As a surgeon, the most basic operation is dressing change.
However, dressing change is not only the operating standards taught to us by teachers or Lao He, but also many things that need us to improve. We need to crawl around and learn continuously in clinical practice. We need to adapt to illness and people.
The operating standard is [guide], which is [informal and incomplete guide] due to the personal system.
1
A father, dressed very well, brought his daughter to me to change dressing. I took the female intern to lead them to the dressing room. As it was a small breast surgery done by the outpatient department, it was a private part and inconvenient. I asked the father to wait outside the bed curtain.
However, he repeatedly told me that interns were not allowed to change dressings, but I had to change them myself. I reluctantly agreed.
Just as he was about to stretch out his hand to tear the dressing, the patient screamed…
I was frightened, and the patient’s father was also frightened. He asked loudly outside the bed curtain, “How did you change dressing?” ]
However, it is obviously useless to explain. During the period when the dressing was torn open, there were screams one after another. The patient’s father couldn’t help pulling open the curtain to see if I had done what to his baby daughter. The intern on one side quickly pulled the bed curtain.
I think it is the softest dressing change, but as a result, the dressing change is accompanied by the crying of the patient in front of me and the reproach of the family members behind me: “the child is still young, can’t you be gentle?” ]
Take a look at the medical record, 23 years old!
Two! Ten! Three! Years old!
Kid! Son! Give it back! Little!
Finally, I couldn’t stand it. I invited the patient’s father out of the dressing room and said to the patient-
[Your father has gone out, it is useless for you to shout and break your throat.]
Don’t say, it really worked, and the patient stopped shouting pain. Of course, he didn’t shout [broken throat].
2
I once changed dressings for a patient with gastric cancer after surgery. Every time I changed dressings, I felt like a light bulb.
The thing is, every time the dressing was changed, the patient didn’t cry out for pain, but his eyes were closed. The patient’s wife was aside, his right hand bypassed the patient’s neck, and he tightly hugged the patient’s whole head. The husband and wife’s face was attached to the face, and his left hand kept touching the patient’s face gently. Over and over again, his mouth was chanting in Minnan:
[Baby, it doesn’t hurt, it doesn’t hurt, it’s good, it doesn’t hurt. Darling, darling, not afraid, not afraid with me, not afraid]
Then shout twice, shout, shout, shout…
This ambiguity makes me completely transparent.
I can only pretend to change dressing calmly. No, I have to stabilize and my hands cannot shake. I have to change quickly and escape from this right and wrong place. My heart will soon be crisp and melt.
In this case, the key is to keep a calm heart and have a state of no self and no things.
-As long as you don’t show off [I’ll blow it for you if the wound hurts].
3
You light, light, light;
You tear slowly;
The patient is very painful, you should be gentle.
Here, here (and point with your finger), here, the potion has not been wiped, it is almost there, er, you apply more potion here, and here;
Here, there is too much liquid medicine to flow down. Quick (take out a few facial tissues skillfully and wipe them, facial tissues! );
This is something from what (pointing to a small scab). How black is it? Take it off;
Dry this way;
More gauze pads, this is not enough, put a few more pieces;
This is not pasted;
This sticker is too wrinkled;
… …
Finally, check with critical eyes and press the periphery of the dressing.
Every time I meet such a family member, the best response is to gently ask: “What a coincidence, are you also a doctor?” ].
[No]
Ask again: [Have you definitely learned dressing change? ]
[None]
Again: [Then I am a doctor, and I have been specializing in dressing change for several years. Please don’t talk first. Come on, let me teach you how to change dressing to ensure that it is fast, good and standard. The first is the principle of asepsis! And…]
However, often after this explanation, the next dressing change is another cycle…
4
Most of the time, during ward rounds, family members will hold back their what problems. When they go to change dressings, they will vomit quickly.
Simple mode:
Can I eat in what?
Can I drink water in what?
How many bottles of medicine are there today?
Can I remove the stitches today? (This question can be asked from the first day after surgery to the day of discharge. How many times do you have to ask for each change of medicine?)
When can what be discharged from hospital?
Can I be discharged today?
… …
Normal mode:
Doctor, why is there liquid in this tube?
Doctor, when will this drainage tube be pulled out in what?
Can what pull out this catheter?
Can we not inhale oxygen?
… …
If, unfortunately, we encounter a difficult pattern-
Why is this medicine white?
Why NaCl? Does NaCl have what?
Why glucose?
Is the NaCl in glass bottles different from that in plastic bottles in what?
X-degree says this medicine… (omitted 100 words), right?
Can you drop a few more bottles of albumin?
… …
In case of such family members during dressing change, the problem will be left until the dressing is changed. Don’t be distracted.
Please observe a moment of silence for 3 seconds, then take a deep breath and make a quick decision.
5
[Informal Incomplete Guidelines for Dressing Change] claimed that it was necessary to be alert to possible adverse reactions of surrounding family members during dressing change.
How do you say that?
When changing dressings, some family members will be afraid, afraid to look and hide far away, but more family members will come to look at it out of curiosity, concern or so-called practice.
-As a result, some family members fainted with honor in the process of bravery training.
I can only quickly put down my work, organize my family to carry the fainted family member to the accompanying bed, set up my body position, and call the nurse for a simple examination…
Before changing dressings, the family members nearby should not look at it. If you must look at it, please be psychologically prepared first-it can be used as a pet phrase.
6
Most patients still respect doctors very much. For example, people in southern Fujian regard doctors and teachers as “sir”, for example, Wang Xian, Wu Xian, Zheng Xian, etc.
However, I occasionally meet such patients or family members, probably because I often change dressings. They think I am not a doctor in their hearts. When they define me as [changing pharmacists], they will call me: [changing pharmacists, or changing dressings]. Some don’t know how to call them, so they directly call them: [surnamed Wu].
Let’s listen to these, but very few family members will call me “younger brother”. Every time I change dressing, it is before and after the younger brother. In the corridor in front of a group of patients’ family members also call me “younger brother”, in the office in front of all doctors also call “younger brother”, which can amuse everyone.
Therefore, I also specially searched the word “younger brother” to explain as follows:
1. [young brother]: My younger brother heard that my sister was coming.-< < Yuefu Poetry Collection Mulan Poetry > >;
2. [friend or acquaintance]: Male friends are humble names for each other;
3. [Young male service or young waiter]: Young male servant or waiter;
4. Refers to male genitals;
5. Synonymous with [messenger], generally refers to those who act as thugs and accomplices of the leaders of black evil forces, slightly derogatory.
The hospital did not have a “younger brother”. It was the same person who decided on the treatment plan, performed the operation, explained the disease condition and changed the dressing. When changing the dressing, it became a “younger brother”…
Alas.