Guide
Doctors do what they have to do. In the end, you can only do your best to obey the fate, and the rest can only be left to luck.
Source: Medical Pulse
Author: Running emergency room old Liu
This article is published by the author with the authorization of Medical Pulse, please do not reprint it without authorization.
"Jiangsu Suining's one-and-a-half-year-old child got stuck in his throat and died after being rejected for having no nucleic acid certificate!"
"Too light! As a result of the treatment of the one-and-a-half-year-old baby who died of a stuck throat, only the doctor was suspended and the dean was dismissed."
"A one-and-a-half-year-old baby died in hospital! Insider disclosure, parents must see! ”
Over the years, I have seen various medical incidents that have been reported by some media people as "unrecognizable", the headlines are shocking and eye-catching, the content is whimsical, and public opinion has one-sidedly accused doctors.
Nowadays, when seeing such a title, Lao Liu generally floats by automatically, and even the plot of dog blood cannot attract lao Liu's attention, and then the tearful accusations, and finally there is another plan.
Because, I firmly believe that even without the noble character of "serving the people wholeheartedly", no doctor will allow patients to have an accident and be indifferent.
Case Review
The news of "Jiangsu Suining's one-and-a-half-year-old infant tracheal card foreign body was rejected due to no nucleic acid certificate" was constantly forwarded, and various bad reviews were also all over the Internet.
The event first fermented because of a video with the caption describing:
"My name is XXX, live in Jincheng Street Wei Wei Society, 2022, 4.29 night, the child does not know what to eat the card arrived, I was in a hurry to call 120 to Suining People's Hospital for medical treatment, to the emergency department, first let us do nucleic acid, we also did as the doctor said, we asked to save the child first, the doctor said that you must get the list to save, waiting for 7-8 hours in the middle and no doctor came to see the child, until the child's mouth was purple, I was angry to hang up the suction (oxygen) device for the child, Hanging on to the sucking (oxygen) also let us wait for the list also do not give Ye, the list took, let us go to Xuzhou, to Xuzhou Hospital, the doctor said that it was late, has been taken care of (delayed), has no help, the child is gone, has been placed in Suining ZhuLou Binyi Hall, the child will always be set at one and a half years old ..."
The results of the survey were then officially released:
After investigation, Suining County People's Hospital received the child Shi Mouyuan (male, 1 year old and 5 months, his aunt Shi Mouye) at 20:10 on April 29, and his aunt and grandmother reported that the child had swallowed a foreign body by mistake, and the family cut out half a shelled pumpkin seed from his mouth. After asking about the medical history, auscultation of the lungs, the receiving doctor preliminarily judged that it was a foreign body in the trachea, and gave the child first aid measures such as oxygen inhalation and continuous monitoring of pulse oxygen. Suining County People's Hospital considered that its own treatment capacity was insufficient, and issued a referral form at 21:00 that night, informing the relatives of the children to be referred as soon as possible. Because the child's parents were not present, his aunt and grandmother failed to agree to the referral. At 21:45, the parents of the children arrived at the hospital. At about 22:00, the receiving doctor handled other cases after explaining the condition with the father of the child, during which he repeatedly called the father of the child at 23:55, 0:00 on the 30th, 1:04, 1:07, 1:19, and 1:23 to inquire about the condition and urge him to transfer to the hospital. The Medical Department of Suining County People's Hospital contacted the general duty office of Xuzhou New Health Hospital at 22:00 on the 29th. At 1:08 on the 30th, the child's mother dialed 120. At 1:22, the 120 ambulance of Suining County Emergency Medical Station rushed to the county people's hospital and arrived at the rescue room of Xuzhou New Health Hospital at 2:30. The doctor on duty perfects the examination, opens the venous channel, gives oxygen, ECG monitoring and treatment, and assists such as CT and blood routine. At 3:47, the child suddenly appeared apnea, the hospital immediately implemented cardiopulmonary resuscitation and other rescue measures, and organized expert consultation, at 4:56, the child died due to ineffective rescue.
The investigation showed that after receiving the treatment of Suining County People's Hospital, in the absence of a report of nucleic acid test results, the emergency treatment was carried out and a referral form was issued in a timely manner; during the period, at 20:22 on April 29, nucleic acid sampling was taken on the child and his aunt, and in the process of treatment, reception and referral, Suining County People's Hospital and Xuzhou New Health Hospital did not require them to provide nucleic acid test results.
The investigation found that suining county people's hospital in the process of diagnosis and treatment of the child Shi Mouyuan in the first diagnosis responsibility system is not strict, did not take relevant examinations in time to further clarify the diagnosis, did not communicate with relatives enough, and did not inform the child's condition and the serious consequences that may occur; in the process of referral, there was a lack of connection, and the detailed condition of the child was not fully informed to the receiving hospital in time.
According to the results of the investigation, in accordance with party discipline and relevant laws and regulations, the units involved and the relevant responsible persons will be seriously dealt with:
1. The Xuzhou Municipal Health Commission gave a warning to suining county people's hospital, and zheng mouxiang, a doctor who was diagnosed with the clinic, suspended his practice activities and conducted further investigation. Suining County People's Hospital was instructed to carry out comprehensive internal rectification.
Second, the Suining County Party Committee gave Wang Yanlong, secretary of the party committee of the county health and health commission, a warning within the party, and removed Zhang Tao, secretary of the party committee and president of the Suining County People's Hospital, from his posts inside and outside the party.
3. In accordance with the relevant regulations on the management of medical institutions, report to the higher-level departments to demote the Suining County People's Hospital.
In view of this incident, Xuzhou City and Suining County will deeply learn lessons, seriously summarize and reflect, and resolutely avoid similar situations.
What do doctors think about this incident?
What exactly is the truth of the incident? The final details remain unknown.
Doctors and patients have different opinions, and the details cannot be verified. No matter what the outcome of the investigation is, the child is dead, the hospital is injured, the health administrative department is in chaos, and the doctor on duty can never escape the fate of the back cooker.
After this incident, Lao Liu could guess the content through the title and know the ending. I have experienced this kind of incident a lot, and I can't afford any splash in my heart, no anger, no helplessness, and I am only glad that it is not myself who encounters things.
What do doctors think about such incidents? Both the @Burn Superman Apo and @Last Dopamine that I liked commented on the incident.
@Burn Superman Apo comments below:
Image source: @Burn Superman Ah Bao Weibo screenshot
@Last Dopamine comments below:
Image source: Screenshot of the "Last Dopamine" WeChat public account
I think these views basically represent some of the views of frontline doctors, especially seeing the "last dopamine" of the same emergency department doctor, although the final statement is not so "positive", but it is very resonant for doctors who have experienced emergency departments.
In the case of pediatric airway obstruction, how should I give first aid?
Xiaobian asked Lao Liu: Why don't doctors save?
Lao Liu answered: There is no condition and ability to treat and treat. Even in a large city like Beijing, there are only a few hospitals that can handle such cases. In addition, in recent years, a large number of pediatricians have been lost, and the treatment work has become even worse.
Once a foreign body enters the airway and causes airway obstruction, urgent first aid is required, and the most practical and effective is the "Heimlich First Aid Method". For infants and young children under 3 years of age, this should be done:
5 times back patting method: the child's body is supported on the forearm of the rescuer, the head is low, face down, the rescuer supports the child's head and neck with one hand, and the palm of the other hand is used to pound forward between the two shoulder blades on the child's back 5 times.
5-stroke chest compression: If the blockage is still not eliminated, the 5-stage chest compression method can be implemented. Place the child flat, facing upwards, and place the middle and index fingers of both hands on the abdomen under the thoracic cage and above the umbilicus, and quickly press upwards 5 times.
Can be repeated until the foreign body is discharged.
After emergency treatment, whether it is effective or not, be sure to go to the hospital to check whether the foreign body is discharged, so as not to delay the disease. If there is still a foreign body in the airway, tracheoscopic painless foreign body removal is performed depending on the size of the foreign body and the location of the obstruction.
Airway obstruction management, not so simple!
Foreign bodies entering the airway can cause damage to the airways, which are divided into direct injuries and indirect injuries.
Direct injury also includes mechanical injury (such as mucosal injury, bleeding, etc.) and mechanical obstruction, foreign body inhalation may be embedded in the bronchi at all levels of the lungs, resulting in atelectasis and emphysema changes in the lobes or lung segments below the site of obstruction.
Indirect damage refers to the presence of foreign bodies leading to inflammatory responses, infection, granulation, etc.
Diagnosis begins with the admission of such patients. In general, the history of foreign body inhalation (severe choking cough after witnessing the aspiration of foreign body) is the most important diagnostic basis for airway foreign body, and the clinical manifestations include cough, dyspnea, wheezing, stridor, cyanosis, etc. Hyposonym on auscultation of both lungs may be heard with low foreign body-side breath sounds, and symmetrical breath sounds on both sides when the foreign body is under the glottis, but characteristic subglottic tapping is often heard.
Imaging tests such as chest X-ray, chest x-ray, lateral cervical x-ray, and CT scan can help with the diagnosis. Only about 10% of foreign bodies can be developed under X-ray irradiation, and fiber bronchoscopy is a minimally invasive diagnostic method.
Taking a foreign body under a dural bronchoscope (most commonly Karl-Storz bronchoscopy) is still the most common surgical method for airway foreign body removal, and different anesthesia methods need to be selected preoperatively according to the location of the airway foreign body and whether there is significant respiratory distress before surgery.
While early diagnosis and early surgery can improve the success rate of airway foreign body removal and reduce the incidence of complications, bronchoscopic surgery is a high-risk, highly specialized type of surgery that requires the cooperation of experienced otolaryngologists, anesthesiologists, and caregivers.
How to avoid medical risks that exceed the capacity of diagnosis and treatment?
Hospitals can't handle all medical problems, and top-three hospitals are no exception.
There are always cases that hospitals cannot deal with and need to be transferred to more specialized hospitals, and the emergency department is referring large households, especially hospitals below the top three.
As an emergency department physician, the first thing to do is to clarify the following before taking up a job:
What can I do?
What departments are there in the hospital?
What can each department do?
Which departments cannot provide emergency services?
What technical emergency departments can't be done?
What diseases and types of patients can't handle?
What is the direction and process of referral for all types of patients who cannot be treated?
Once you receive a patient who exceeds the diagnosis and treatment capacity, do not hesitate to explain the situation at the first time and assist in the transfer. The more you drag it, the more difficult it is to walk, and the more you stay, the more likely you are to have an accident.
120 patients sent to the emergency department are often more difficult to deal with, and if it is determined that there is no ability to receive treatment, the best way is to directly let 120 go away. Once received, it is relatively difficult to call 120 to transfer away, and it will be accused: can not see why to pick up?
The notification should be sufficient and signed as proof. Patients who repeatedly confess that they still refuse to transfer cannot be ignored, the tests that can be done should be done, and the measures that can be taken should be done as much as possible. Then confess, then sign, report to the superior, ask for instructions, get the support of the doctor, help persuade.
Risky patients should keep evidence, the signature of the signature, the telephone communication should be recorded, and the face-to-face communication should be preferably recorded and videotaped. Once someone starts talking nonsense, there is some evidence to come up with.
Doctors do what they have to do. In the end, you can only do your best to obey the fate, and the rest can only be left to luck.
Consultant Lawyer
Xiang Haiman, a lawyer at Beijing Quanzhi Law Firm (formerly Beijing Renchuang Law Firm), has long been engaged in medical legal research and practice, and has rich experience in medical law.
The cases in this issue come from the Internet.
Editor-in-charge | Su Mu Yiyi