Chapter 1004： 【1004】Surgical understanding

Chapter 1004 [1004] Surgical Understanding

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

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

There is always something surprising about her statement.

Everything should pay attention to evidence, preferably statistical data in medicine. Statistics both at home and abroad show that, regardless of whether it is divided into people and children, the proportion of patients admitted to the intensive care unit after surgery is relatively small.

The biggest benefit of surgery is the operation. If surgery is not possible, it is basically hope and request that the patient be referred to internal medicine. So looking at the two together, it shows that the intensive care unit may not be the most important for surgery.

Specifically, look at the various surgeries, I heard that even the neurosurgery plans to build a neurosurgery-specific intensive care unit similar to the extracardiac area, and put it in the newly built surgical building. The establishment of an intensive care unit in its own department means that the proportion of intensive care after surgery is not high, the number of beds required is not large, and there is even no need for a special ICU doctor.

In this case, the premise of each department is to maximize the benefits, and the money will not be distributed to the intensive care unit. Moreover, in fact, most of the patients admitted to the intensive care unit belong to the acute patients who came in from the emergency department. Even if such patients are not sure whether they can undergo surgery before surgery, they may not necessarily be classified as surgical patients. In fact, some patients are like this. After directly entering the ICU, they die in the ICU and cannot survive the surgery.

Xie Wanying once again gave an example: "The most critically ill children admitted to the PICU are respiratory diseases, followed by neurological diseases and postoperative children. Among them, children's respiratory diseases involve the surgical field, I am afraid Only some of them are cardiogenic. Most of the pulmonary diseases are medical treatment. The two major diseases of cardiogenic respiratory disease and nervous system disease 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 hospitalization time in the intensive care unit is not long, and the bed turnover rate is high. If the preoperative assessment is done well and the surgical risk is well controlled, I believe the hospital's judgment is that it only needs to be in the pediatric ward. Build a few ICU beds like the extra-cardiac area."

Having said that, what Li Expert said on the stage may be misunderstood by those who listen to it if they don’t think about it carefully. Judging by the data, the significance of PICU is of great significance to critically ill children, but not necessarily to pediatric surgery.

"In the case of surgery, the most important thing is to do a good job in the preoperative assessment, prevent postoperative risks, and do the surgery well. It is too late to make up for everything after the surgery." Xie Wanying stated her basic understanding of surgery.

Besides, the intensive care unit ward is now equivalent to a big basket, and patients who are unsure of any department are sent there to stay for a few days. But in fact, many medical technologies in the intensive care unit need the support of specialists. The simplest example, ventilator intubation, requires an anesthesiologist. Thoracic drainage, you need to find cardiothoracic. Peritoneal dialysis and ECMO require the assistance of a surgeon. Bronchoscopy can perform endoscopic treatment. Some ICU doctors cannot do it, and they have to call doctors in respiratory departments and other departments to do it.

What is the biggest difference between the intensive care unit and the general ward? According to the relevant standards set 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 the ICU is about 2.5 to 3 to 1.

(end of this chapter)