Surgical Duty Book: What about all kinds of emergencies?

Night shift is a must for every doctor. People who make money work night shift are basically doing sit-ups for one night. When you set foot on the job as a medical student, the feeling of excitement, uneasiness, fear and helplessness for the first night shift is often unforgettable for life.

Therefore, Clove Garden (Micro Signal: Dingxiangwang) has prepared a handling of common night shift events in general surgery (excluding surgery) to help every [night shift rookie] turn luxuriously into [old driver].

However, this is only a personal experience reference and cannot be applied mechanically.

Fever (one of the most common events)

Physical cooling is preferred. Blood is recommended for blood culture, blood routine and blood gas if it exceeds 38.5 (if the first fever exceeds 38.5, the cause of fever can be found through existing examination and physical examination, blood culture and other examinations may not be performed)
Indomethacin suppository 1/2 ~ 2/3 anus plug (the elderly use less, told to drink more water)
When common cooling measures are ineffective, dexamethasone 3 ~ 5 mg iv or methylprednisolone 20 ~ 40 iv can be used.

Postoperative pain (one of the most common events)

Flurbiprofen Axetil Lipid Microspheres Injection 100 mg iv
Parecoxib sodium injection 50 mg iv
Tramadol 100 mg im

Spasmolysis and analgesia (common events)

NS 250 mL + anisodamine (654-2) 20 mg ivgtt
Tramadol 100 mg im (use with caution, the cause of pain must be clearly defined to avoid covering up the disease)

Postoperative abdominal distension/constipation (common event)

Gastrointestinal decompression, colonoscopy when necessary (try to complete day shift, night shift generally try to avoid invasive operation)
Lactulose 15 mL po
20 ~ 40 mL Kaisailu plug anus
Neostigmine 0.5 mg im (only for refractory abdominal distension, pay attention to contraindications)

Diarrhea (Common Event)

Berberine 100 mg po tid
Montmorillonite powder 3 g tid

Hypertension (Common Event)

Nifedipine 1 tablet, sublingual
Labetalol 200 mg po tid
Urapidil 100 mg + NS 30 ml ivvp 3 ~ 4 mL/h is regulated according to blood pressure
Pay Attention to Drug Contraindications

Hyperglycemia (common event)

Blood glucose 11.1-13.8 insulin 6u
Glucose 13.8 ~ 16.7 insulin 8u
Blood glucose 16.7 ~ 19.4 insulin 10u
Glucose 19.4 ~ 22.2 Insulin 12u
Urgent Check Electrolyte + Osmotic Pressure + Ketone Body + Blood Gas
If Coma Appears: Endocrine Consultation

Nausea and vomiting (common events)

Metoclopramide 1 im

High potassium

Furosemide 20 mg iv
High glucose insulin: 50% GS 40 ml + insulin 5U micropump static push
10% calcium gluconate 20 ml iv or plus GS ivgtt to combat arrhythmia
5% sodium bicarbonate 100 ml ivgtt
Urgently check blood gas, electrocardiogram and electrolyte

Low potassium

10% potassium chloride po tid
0.9% NS 500 mL + KCl 15 mL ivgtt
Recheck electrolyte

Decrease in oxygen saturation

Asphyxia: Suction of sputum
Oxygen inhalation
Urgent check of blood gas and natriuretic peptide
Contact anesthesiology department for tracheal intubation if necessary

Hypotension

Dobutamine 100 mg + NS 50 mL ivvp (regulated according to blood pressure)
Norepinephrine injection 10 mg + NS 50 mL ivvp (adjusted according to blood pressure, increase the dose of norepinephrine injection if necessary)

Allergy

Stop the drug immediately
5% GS 10 mL + calcium gluconate 10 mL iv
Dexamethasone 3 ~ 5 mg iv
Promethazine 50 mg im
In case of shock: ask for instructions from superior + venous access + fluid infusion + pressure booster + epinephrine + dimeters

Gastrointestinal hemorrhage (accidental event)

5% GS 250 mL + ethylaminosulfonate 3000 mg + aminotoluenic acid 500 mg ivgtt
Omeprazole 40 mg iv q12H/esomeprazole sodium 40 mg iv q12h
0.9% NS 100 mL + Vitamin K1 injection 30 mg ivgtt
0.9% NS 48 mL + somatostatin 2 ivvp 4 mL/h
Somatostatin for injection 3 mg + NS50 ml ivvp 4 mL/h or octreotide 0.1 mg subcutaneously q8h
NS 40 mL + pituitrin 18U ivvp 4 ml/H
Gastrointestinal decompression, nasal feeding q6h: 4 norepinephrine + NS 100 mL, NS 100 mL + prothrombin complex 2kU

Acidosis (incident)

Mild HCO3-16 ~ 18 mmol/L, mainly fluid infusion
Serious HCO3-is lower than 10 mmol/L, 5% NaHCO3 is 125 mL, and reexamination can be repeated for 2 ~ 4 hours when electrolyte is still low.
Principle of Attention: Better Acid than Alkali

Irritability (incident)

Observe vital signs, if there is no difference:
Diazepam 1 tablet po
Diazepam 5 ~ 10 mg iv
Chlorpromazine 25 ~ 50 mg im, if the effect is not good, promethazine 25 ~ 50 mg im can be combined.
Necessary Neurology/Neurosurgery Consultation

Epilepsy (accidental event)

Diazepam 5-10 mg iv
NS 40 mL + sodium valproate 400 mg iv (within 20 min) or ivvp 4 mL/h

Asthma (Accidental Event)

NS 20 mL + methylprednisolone sodium succinate 40 mg ivvp
5% GS 250 mL + aminophylline or doxophylline 0.2 mg ivgtt

Cardiogenic asthma (accidental event)

Recumbent position, unobstruct respiratory tract, check electrolyte, electrocardiogram and blood gas urgently, and control infusion volume
Other than asthma and inducements (e.g. Blood transfusion)
Qiangxin: cedilanid 0.2 ~ 0.4 mg iv
Diuresis: Furosemide 20 mg iv
Vasodilator: NS 40 mL + nitroglycerin 10 mg ivvp (regulated according to blood pressure)
Cardiology consultation

Hiccups

Chlorpromazine 12.5 mg im

Hemoptysis (accidental event)

High risk, ECG monitoring, oxygen inhalation, absolute bed rest
NS 40 mL + pituitrin 18U ivvp (4 ml/H)
NS 250 mL + procaine 300 mg (skin test) ivgtt
5% GS 250 mL + ethylaminosulfonate 3000 mg + aminotoluenic acid 500 mg ivgtt
Snake venom hemagglutinase 1U iv
NS 100 mL + tranexamic acid 1.5 g ivgtt
When the amount of bleeding is large, anti-shock must be carried out at the same time: blood preparation and fluid infusion
Bronchial artery embolization and surgical hemostasis shall be performed in interventional department or thoracic surgery department when necessary.

In addition to these treatment of sudden diseases, clove garden forum station friend @ wuyaolu also gave some life experiences to night shift [novices]:

After meeting the call from the family member, immediately respond [immediately] and remember the bed number clearly. Unless the critically ill patient is rescued, the computer will be turned on to look at the general information of the patient and what has been operated on. Now it is a few days after the operation, and the group of patients. Otherwise, the family member thinks that you what do not know, irresponsible, medical industry, and others will not understand.
Only deal with it, not explain it too much, because you don’t know how the doctor in charge explained it, what if it is inconsistent?
Don’t be too good about patients who don’t belong to your charge, otherwise the family members may accuse the doctor in charge in front of you, especially those who may have disputes, and may use this to talk to the doctor in charge in the future, then the hospital will compensate more.
For elderly male patients, anisodamine is not used as much as possible to relieve spasms, and it is possible to wake you up again due to urinary retention.
Before preparing for medication, one must ask about what before. What medicine cannot be used. Otherwise, the patient may say [he cannot use this medicine] when the nurse is taking the medicine.
When seeing a patient, be sure to make sure that the patient lying in the bed is the patient you were asked to deal with at that time.
See unreasonable places only deal with, don’t talk. For example [why did the oxygen tube take off, still don’t know? The catheter is clamped. Can there be urine? ]
When the superior doctor wants what, don’t say it’s gone, it’s used up. You can directly say that Corey has something that can be replaced, such as epinephrine. You can say, Director, how much atropine is used?
When you are not satisfied with your handling, don’t argue with your family members. You can say, Sorry, why don’t I communicate with your doctor in charge and ask his opinion?
Never show that you can handle what well. What if it doesn’t work?
Whenever you see a doctor, you should put on a white coat and hold a stethoscope. Otherwise, people will not necessarily treat you as a doctor.
You must not wear slippers. First, you do not respect others. Second, you can leave immediately in case something happens.

The medication in this article is only a summary of personal experience. The dosage of drugs varies from hospital to hospital and from brand to brand, which is for reference only.

Abbreviations and annotations: intramuscular injection (IM), intravenous drip (ivgtt), intravenous injection (iv), oral administration (PO), micropump injection (ivvp), normal saline (NS), glucose (GS).