Chapter 1004 [1004] Surgical Knowledge

Brother Luo next to her wants to share his views on the expert lectures with her.

Xie Wanying said: "The intensive care unit is very important, but it is not the most important for surgery now."

There is always something surprising about what she says.

Everything should be based on evidence, and in medicine it is best to use statistical data. Both domestic and foreign statistical data show that, regardless of adults and children, the proportion of post-surgical patients among the diseases admitted to the intensive care unit is relatively small.

The biggest benefit of surgery is surgery. If an operation cannot be performed, it is basically hoped and required that the patient be transferred to an internal medicine department. So taking the two together, it shows that the intensive care unit may not be the most important for surgery.

Specifically, look at the various surgical departments. I heard that even the Department of Neurology is planning to build an intensive care unit dedicated to neurosurgery similar to the extra-cardiac area, and put it in the newly built surgical building. The establishment of an intensive care unit in one's own department means that the proportion of intensive care after surgery is not high, the number of hospital beds is not large, and there is no need for a dedicated ICU doctor.

That being the case, each department takes the maximum benefit as the premise, and the money is not distributed to the intensive care unit to earn. Moreover, in fact, most of the patients admitted to the intensive care unit are acute patients who come in from the emergency department. Such patients can't say whether they can have surgery even before the operation, and they may not necessarily be classified as surgical patients. In fact, some patients are like this. After being directly admitted to the ICU, they died in the ICU and could not survive the surgery.

Xie Wanying gave an example again: "Respiratory diseases occupy the first place among critically ill children admitted to the PICU, followed by neurological diseases and postoperative children. Among them, children's respiratory diseases involve the field of surgery, I am afraid Only some of them are cardiogenic. Most of the lung-derived diseases are treated by internal medicine. The two major diseases of cardiogenic respiratory diseases and nervous system diseases belong to the two major specialties of surgery, cardiac surgery and neurosurgery. The pediatric surgery department of our hospital It should be based on pediatric general surgery. The length of stay in the intensive care unit is not long, and the bed turnover rate is high. If the preoperative assessment is done well and the risk of surgery is well controlled, I believe the hospital’s judgment is that it only needs to be in the pediatric ward. Create several intensive care beds like the extracardiac unit."

In this way, if the listeners don't think carefully about what Expert Li said on stage, they may miss it. Judging from the data, the significance of PICU is great for children with acute and critical illnesses, but not necessarily for pediatric surgery.

"For surgery, the most important thing is to do a good job in preoperative evaluation, prevent postoperative risks, and do a good job in surgery. It's too late to make up for it after surgery." Xie Wanying shared her basic understanding of surgery.

What's more, the intensive care unit ward is now equivalent to a big basket, and patients who cannot be handled by any department are sent there to live for a few days. But in fact, many medical technologies in the intensive care unit require the support of specialist doctors. The simplest example, ventilator intubation, requires an anesthesiologist. For thoracic drainage, it is necessary to find a cardiothoracic source. Performing peritoneal dialysis and ECMO requires the assistance of a surgeon. Bronchoscopy can perform endoscopic treatment. Some ICU doctors can't do it, so they have to ask doctors from departments such as the respiratory department to do it.

What is the biggest difference between the intensive care unit and the general ward? According to the relevant standards formulated by the national health department, the actual ratio of the number of nurses to the number of beds in the hospital is 0.4 to 1 in the general ward, and about 2.5 to 3 in the ICU.