she hopes more colleagues will write stories.
This article comes from WeChat public account: sandwich (ID: china30s) , author: rainbow child, head Figure source: Figure worm
There is a telephone in the emergency room dedicated to 120 dispatch contacts. Every time the phone number ending with 8941 rings, everyone’s heart can’t help but tense, the physician and the surgeon look at each other, as if they are guessing who the order is with rock-paper-scissors with their eyes.
Oh, No, it’s mine.
The operator will provide 3 key messages on the phone:
1. Address . Because there are many places in the countryside where the doorplate cannot be specified, this requires a positioning description to help the driver find the location as quickly as possible;
2. Contact information for calling for help . After 120 hung up the phone, we need to contact each other on the road directly using the hospital’s “Little Smart” (You read the thing more than 10 years ago. In use) to contact each other for further orientation;
3. Patient symptoms . For example, a car accident or trauma requires surgical visits, and coma, asthma, chest pain, hemoptysis, and vomiting are medical examinations. Symptoms determine who the visiting doctor is.
When the outpatient nurse picks up the phone, they will call the driver directly. The driver will drive the ambulance to the emergency department entrance. The doctor and nurse will take the portable ECG machine and the outpatient box to the car and leave. Although I know the destination, because I don’t know the current situation of the patient, I will always be very anxiousAnxiety, the most feared is life is dying, you may not be able to support the hospital when you get on the car, you can only explain to your family on the scalp, and then sign off. Sometimes people are gone, and their families can’t believe it. We went to the scene to confirm the death.
Every 120 visit is an adventure, a known destination, and an adventure with unpredictable endings.
Dead fumigant
The call was from Yinquan Hospital. There was an old man who said that he could not take two fumigants. Now he asked to go to our county hospital to continue treatment.
Fumigant, I didn’t know what it was until I came back to work. Because I have never lived in the countryside, I have never done farm work, so I know nothing about the countryside.
This is a kind of pesticide. It is ignited to deworm rice. The main ingredient is aluminum phosphide.
Fumigation cases of poisoning have occurred before, but most of them are caused by smoked rice in the warehouse before bedtime, and poisoning caused by gas leakage while sleeping, and the disease is mild or severe, and many die. In this case, two pieces of aluminum phosphide were swallowed directly, and there was almost no way to save them.
On the road in the past, I was struggling with how to deal with the patient after receiving it. Although I know he must not be late at night, he still needs to take some measures.
Want to have a gastric lavage? Where to stay in hospital? Will it not work on the spot?
Pick up your mobile phone and call back to the hospital to confirm whether the intensive care unit has a bed. The information obtained is full.
That can only be sent to a Chinese medicine hospital.
We are here in 25 minutes. A group of people gathered around the site, with an old-fashioned bench in the middle, and the family lying on it hugging the old man. The old man’s face was covered with blood. Seeing us coming, the family immediately lifted the old man into the ambulance. Before I started the consultation, my family started urging us to get back to the hospital.
In the car, we said that the hospital intensive care unit can only be sent to the hospital without a bed. The family agreed. Then ask why to take fumigation medicine, the family said that the personality changed after cerebral infarction, often thinking about dying.
The depression caused by cerebral infarction is not the first case I have encountered.
Whistling all the way, the driver slammed the throttle and said to me, “This old man is definitely not saved. A few years ago, an old lady took fumigant at home, and she was already bleeding when she arrived at 120 … … “
I didn’t listen carefully afterwards. I opened the middle window and asked the nurse about the patient’s condition. The nurse said that it was relatively stable, and I was relieved temporarily.
I arrived at the emergency department entrance of the Chinese Medicine Hospital in 20 minutes. I took the splint of the consultation sheet and got out of the car, and hurried to find the physician on duty. The medicine needs to go in right away. One more sentence, there is no gastric lavage.
The emergency doctor also became an old face in the rendezvous of many transfers. He asked me with a puzzled look: was he taking fumigation medicine? What should I do? I haven’t met it yet.
I added a sentence: Stomach lavage before sending ICU, it is estimated that it can’t survive the day.
He immediately realized that the situation was serious. He signed on my consultation form and quickly hurried to the door to look at the old man, his face covered with blood. He was more afraid. This situation is indeed critical because I don’t know when the time bomb will blow up, and everyone is afraid that he will blow it in his own hands.
The rescue of poisoning itself is very difficult. Because, as in the martial arts novels, one poison corresponds to one antidote. Many toxins enter the human body are incurable, and must die.
The old man entered the rescue room, and the doctor and nurse started to deal with it. We will return by car after the transferBack to the hospital, the horrifying hour passed, and my back was a little soaked. I wondered in my mind how the last few hours of the elderly would be spent?
Deep venipuncture, tracheal intubation, mechanically assisted ventilation, cardiopulmonary resuscitation, cardiac arrest, respiratory arrest, declaration of death …
Mother and daughter farce
At about 9 o’clock the other night, the “hotline” rang again. The call for help came from the residential house on the North Road of the hospital, and the distance from the emergency room was less than 300 meters.
A middle-aged woman took 20 pills sleeping pills …
While complaining about why the family did not send the patient directly, we took the guy into the car and went to the designated place for help in three minutes. He waited for us downstairs and saw the ambulance rushing to wave at us.
After getting off the bus, I immediately confirmed with my family what kind of medicine I was taking, and did I drink alcohol? Make sure the patient is slightly relieved not to drink. Because sleeping pills and alcohol can cause respiratory depression to be life threatening.
Up on the second floor, the patient is about the same age as my parents and is lying on the bed in thin clothing. The family pulled her up, and she was very emotional, saying “let me die” and “I don’t go to the hospital.” The husband called his elder brother to persuade him, but it was useless. Brother Daxi kept pulling the patient in the room, and his temper came up so loud that my ears were sore when I stood at the door.
Suddenly, a girl the same age as me came out of another room and stood at the door of the room and shouted at the woman: Do you want to die? You are dead, everyone is so peaceful …
The woman was even more annoyed, crying under the quilt and saying, “Look, it’s my daughter who forced me to die.” I don’t want to go to the hospital, you just let me go to sleep.
The husband couldn’t bear the woman’s work, and he was so angry that he dragged the woman out of bed. The woman stood tremblingly and her husband pulled her clothes brutally to put on her. I asked if we could not go to the hospital. I said that we might be lethargic in the future. It would be better to go to the hospital for gastric lavage and get some water to promote the early discharge of the medicine.
The woman took the opportunity to sit at the dining table in the living room again. I talked to the accompanying nurse and she turned a deaf ear. The reason she refused to go to the hospital was that her daughter couldn’t get along with her and kept saying that her daughter wanted her to die.
The daughter ca n’t stand the mother ’s constant nagging again, she burst out of the room and shouted at her mother: “I told you that taking medicine did n’t die fast enough, I have a quick way. After saying that, he went straight to the kitchen and picked up a knife to cut it on his wrist, but was stopped by her cousin in time. The daughter’s emotions were suppressed to the apex, and she snarled in the kitchen. The children in the room heard the sound outside, Sitting on the bed and trembling while crying, her daughter was persuaded by the cousin to cry in the room and hugged the child.
The three men stood beside the woman and continued to lobby. Later, they felt that they could not do it. They immediately lifted the person up, and quickly went downstairs into the ambulance compartment.
The driver started the car and arrived at the emergency room door in two minutes. After asking about some medical history details, he decided to give her a gastric lavage. Gastric lavage is very painful. It is no different from a gastroscope. A water pipe is inserted into the gastric cavity and a large amount of water is used to flush out the poison in the stomach. After the husband finished signing, the two family members held the woman’s hands and feet, the nurse inserted the tube, and the woman kept sobbing. Undissolved tablets can still be seen in the washed water, and there are a lot of powdered medicines floating on the water surface.
In 5 minutes, I washed 15 liters of water and basically washed it. The residual medicine in the body started to work, and the woman was a little sleepy. I gave her some naloxone to resist the effect of the sleeping pills, because I just added some medicine to protect the stomach after washing the stomach. Some electrolytes and sugar water, put her in a quiet corner and watch.
When the patients in the rescue room were gone, I talked to her husband. Her husband said that in fact it was not a big deal. After a few quarrels with the child, the result became louder and louder, and he did stupid things out of control. I asked if there were any fluctuations in mood. In summary, it feels like a typical state of depression. This aunt really wants others to understand her from her own standpoint. She always feels that the world is hostile to her and that her life is not going well, and her family is very happy in the eyes of others. .
Later, I told her husband that I usually care more about her. It is better to consider doing a psychological consultation to eliminate depression, so as to avoid such things in the future. I also persuade the children to go back and have any arguments with my mother. The family is never absolutely right or wrong.
I said this to myself silently.
Scary coma
It was another noon. The “hotline” came in and said the old man at home was lethargic. Let us go and see. The house where people are calling for help lives on the other side of the canal opposite the hospital. We crossed the bridge to the small business district.
Called the caller again to confirm the location, and later met at the door of a restaurant. He led me to the sixth floor with the nurse on duty, only to hear a woman at home crying, “Sister, wake up soon!Other members of the Cardiology Department prepare for emergency coronary angiography. In this short quarter of an hour, the patient hovered several rounds on the line of life and death. The family members were scared and crying outside.
While the doctor and his family members were in critical condition, the family members tremblingly picked up the pen to sign, and the defibrillator over there began to call the police. Ventricular fibrillation reappeared, and after a few seconds it was a straight line!
Nurse resuscitates again, the doctor checks the energy, smears the conductive paste, warns to leave the bed, and defibrillates again, thankfully the autonomic rhythm is restored. This is really terrible.
The patient wakes up again, and his chest pain makes him very irritable. Family members understand the risks of surgery and can only take a chance, otherwise there is no chance of life.
After all parties are in place, we transfer the patient to the catheterization room. Even if the distance is less than 100 meters, there is a very high risk. Two people pushed the bed, one pushed the defibrillator, and someone held an intravenous infusion to maintain a life-saving channel in their hands.
After arriving safely in the catheterization room, the cardiology team started the interventional angiography at the fastest speed.
I was just shocked, and I heard that the patient ’s heart stopped three times during the operation, and three resuscitation and defibrillation rounds, but they all came over. Everyone says that this life is really big.
About an hour later, the director of the cardiology department sent me a message telling me that the operation was over. The patient’s stent was blocked by a thrombus and the stenosis was very dangerous. Fortunately, the blood vessels were dredged as fast as possible, saving lives.
Everyone was relieved to hear the good news.
Now is the peak period of myocardial infarction. Everyone should have a common sense of myocardial infarction. For sudden chest pain, you need to go to the hospital in time, and the high-risk groups need to do secondary prevention.
(picture source is Weibo @ 医疗 美图)
Timely detection of myocardial infarction can save a life.
The old man said more and more sad, I felt that life was too hard.
The old man said that he was not too old, and he was a bit of a craftsman. He switched to working in the same village and earning money. However, the home is inseparable. The granddaughter’s illness showed no signs of improvement, and she was inseparable from care. The old woman is also getting older, and her child is getting heavier and he cannot stand and walk. Therefore, I had to stay at home and take care of the children with the old lady.
In this way, the burden of making money all falls on the daughter. Divorced for many years, dragging such a child, without foundation and culture, can only make noodles in the breakfast shop. I have to get up early every day to open the shop, so I had to live in the store. When the child got sick, the old man called his daughter and then let the car pick up.
The stability of the drug has not yet passed, and the pediatrician came to the consultation to think that the child’s condition was more complicated and suggested to go to a superior hospital. Family members understand the situation, but they also know that the doctor will definitely say that every time. This was also very helpless, telling her that the best ambulance would take it, but considering the long-distance cost of the ambulance, the family still refused. I asked them to sign the medical records.
The child’s mother asked her relatives to drive together and prepare to go to Nantong to see a doctor.
I still confess that the best way to transfer to hospital is to use an ambulance, but my family still finds it expensive. When the family members decided to transfer to the hospital on their own, they explained the risks to their family. They all understood that the daughter signed the letter and took the sleeping child toward the car at the door.
When they leave, the nurse on duty and I ca n’t help but sigh, thinking about how long the child can be, how can this family survive …
This article is from the WeChat public account: sandwich (ID: china30s) , author: rainbow children