討論:con clear, 林XX, 5176XX, 男性, 61歲 11:46 suden onset lower abdominal pain with cold sweating 11:56 abdominal echo revealed peritoneal fluid and strange mass under ths suspicion of DAAA, CVP was set up abdominal CT –sigmoid colon perforation consult GS and CV prepare blood tansfusion on Foley, urine clear On NG , but he refused 12:40 GS came to persuaded him to receive lapa and colostomy AAD was arranged for him to go to Mackay hospital Discussion l 急性腹症, 點滴伺候 l 腹超, 電腦斷層找出出血源 l 排除其他可能, l SOP of internal bleeding, IV, stabilize vital sign, abdominal echo, abdominal CT, GS, lapa l 討論: 1. 作病人生命中的貴人, 張老師 2. ETTC training is suggested 3. culture of this ER, do or not to do, 轉院成為反射動作, 很奇怪 4. 醫療成為不賺錢的行業, 從事只剩良心和責任, 很可憐 5. 用行捨藏, 這是前仁愛醫院的印象, 後來醫院整個崩解, 院長得跑法院解釋貪瀆問題, 苟全性命於亂世, 但是本身之本職學能不可廢, 當時機到來, 或是危機當頭, 就得挺身而出 6. 病人自動出院, 轉診馬偕, 亂世求生, 裝笨可能是策略之一 7. 我聯想起梅尼爾鎮的音樂家, 老邁無用的各種人才團結起來也能過好日子, 像我們現在一樣 8. 我也聯想起查泰來夫人的情人, 曾幾何時, 本院變成轉診中心了,老婆會因為老公性無能而搞外遇, 但是性慾爆發前, 好歹要先試試自己老公, 不行再轉診, 這是基本尊重, 也是基本禮貌, 但願大家能了解.
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