Vol 2 Chapter 1309: Astounded

   Chapter 1309
   "Zhang Yuan has finally rounded the ward!"
   "The boss is going to round up!"
   "The director of the Gastroenterology Department has almost peeed his pants these days, and finally Boss Zhang is going to round up!"
  When Zhang Fan was about to round the room, the female doctors in the internal medicine department seemed to be frightened, and they almost held the seeds one by one!
  However, Zhang Fan rarely came to the internal medicine department every day this week, and it also made other people feel something in their hearts. This time, not only the leader at home came, but even the pill specialist in bowel surgery also applied to participate in the rounds.
   "Finally remembered the internal medicine department, and no matter what the internal medicine department is, in the future, the teasu hospital will be the teasu surgery hospital.
  Do you think this flower is sick, why is it lying down? Not enough water? Is there still not enough fertilizer? "Ouyang looked at the cactus in front of him tangledly. It was straight yesterday, but why is it crooked today?
  She has nothing to do these days, and she waters the flowers when she is bored.
   "European Academy, are you going?" Old Chen pretended not to hear Ouyang's words.
   "I won't go. I don't touch the ground all day long!" Ouyang said proudly. The old lady is very happy these days.
  Because Mishima GlaxoSmithKline has built a tea plant, the tea plant government is not confident enough to face such giants. I was thinking of asking the other party to pay more, but I was also afraid that people would dislike the uglyness of tea vegetarian.
  So, in order to make everyone harmonious, Ouyang was invited by the Tea Vegetarian Government to communicate with Ms. Zeng from Mishima GlaxoSmithKline.
  The tea government and Ms. Zeng of GlaxoSmithKline actually wanted Zhang Fan to be the intermediary, but Zhang Fan recently turned on internal medicine and ignored them. So as a last resort, Ouyang was invited to go.
  Ouyang likes this kind of big project.
Early on Monday morning, the weather was good, and it rained more at night than during the day. Because of the snow-capped mountains, the temperature during the day was too high, and there would often be a light rain or moderate rain at night. The next morning, the air was filled with oxygen. ion.
  Moreover, the blooming of various flowers in summer makes the air of tea plant more delicate. In the frontier, in the northwest, in a place where almost half of the territory is the Gobi, such a city is really very different.
  Of course, today the tea hospital, the other doctors do not know how the mood is, the doctors in the gastroenterology department are very nervous up and down.
"Is there anyone with a sick number, a drug exceeding the standard, or a bed-ridden? Why are you still writing medical records? Oh my god, the dean has hit the door. Do you want to do it or not." Digest The director of internal medicine was about to jump up and stand upright in his anxiety.
  In the department one hour before going to work, not only did all the staff be in place, but they also got in trouble. One is more hurried than the other.
  The head nurse led the nurses to check the ward over and over again,
Clean up all the extra stuff, and the ward should be tidy, and whoever’s rice cooker should be taken away immediately. Don’t come to the hospital next time you see it.
  Master, what are you messing up with? Hurry up and replace the blanket you put on with a hospital blanket. "
  When it was time for work, I heard the sound of footsteps in the corridor, and there were still a lot of people. The director of the gastroenterology department was sweating in the doctor's office. "Are you here?" he asked quietly.
   "Come on! It's all here!" The nurse said immediately after standing at the door and taking a peek.
  Zhang Fan is here for the rounds!
  The hospital leadership, except for Ouyang, who did the big business, did not come, all the other leaders came.
  Middle-level leaders, Lao Ju also came with a group of section directors.
  Lab, doctors and masters who have something to do with digestion are also here.
  It can be said that this round of ward rounds is estimated to be the largest and most comprehensive in the history of Chasu.
  When Zhang Fan came to the Internal Medicine Building in the morning and saw a group of people waiting in the lobby on the first floor of the Internal Medicine Building, he directly saw a team of no fewer than 30 people waiting.
   "Everyone is not busy today!"
  Zhang Fan glanced at Xiao Chen.
  "It’s been a long time since the rounds were rounded. This time Zhang Yuan spoke. Everyone is very enthusiastic. We can't decouple our business studies!" Old Chen hurriedly answered the conversation.
   "Hehe, why do you think of the ward round of the Gastroenterology University?" Yan Xiaoyu asked.
  She was worried that Zhang Fan was dissatisfied with the internal medicine, but she did not say that it was most frightening to not send it.
   "The internal medicine department hasn't come to the ward rounds for a long time, and it happens that these few days are not busy! Since everyone is not busy, let's go for the ward rounds. Today, everyone should be prepared to be hungry." Zhang Fan said with a smile. I stepped into the elevator first.
  All eight elevators were on standby, and Zhang Fan's smiling face couldn't come out. "Let's not take it as an example. The patient climbs the stairs, it's not sensible!"
   Although Xiao Chen is not the leader, she has to follow the leader, so after several leaders entered the first elevator, Zhang Fan said something to Xiao Chen.
  Xiao Chen stuck out his tongue and quickly agreed.
  Thirty people came into the internal medicine office.
  The director of the Gastroenterology Department looked at Zhang Fan, meaning that the leader was speaking!
  Zhang Fan waved his hand for him to continue.
  "Today's big rounds, starting from the first bed, please turn off the phones, and be responsible for preparing the various cases and information of the patients who manage their beds in advance, and now start the rounds."
  After finishing speaking, the director of internal medicine hurried to Zhang Fan and let Zhang Fan go first.
  This is the rule.
  In any department, during rounds, the subject leader must be at the forefront, followed by the next three levels. Whoops, the number 30 brought by the leader, the original doctors in the department plus the internship specialists, are almost the number 30, and the nurses are more than 30, which is almost a small team of 100 people.
"Three beds, female, forty-five years old. She had a history of liver cirrhosis for more than ten years. She was admitted to the hospital due to hematemesis, melena and shock ascites. After admission, she was given active treatment to correct shock, improve hemoglobin, and control bleeding... "
  In the first room, there was a serious illness number.
  After the tube bed doctor seriously reported the condition, he looked at the big rounds.
  There are generally three types at this time. Non-professional leaders will nod their heads, then look at the patient's number from a distance, and then ask: "The windows should be closed on time, ventilation and warmth should be paid attention to, and the patient should not catch a cold!"
  Then shook the patient’s hand, and the reporter from the hospital newspaper snapped the photo immediately, and then the round was over. The doctors actually didn't catch him at all in their hearts.
  The second type, professional leaders but not leaders of this profession. During ward rounds, I don’t ask much questions, but I will see the doctor’s advice and occasionally ask the patient to lie down to check the individual. After the physical examination, after reading the doctor's advice, I rarely ask questions. The Chinese leaders are very good at hiding the clumsy way.
  The last kind is the leader of this profession. This kind of leader makes ward rounds, doctors and nurses are in fear.
  After the doctor’s report was completed, Zhang Fan did not see the medical record, so he went directly to the physical examination, "Hehe, I am the dean of the Chasu Hospital, today I will do a physical examination for you, and you lie down."
  Zhang Fan smiled and said to the middle-aged woman in front of him, and then lifted the patient's shirt.
  The patient was trembling a little, and she was not in good health. Looking at her doctor who is taller than a big cock, she would look like a quail. She was also nervous. She didn't know what was going on. This was what she was going to do.
   "It's okay, it's all experts. This time you are lucky. With so many consultations for you, it is usually difficult to find all these experts." Seeing that the patient was a little nervous, Lao Chen explained slowly with a smile.
"Oh!"
  I heard that the patient of the other bed was an expert or a dean, so he lay on the bed anxiously, opened his clothes to reveal his belly, and waited for the expert to touch it.
  ……
"The liver is palpable under the ribs, and it's hard..." Zhang Fan reported his data while checking. The gastroenterology doctor, regardless of the tube or bed, took out the notebook to record, anyway, I don't know what he wrote. , But the posture is put out.
   "Is there a primary prevention preaching to patients before bleeding?"
   "Yes, Zhang Yuan."
   "After bleeding, has the patient been circulated?"
   "Cycling, it's almost a year now."
  "After one year, what is the bleeding rate?"
   "Yes..." The tube bed doctor can't answer!
   "60%!" Doctor Tube Bed's superior doctor quickly stood up and answered.
  Zhang Fan didn't say anything, but the bed doctor was already flushed.
  "Have kidney function been tested regularly?"
   "It has been checked regularly!"
   Zhang Fan asked in detail, especially in detail.
  In detail, Ren Li and Yan Xiaoyu looked at each other. "I'm afraid that this level has reached the deputy high school of internal medicine. Isn't it a reluctance to say that the internal medicine of Zhangyuan?"
   Yan Xiaoyu was shocked. Is this really the legendary pretending to be a pig and eat a tiger? Being so young, oh my God, with such a deep mind, Yan Xiaoyu thought about it, and quickly recalled whether she had made any mistakes in business since she came to the Chasu Hospital.
  "Why not add isosorbide mononitrate?" Zhang Fan had already taken the medical record and started the doctor's order.
  The doctor on the tube bed was stunned, yes, why do you want isosorbide mononitrate?
  The superior doctor was also stunned.
  Internal medicine, how can I put it, it is like a lottery. Before the prize is drawn, everyone is covered in clouds, but once the prize is drawn, everyone suddenly realizes that it is like this.
  It seems that everyone can understand it, but in fact, this is the beginning of medication according to symptoms, signs, and development of the disease.
It’s well written in the textbooks. This medicine is used for this disease. It doesn’t seem to be responsible at all. To be honest, if it’s really that simple, just pull out two high school students and let them read the internal medicine books. They can also give it to them. People are getting medical treatment.
   "Oh? Didn't you think of it? Octreotide is a solid use!" Zhang Fan patted the case in his hands.
   "Come on, Director Li, tell me why not isosorbide mononitrate!" Zhang Fan said to the director of the Department of Gastroenterology with a smile.
  Today, if the director didn’t even know why isosorbide mononitrate was added or not, Zhang Fan was determined to take him.
  The director who wiped his sweat didn’t know Zhang Fan’s target at this time. In the end, he came to catch the expensive medicine octreotide, or to catch the quality of the cases!
   "Although the patient has been cercled for nearly a year, the bleeding is not obvious at present, and the patient's liver function is poor. In order to protect the liver, we did not consider using isosorbide mononitrate!"
  When Zhang Fan heard this, he looked at the director of the Gastroenterology Department, "I have the level, but my heart is not here!"
  The director level of the gastroenterology department is still there.
"Then when do you say it is appropriate. There is a 60% possibility of recurrence, and she is bleeding again now. If you can't vomit blood, give octreotide. If you stop the bleeding, don't care. My chief director, can you use snacks? "
  Zhang Fan handed the medical record to the director of the digestive department, but did not let go. The director of the digestive department, Lao Li, looked ashamed.
  The time is just tens of seconds, as if a long, long time has passed.
  The people in the rounds, especially the surgical leaders, looked at Zhang Fan with horror in their eyes.
   "Zhang Yuan is going to do internal medicine?"
  Zhang Fan ignored them. After letting go of the case, he said, "Continue the round."
   Turn around and continue.
  Everyone looked at Zhang Fan.
  It seems to be like the more popular sentence, I am standing here, you see, I am a bit like back then!
  Zhang Fan made rounds while checking the system in his mind. Internal medicine is actually more complicated than surgery.
  Some treatments are good in the short-term, and it’s good to go to the left and right, but it’s not the same in the long run.
  Maybe doctors who look at the long-term are too few.
  So Zhang Fan took the treatment plan into the system and compared them one by one.
  (End of this chapter)