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王白水

白水房

志闲少欲,心安不惧 泛中医论坛https://forum.beginner.center/
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xiaoyuzhou

A037's first emergency night - happy and painful

Overview#

Yesterday, the handover was completed at four-thirty in the afternoon. I went to bed at eleven and woke up at four. Today, I left at eight-thirty. I received 9 patients with a second-line senior sister and a duty teacher, and actually participated in the treatment of 5 patients. I wrote 0.5X3 medical records, 0.1X1 rescue records, measured blood sugar 20+, blood gas analysis 2, etc.

Thank you very much to the senior sister for taking the lead and bearing most of the pressure (at least 80%) 🙏

The Joy of Building a Knowledge System#

It is well known that only by practicing in a clinical setting can one truly become competent. Last night, I gained a very deep understanding of respiratory failure. The reason is simple: I encountered too many cases of respiratory failure and observed how the teachers handled them. Combined with reading tutorials temporarily, I roughly understood it.

I have heard several related lectures before, but I was always confused because I wasn't paying attention in class. And the reason I wasn't paying attention was mainly because I didn't find it interesting. But this time, wow, there were several cases of respiratory failure right in front of me, and the lectures that were decently delivered were quite interesting. They directly connected with pathology, which is the significance of learning in a clinical setting. It's the most efficient way 👍.

Unfortunately, when I talked about this point during the morning handover, I was too nervous and didn't hear what the director said. Next time, I should have a thicker skin during the handover and listen to the director more.

The Joy of Mastering New Skills#

Last night was the first time I took blood sugar measurements. I had observed closely how the nurse did it before, but when I tried it myself, I couldn't even insert the test strip properly. Which side should face the machine? I was embarrassed in front of the nursing staff, but quickly switched gears and pretended to be calm, and after a few tries, I still couldn't get it 😂

In the end, I completed it with the help of the nursing staff. After that, I became more proficient. I measured more than twenty blood sugar levels.

In addition, I also learned how to measure blood gas. I didn't get to draw blood gas myself; the nurse did it. I was only responsible for sending it to the machine for analysis. On the way, I saw serum separation for the first time and was worried that the blood sample would be wasted. But the designers of the machine had already thought of that. After the blood is drawn into the machine, it will be mixed. The blood gas test is very fast, with results in 1 minute. Including transportation time, it should take about 5 minutes from drawing blood to getting the results.

I also observed the detection of myocardial injury. This machine is even more advanced and even uses the Android system (my focus is so strange). The myocardial injury test takes 11 minutes. Including transportation time, it should take up to 15 minutes from drawing blood to getting the results.

These two projects dispelled my misconceptions about the laboratory. I used to think that these tests were very troublesome, but it turns out they are fully automated!

The Joy of Witnessing Rare Cases#

I saw a patient with food poisoning for the first time. He was a middle-aged man who couldn't speak due to tongue paralysis after drinking mineral water (maybe he was poisoned?). He had excessive saliva. Our hospital couldn't handle it, so we sent him to Chaoyang Hospital nearby. This case came in and out in less than 3 minutes. I was lucky to have seen it. So this is what food poisoning looks like.

I saw a drowning patient for the first time. She was a young woman. After drowning, her body temperature dropped suddenly (she was wrapped in aluminum foil for warmth) and a large amount of water was poured into her lungs (I guess she will have severe pneumonia in the future, but she looks young and should be able to get through it). She was conscious and responded fluently, but she seemed to have split personality and talked to herself all night.

I saw a patient with right-sided chest pain for the first time. She was an elderly woman who woke up suddenly with severe right-sided chest pain during sleep one and a half hours ago. The pain worsened with breathing. The electrocardiogram and CT scan showed no problems. We didn't investigate further. It's usually left-sided chest pain that we see, so it's the first time I've seen right-sided chest pain. It's ruled out as a heart problem, and it may be related to the lungs?

I participated in the rescue of a patient with respiratory failure for the first time. She was an elderly woman, and I didn't remember her medical history. When I went to check on her, I saw that she was confused and unresponsive. I shone a flashlight on her, and her pupils were dilated and reacted slowly. The teacher quickly asked me to call the nurse and start the rescue. I was confused, and the nurse was also confused at first, but she had a lot of experience and quickly got to work. I was mainly responsible for moving the patient and running errands (the blood gas test mentioned earlier was for her). When I finished running errands, the ventilator and medication were all done (emergency rescue commonly uses dopamine, norepinephrine, etc. for medication, I will learn more about this in the future).

I saw a patient in the terminal stage of ovarian cancer with metastasis for the first time. She was a middle-aged woman. After ovarian cancer surgery, she didn't have regular follow-ups for a year. She had a large amount of ascites and her abdominal skin was tight. The CT scan showed large metastases under the skin. When I saw her in the afternoon for the first time, she was vomiting thin yellow liquid (probably bile, also the first time I've seen it). The next time I saw her, she was in severe pain and was given painkillers. Later, we prepared to drain the ascites for her, but her heart rate was too high and her blood pressure was not high enough, so we didn't dare to do it. When I woke up at three o'clock and came back, her blood pressure couldn't be measured, her heart rate was 160, and she had already undergone defibrillation and intubation for breathing. It's very pitiful. She has been crying in pain and discomfort all night, but we don't have a good solution. Her elderly mother accompanied her to seek medical treatment, and she had a blank expression on her face, showing a sense of hopelessness.

And so on and so forth.

Other Joys#

The joy of eating melons. After rotating in the ward recently, I heard a lot of gossip. I'm not a person who is interested in gossip, and I have always been curious about where others get their gossip from. It turns out that the ward is an important source.

I witnessed some strange family members: The patient was critically ill the day before yesterday, and the family members rushed from Xi'an to Beijing yesterday morning. They cried for a while in the afternoon and disappeared with a nanny in the evening, which is beyond my understanding. The teacher said they were just putting on a show, maybe that's the case.

Pain#

We often say, "Pain and joy." At first, I wanted to write about how tiring this night shift was and what I gained from it. But then I thought, everyone already knows how tiring night shifts are, so why reinforce that point?

It's better to change the perspective and emphasize what can be gained from night shifts. If the students who read this article in the future feel anticipation and calmness instead of fear and uneasiness when they have their first night shift, then I have conveyed the meaning of this article!

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