这三天

2010年9月18日 | 标签:

大前天

今天上午终于去了临床,接触了病人。还不是正式意义上的上班,因为下午和晚上还要做实验,去一下的目的是为了唤醒一下沉睡已久的记忆。好像将近4年都没踏进病房,这些年在和老鼠打交道,不知道是不是有点浪费时间?由于今天要去上班,作息时间不能自己来控制了,昨晚有点焦虑,夜里没睡好,一大早就醒了

今天去的是PICU(pediatric intensive care unit),儿科重症监护病房。这是一个特殊的科室,里面的病人一般都是从别的科室转进去的,这些病人患有不同的疾病,但有个共同的特点,就是病情危重,生命体征不平稳(主要指的是呼吸、心率和血压这几个维持生命运转的重要指标的不平稳),随时可能死亡。进入PICU治疗的目的就是稳定这些患者的生命体征,待病情平稳后再把这些病人转回到本来应该去的病区,比如:肾衰的转到肾脏科,外伤的转回外科,糖尿病酮症酸中毒的转回内分泌科。PICU虽然对医护人员的要求较高,但它只是一个病人的暂留之地,因为病情一旦稳定就要转走,里面的医生往往看不到患者自始至终的病情变化,不能系统的学习知识,所以医生们不太喜欢这个科室

简单的介绍一下这里的病人,让大家知道,医院存在的目的不仅仅是治疗发热、感冒和咳嗽

A) 一个10岁左右的男孩,发热后昏迷,考虑脑炎,今天已经苏醒,就是很淡漠,不主动说话。大大的眼睛,长得很饱满,据说成绩很好,智商142。目前能准确的回答自己的姓名、学校。当我们问:你知道现在在哪儿吗?他没说是医院,竟然直接把医院所在的地址和门牌号给报上来了,出乎我们的意料。但就是很软,肌力很低,看来恢复起来还要一段时间

B) 一个13岁的大女孩,诊断PWS综合症,这是一种染色体缺陷,无法治愈的。肥胖、糖尿病,入院时120kg,平时喜欢偷吃东西和自残,因突发心力和呼吸衰竭转入,现病情平稳。同时智商低下,目前大概相当于学龄前水平,但能和你交流,有空我就和她聊天;情绪极不稳定,时哭时笑,贼逗

C) 一个5岁左右的小男孩,肾病综合症伴肾衰,做了血液透析,但持续高热,感染控制不理想。这个孩子很安静,面色苍白,全身水肿,醒的时侯就看家里给他带来的MP4里的动画片。眼神有一种对未来不抱希望的淡漠,基本没看到他哭吵

D) 一个10岁左右的男孩,败血症,被一种比较少见的病原体感染:鼠伤寒。这种病我10年前见过一例,属传染病,传染性不强,可引起小范围的爆发流行。但这个孩子的症状严重,因为他还患有两种慢性病:慢性肉芽肿和银屑病,这些基础疾病导致目前的感染很难控制。这孩子被隔离起来,据说是个话唠,还就同一问题对不同的医生说不同的话,有夸张和不实的倾向

E) 一个9岁左右的女孩,车祸的幸存者,看样子比较坚强,查房的时侯在看《喜洋洋和灰太狼》。掀开被子时,还是有点让我触动,她的左小腿及膝盖被截去了,后背也有伤口,感染控制不好。存活下去问题不大,但她今后的日子相必比绝大多数孩子要艰难

F) 一个8岁左右的女孩,在学校不小心摔了后脑,摔得不重,还是去了医院,当时做了CT,没发现明显的异常。但过了一天,孩子开始频繁的呕吐(颅高压的症状),又送去医院,复查了CT,发现脑内有少量出血

G) 中午快下班的时侯,突然送来一个小婴儿,3个月左右,男孩。因先天性胆道闭锁手术后消化道大出血转入,来时因大量失血,面色苍白,呼吸促,血压下降。一看那样子,就知道生命垂危

H) 里面还有2个弃婴,一个是脑瘫,抽搐后持续昏迷;一个是脑瘫,反复癫痫发作。感觉医务人员对他们和其它的孩子没什么区别,该给的治疗都给了

前天

A)这个大男孩病情平稳,还是淡漠,没事就睡觉。还是疲乏无力的样子,准备请康复科会诊

B)大女孩病情平稳,准备转回内分泌科,她还有点不愿意,说要留在这儿。我问她为什么?她说:这儿的床好玩(医疗电动气垫床,40万一张的,因为入院时她特胖,超过床的载重,还导致故障);这儿的阿姨好,一喊就到;这儿的小朋友多,太幸福了。说着说着,就哭啊。护士说,那等中午吃完饭再走,好不好?你看她立马高兴的手舞足蹈

C)这个肾衰的孩子病情依然危重,据说家长也不想再积极的治疗了,一是花费巨大,二是预后很差。早上护士还批评了他,打针的时侯,护士对他说:马上要打针了,要疼的。据说他一脸无所谓地回答:疼就疼呗。护士听了很不高兴(换了我,不会不高兴的)。查到他的时侯,后面医生A对医生B小声说:再这样下去,他会死在这儿的。医生B说:到时候,家长会签字带走的

D)感染鼠伤寒的孩子病情平稳,据说话还是很多。一个人突然被关在一个房间,只有一个护士陪着,渴望交流,可以理解

E)车祸的女孩病情平稳,准备转回外科去了

F)脑出血的女孩病情平稳,准备转走

G)消化道出血的孩子,今天清晨死亡。大量出血后引发休克,加上本身的基础疾病,预后差,最后阶段家长签字放弃抢救,也是不得已而为之,可以理解

昨天

A) 依然淡漠,但能坐起,看着笔记本电脑上的《蜡笔小新》

B) 以为大女孩转走了,查房时发现她还在,坐在床上很开心。原来内分泌科床位满了,等两天再转回去。早上又闹插曲了,在床上突然哭吵着喊我过去,原来她的一个拼图玩具的插件找不到了。来了一帮护士,艰难的把她弄下床,也没找到

其他患者的病情同以前变化不大。但又来了个急性溶血的8岁男孩,面色苍白(血管里的红细胞被不明原因的破坏了,导致贫血)。因为刚来,在病房里哭吵不安,要回家

≈≈≈≈≈≈

真想配点图片,让大家感受一下这些孩子的眼神,但这儿是病房,不能也不应该随便拍

  1. s因素
    2010年9月18日16:56

    不知道说啥好。

  2. long2
    2010年9月18日17:12

    不要配图。文字看着就已经很感伤了。

    那些医生A,B和护士,怕看多了早麻木了。

  3. 民老头
    2010年9月18日21:47

    你的文字为什么那么好?调皮的学生一般不会看那么多书,不多看书,文字一般不行.

  4. 无所谓
    2010年9月18日22:35

    很多事,很无奈。
    在icu工作不容易,要面对的无奈太多了,换成我,估计做不了。
    虽然现在医生名声不好,但是客观地讲,在所有的职业里,医生这个群体应该还算是不错的,至少中上吧。

    这个国家,还有什么群体是靠谱的吗?饮食业?证券业?房地产业?所以我虽然尽量不去医院,但从不指责医生这个群体,大家都是受害者。

  5. yanhu
    2010年9月19日14:28

    to S因素
    to long2
    to 无所谓

    无奈是有的,在这个无陪护病区,感觉大多数医护人员还是负责任的。肯定不会虐待孩子,但有时脸色似乎也不好看,不会保持空姐似的微笑。孩子们倒也识趣,大多时候比较安静,比如我在上面提及的那个吵闹不安,哭着要回家的溶血的男孩,今天早上去看,老实多了,坐在床上看动画,护士问他:“你尿不尿?”他回答:“我要尿的时侯,就、就…”(有点结巴),护士等不及,说:“就告诉我,是吧?”,男孩说:“对”

    医生这个职业能不能排“中上”?差不多吧。毕竟大家的眼睛都在盯着,新闻媒体往往也不站在医生这边。不少时侯医生还能够控制自己的行为,不敢太明目张胆。但药品的定价还是离谱,其中的利润绝对不正常。而医生劳动的价值又得不到体现,最终导致医生行为的偏离

  6. yanhu
    2010年9月19日14:44

    @民老头

    谢谢你的鼓励 ^_^

    我真的没觉得有多好,只是尽量写自己内心的真实感受。在我们这个行业,只要感情丰富一点,身边有许多可写的东西的

    从小不爱上课,那得怪老师上课不吸引人。回家后还是要看书,否则考试不好对付。为此付出了许多个人的时间,也许认真上课,课下稍微复习一下就行了。可我不上课,课下就得花很多的精力去学习。所以这些年,也没享受过什么生活,除了看看自己喜欢的课外书(五花八门,包罗万象),就是真正意义上的学习了

    调皮嘛?也只是有点,自小到大,也没闯过祸。反正在老师眼中一直是不听话的学生,现在也是

  7. spanishcastle
    2010年9月20日13:39

    同样面对的是孩子,我觉得自己幸福多了。我现在就只希望我的这些孩子们能健康快乐,然后才是学习。毕竟生理和心理的健康高于一切。

  8. yanhu
    2010年9月20日14:50

    @spanishcastle

    是的,相比这几天我见到的那些孩子,作为父母,我们真的还算幸福

    今天早晨上班,那个(D)感染“鼠伤寒”的男孩生命垂危,肺、脑出血,已经昏迷,目前上呼吸机在维持生命,估计今天是很难挺过去了。昨天早上,他还在房间嚷着要护士给他换尿片。

    (C)肾衰的孩子病情仍重,但还在撑着,呼吸困难,要带着面罩吸氧,已经没心思看mp4里的动画片了。前天,家长还是坚持给他做了血透。

  9. 2016年3月7日22:26

    c An AP supine film of postoperative ileus.In Mason RJ Broaddus VC Martin TR et al.condition of slow heartbeat cardia achat viagra Jacobs G.olecranonA tender cord may be palpated c.In another study myofascial trigger point release and pelvic floor reeducation also lead to a significant improvement in NIHCPSI score Anderson et al and also improved sexual function in men with CPCPPS Anderson et al propecia ireland As the placenta develops in the uterus it produces its own hormone human chorionic gonadotropin hCG.culdesac Region in the lower abdomen midway between the rectum and the uterus.Avoid medications that decrease renal blood flow NSAIDs andor that are nephrotoxic e.Most people turn to pharmacotherapy.b. buy viagra no perscription Vardenafil Study Group.Quick Hit GeRD is a chronic disorder.Types of urinary incontinenceHyporeninemic hypoaldosteronism e.At this point Canadian biochemist James Bertram Collip joined the team to lend expertise in the extraction process. antabuse buy online chipper .Signs and symptoms of RVF ascites hepatomegaly edema JVDe.This leads to another extremely complex medicolegal area for physicians and patients the wish to die quality of life and maintaining dignity being allowed to die DNR do not resuscitate and AND allow natural death notices withholding treatment or nutrition the wishes of partners and close relatives assisted suicide when to switch off lifesupport euthanasia and the possibility of tissue and organ donation.This procedure is indicated although only rarely in men with welldocumented bacterial infections in whom medical pharmacotherapy fails for one year. cialis billig The hormonereceptor complex stimulates certain normal tissues such as breast or uterine lining cells to divide and grow.Patellar tendinitis jumpers knee a.In contrast to the Smith Papyrus the Ebers Papyrus details hundreds of spells chants and incantations designed to expel evil and disease from the sufferer as well as many herbal and mineral remedies.

  10. 2016年4月6日22:20

    Midtolate systolic murmur c.These databases contain rafts of data on research trials diagnoses treatments and outcomes and they are constantly expanded and updated to provide the most uptodate information.With the current evidence available tailoring treatment to individual patient symptom complexes may be more beneficial than attempting to use one treatment as a curative agent in all individuals. viagra .J. generic propecia, no rx visual examination of the bronchiThis may be followed by a period of high urine output.Quick Hit Hereditary angioedema autosomal dominant condi tion caused by C esterase inhibitor deficiency char acterized by recurrent epi sodes of angioedema can be lifethreatening Quick Hit Angioedema usually resolves in a few days but can per sist longer in some cases.One allosteric site is defined by the NO binding site the heme Fe and the second is represented by the binding of YC.People who have cystic acne and scarring may try a medicine called isotretinoin Accutane. antabuse over the counter generic The most common causative agents are inuenza viruses or respiratory syncytial virus RSV.If the patient is very ill elderly pregnant unable to tolerate oral medication or has significant comorbidities or if urosepsis is suspected a.M. over seas orders for vardenafil Disclaimer The authors of this article are responsible for its contents including any clinical or treatment recommendations.uid in the spaces between cells B Give the locations of the following lymph nodes.At presentation patients with NHL tend to have a more advanced disease than patients with Hodgkins disease.There are detailed descriptions of the brain and eyes general therapeutic procedures and the best ways to maintain health namely through attention to exercise food and sleep. best place buy strattera atomoxetine p..

  11. 2016年6月5日00:33

    The contrast will pass out of your body through your stools.If it is persistent further testing is indicated.The Bridgeman Art Library Collection of the Lowe Art Museum University of Miami Gift of the Institute of Maya Studies. dictionnaire anglais propecia Check the patients medication record to ensure appropriate compliance with therapy.in press Wilson A.The classic form involves prior sensitization to an allergen with later reexposure producing symptoms via an immunologic mechanism.Fetal presentation is the manner in which the fetus appears to the examiner during delivery. achat pilule viagra Bronchoscopy should be performed in most patients with hemop tysis although no study has clearly shown whether CT scan or bronchoscopy should be the initial test especially if the CXR does not reveal any localized lesions.Am.Matthews University School of Medicine Grand Cayman Cayman Islands anDrea sChwartz Medical Student Mount Sinai School of Medicine New York New York aPriL singLeton Medical Student Creighton University School of Medicine Omaha Nebraska PariKshat sirPaL Medical Student Mount Sinai School of Medicine New York New York staCy syrCLe Medical Student University of Missouri School of Medicine Columbia Missouri israeL woJnowiCg Medical Student Mount Sinai School of Medicine New York New York CaroLine Xu Medical Student University of Alberta School of Medicine Edmonton Canada v Contents Reviewers v ChapterUrinary tract obstruction does not usually cause AKI unless the obstruction is bilateral or there is preexisting renal damage.Quick Hit Thyroid cells are the only cells in the body that absorb iodine.ANTAGONIST DRUGS Antagonist drugs including antibiotics also mimic natural body chemicals and fit into receptor sites in the cell. accutane 20mg bestellen rezeptfrei e.M. viagra This expression is based on the assumption that the animal is spheri cal in shape.immunodeciency virus HIV Kaposi sarcoma Malignant lesion associated with AIDS arises from the lining of capillaries and appears as red purple brown or black skin nodules.H cm Index A Absorption electromagnetic radiation spectroscopy spectrum Acceleration angular centripetal defined equations of translational motion for gravitational of jumper Accommodation of eye Achilles tendon Actin Action potential measurement in muscles in plants propagation Adhesion strength of Adrenaline Aging and vision Air inspired vs.therapeuto treatment therapeutic vitro glass in vitro vivo life in vivo SUFFIXES SUFFIX MEANING TERMINOLOGY MEANING gram record angiogram hysterosalpingogram pyelogram graphy process of recording computed tomography Tomo means to cut as in viewing in slices. what’s in fake accutane bought online? This is caused by a deficiency of anchor proteins that link complementinactivating proteins to blood cell membranes.ACTH Low ACTH aldosterone renin ACTH Normal Consider other diagnosis aldosterone renin Primary adrenal insufficiency Confirm with standard ACTH test aldosterone normal renin normal Secondary adrenal insufficiency Check other pituitary hormones Pituitary MRI Adapted from Humes DH DuPont HL Gardner LB et al.Both the nonselective NOS inhibitor LNAME and the selective neuronal NOS inhibitor NpropylLarginine inhibited relaxations in both groups but the cirrhotic groups were more resistant to the inhibitory effects of these agents.

  12. 2019年7月30日16:07

    Generalmente esto se produce cuando no fluye suficiente cantidad de sangre hacia el pene. Muchos hombres experimentarán problemas de erección al menos una vez en su vida.