Chapter 406 The chief resident has a leprosy on his head!

Before Li Dongshan arrived at the department, Liu Chengqian and Zhang Xin had already rushed to the department with nervous expressions on their faces. However, when they entered the office door and found that all the bedside doctors were at their posts, they felt anxious.

He breathed a long sigh of relief.

The Jinyi team has now arrived in Shashi, and has also come to the Second Xiangya Hospital for an unannounced visit. And now it has turned from dark to clear, it must be that they are here to kill people. If there is no better resident general at this time, the bed doctor will

If the gathering is incomplete, many vacancies will have to be filled by their superior doctors.

When Lu Cheng saw Professor Zhang Xin and Professor Liu Chengqian arriving at the door, he went up to them and said to the doctor in charge: "You can't change the doctor's orders casually now. You must have heard clearly that you can't change the medical orders casually."

"However, all medical records on file must have logical explanations. If antibiotics are used for more than 48 hours, they must be supported by laboratory tests and physical examinations. All indications and reasons for medication must be written down. If you cannot write

Yes, ask me, your superior doctor for instructions."

After saying that, Lu Chengqian came to the door and went straight to the director's office. Because Professor Liu Chengqian and Professor Zhang Xin had already transferred to the director's office after seeing Lu Cheng entering the office. There were only six computers in the doctor's office, a total of

There are twelve doctors in charge of the hospital, which is completely insufficient.

The director's office is equipped with three computers that can be connected to the medical order system. What they have to do now is to check the medical orders of all patients in the bed.

"Teacher Zhang, Teacher Liu." The door to the director's office was ajar. Lu Cheng was not polite and pushed the door open first, then called someone directly.

"Close the door." Liu Chengqian took a deep breath and said.

Lu Cheng naturally closed the door, but just when he was about to close it, Li Dongshan arrived at the door and opened it again.

Lu Cheng turned around and saw Li Dongshan, quickly stepped aside and invited Li Dongshan in.

"Director Li!"

"Director Li." At this time, Zhang Xin and Liu Chengqian were extremely polite.

As the administrative director of the trauma center, Li Dongshan is the first person in charge if any problems are discovered in the trauma center. And no matter how big the problem is, as long as there are no special problems on the individual, then the person who is to be dealt with will

There must be only Li Dongshan, and he will not beat everyone to death with a stick.

Because if all the superiors of the trauma center are taken away, the trauma center will not be able to operate.

Li Dongshan did not reply to Zhang Xin and Liu Chengqian, but looked at Lu Cheng, lowered his voice and said anxiously: "Do you usually follow the medical orders in the department?"

The Jinyi team came to investigate to check for unhealthy practices. To check for drugs that should not be prescribed to patients, but they are prescribed to them. Or some doctors ask patients to buy medicines at designated prescriptions outside. Both of these are...

It's a certain death situation.

And some junior doctors like to do this very much.

Lu Cheng said: "Master, Teacher Zhang, Teacher Liu, when all the bedside doctors entered the department, I had already done the pre-admission training, and basically I checked the medical orders of all the patients in the department every day.

.”

"There are basically no drugs like those that shouldn't appear in our department. However, except for the patients in our group and the medical orders from Teacher Zhang's group and Teacher Liu's group, I just took a look at the antibiotics and gastroprotective drugs.

Usage time."

"Only if it exceeds three days, I will ask the bedside doctor to take care of it. I will stop it directly or write down the reason."

"However, in principle, if there are no special clinical symptoms, antibiotics can only be used for a maximum of 48 hours, and stomach-protecting drugs can only be used for 24 hours, twice."

"In addition, the medicine we use in trauma surgery is protein powder. I also check it every day. Basically, those who use protein powder have hypoalbuminemia. But in principle, only when it is lower than 30

, you can take oral protein powder for supplementation, and if it is below 25, you can take intravenous supplementation of albumin.”

"If we examine this carefully, there may be problems, because many patients aged 31-35 are directly prescribed protein powder in our department."

“Among the post-operative medications, the drugs we mainly use in trauma surgery are: anti-inflammatory, analgesic, swelling, tonic, and anticoagulant drugs.”

"The use of anti-inflammatory drugs: Currently, in addition to the 15 beds in Teacher Liu's group, the 2.4 beds in Teacher Zhang's group, and the 34 beds in our group, they use piperacillin and sulbactam instead of cefuroxime. These four

I also looked at the beds. The fifteen beds in Teacher Liu's group had exudate from the wounds, and they had undergone debridement after the first open fracture."

"But after the operation, the exudate was not sent for bacterial culture, so the medication has not been stopped to this day."

"The 2 beds in Teacher Zhang's group have drug sensitivity results and consultation opinions from the pharmacy department, and the current wounds are still infected. The last drug sensitivity culture results were two days ago."

"Bed 4 is hypoalbuminemia + wound pus. Although there is no consultation opinion from the pharmacy department, we still requested a consultation today. The pus in the patient's wound was sudden. It seems that it was discovered by the doctor on duty yesterday afternoon.

But it was not dealt with in time.”

"Just now, I called the pharmacy department for consultation. Teacher Sun from the pharmacy department said that he would come to our department in an hour. Because there are many people asking for consultation now."

"Bed 34 in our group, Master, as you know, this patient has no effusion after the operation, there is oozing blood, and the culture result of the oozing blood is that it is sensitive to piperacillin and ineffective to cefuroxime. The current wound recovery is OK, please ask before

After a consultation with the pharmacy department, piperacillin can be used. After checking the laboratory test results two days ago, I asked for a consultation with the pharmacy department and it is recommended to continue using it."

"Because the inflammation index is relatively high."

"These are antibiotics and postoperative analgesic drugs. The non-steroidal intravenous drug currently used in our department is Trina (parecoxib sodium) qd, and the oral drug is celecoxib 0.1g bid. Currently,

There is no illegal use in our department."

"The gastroprotective drug is also commonly used lansoprazole. It was used for this time, but it was a little over the time. It was basically used for three days, and I stopped the drug when I reminded..."

"Anticoagulants are the most irregularly used. I have asked Xie Jian. Except for our group, which uses low molecular weight heparin sodium, most of the medical doctors in other groups use nadroparin calcium...

…”

"Low-molecular-weight heparin sodium costs more than ten yuan a piece, and Naqu is more than forty. But Naqu is also a routine postoperative medication. I also saw it in the guide book that it is a first-line medication. Instead, we use low-molecular-weight heparin sodium.

It belongs to the second tier. But I don’t know if there will be any problems with this."

"Because the use of nadroparin calcium is mostly used for the treatment and prevention of blood clots, it seems to be a bit too much."

"The conventional anti-swelling drugs are mannitol, but there is nothing special about this. Some people have used other Chinese patent medicines for intravenous injection in the past, such as aescin and compound salvia miltiorrhiza injection, but I temporarily stopped them."

Lu Cheng reported everything in detail, not only to explain the problem to Li Dongshan and others, but also to reassure them that he had been attentive during the half month he was the chief hospital resident.

However, when Lu Cheng said this, he still felt a little guilty, because he still had something to say, which was that the reason why lower-level doctors used Naqu was because a drug dealer had found it privately. Although the effect of Naqu was lower than that of

Molecular heparin sodium is better, but its use is illegal, and the preventive use of Natrex is a bit too strong.

It's probably a kickback of a few dollars. And it's not ruled out that the senior doctor in the department told the junior doctor.

There are only a few people in the department, and Lu Cheng can't afford to offend anyone, so it's impossible to talk about it. Moreover, the guideline recommends intravenous anticoagulation with nadroparin calcium if necessary.

As for Chinese patent medicines such as sodium aescinate and compound salvia miltiorrhiza, although they have the effect of reducing swelling, they are not as intuitive as mannitol. Lu Cheng was not sure about taking them, so he stopped them. Even though the guide also mentioned these two

There were several kinds of medicines, but Lu Cheng didn't understand how they worked, so he refused to use them.

Li Dongshan called Lu Cheng to the department so urgently, and Liu Chengqian and Zhang Xin also arrived immediately. There must be something wrong.

When the hospital is inspected, it is nothing more than checking for arbitrary charges, arbitrary prescribing of drugs, and illegal use of drugs.

Fortunately, Lu Chengyou checked the medical orders of all patients in the department every day, so he did not ask some people from the general surgery department to come to the orthopedics department to bring suitable drugs for patients after general surgery. Even if they did, they would be taken care of immediately.

Lu Cheng stopped.

Moreover, he told the nursing station that if any unfamiliar drugs were found in the department, he would call me directly.

When Li Dongshan heard this, he breathed a long sigh of relief: "That's okay, Xiao Lu, thank you for your hard work."

"Liu Chengqian, Zhang Xin, the Jinyi Group's secret investigation team came to our hospital a few days ago, so in the recent period, we must strictly take medication. I know it is not easy to be a doctor, but we cannot offend."

"You will go to the doctor to check the ward later, review the medical orders of all the patients on the shelf, and stop all the ones that can be used or not. If the antibiotics have been used for more than 48 hours, stop them all. If you can't stop them, you should ask for help.

If you want a consultation, please consult me.”

"In addition, you should also take some time to review the medical order standards of your own group, and then give it to Xiao Lu, who will forward it to the bedside doctor who will come to the department in the future."

"These are troubled times. As the secret investigation team turns from dark to bright, someone is bound to suffer. At this time, we can't be a chicken that kills the chicken to scare the monkeys."

Just as Li Dongshan finished speaking, he saw Fang Xiao and Du Xueshen rushing to the door of the director's office.

Du Xueshen immediately found Professor Zhang Xin and whispered something. When Zhang Xin heard this, he cursed: "You too."

"Forget it, it's too late to talk about this now, hurry up and make up for it. You also have to take responsibility. Fortunately, Xiao Lu is always in the department and has the habit of reviewing all doctor's orders. Otherwise, you will be in big trouble!"

Du Xueshen didn't refute, but just glanced at Lu Cheng, his face full of joy.

In fact, everyone knew what Du Xueshen said.

Du Xueshen is now the attending physician. Even though he is the attending physician, his performance distribution is higher than that of Lu Cheng, but it is actually not as good as Lu Cheng. Lu Cheng now has a talent introduction plan, and the bonus given to him every month is much higher than that of Du Xueshen.

.

Du Xueshen is now the attending physician at the Second Xiangya Hospital, and after deducting five insurances and one housing fund, he can only get about 15,000 yuan a month.

He is already a married father, has a house loan and a car loan, and the consumption level in Shashi is not low.

Du Xueshen seems to be an employee of the Second Xiangya Hospital. He has a decent job, but nothing more than respectability. I guess outsiders don't believe him when he says he only has this small salary, but this is the fact.

Fang Xiao is much better, because the associate professor can be the chief surgeon and can perform many surgeries, so the salary is not bad.

Du Xueshen remained silent and could only lower his head.

…

After Li Dongshan, Zhang Xin and others completed the medical orders and medical records of their respective groups, they left. But before leaving, Du Xueshen and Fang Xiao handed over the modification of the medical records to Lu Cheng.

Du Xueshen has been in hospital for four years and is about to be promoted to associate professor. He is really not very skilled in medical record management. So even if he changes it, he is worried that there will be flaws.

Of course, the two of them were quite generous when they asked Lu Cheng to do the work. They directly invited everyone in the department to have dinner and drinks. Those who wanted to drink milk tea had milk tea, and those who wanted to eat pizza had pizza. Detianshun rice dumplings were all provided.

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To be continued...