13. Theo dõi bệnh nhân

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Nurse: Good evening, doctor.
Doctor: Good evening. How’s our TBI patient?
Nurse: Mr. Thomas? It’s not looking good. He had a stroke two years ago. His family found him lying on the floor of the bathroom this morning, then called an ambulance. His blood pressure has been very high, according to his wife.
Doctor: He’s a high risk patient.
Nurse: Yes, he’s still unconscious, doctor.
Doctor: What’s the blood pressure reading?
Nurse: BP is one seventy over one twenty.
Doctor: Mmm. Much too high. And what was it at twenty hundred hours?
Nurse: One fifty over ninety. It started rising an hour later – at twenty two hundred hours it was one sixty over one ten.
Doctor: So, rising all the time. What about his ICP?
Nurse: ICP was stable at twenty at twenty hundred hours. But it rose to twenty five at twenty-one hundred. At twenty-two hundred it was twenty six. Now it’s twenty seven.
Doctor: Right. We must get his ICP back to below twenty. Twenty and over is too high. OK, I'll be there in ten minutes.

Nurse: OK. Mrs Murphy, just lie back on this examination table. Are you comfortable?
Mrs Murphy: Yes, thank you.
Nurse: Have you had plenty of water to drink?
Mrs Murphy: Yes – three glasses.
Nurse: Good. We need your bladder full. I am putting some gel  onto your abdomen. That helps the ultrasound work well
Mrs Murphy: OK
Nurse: Your notes say the baby has stopped moving. Is that right?
Mrs Murphy: Yes. I am a bit worried.
Nurse: And you are in the twenty –second week of your pregnancy.
Mrs Murphy: Yes.
Nurse: Right. Well the ultrasound scan is very simple. When I pass the transducer over your abdomen. It bounces sound waves off the baby’s body and it makes a picture here on the monitor. Then we can see if there is anything wrong. It shows up any abnormalities. A scan can usually show if the baby is a boy or a girl. Do you want to know the baby’s sex?
Mrs Murphy: Yes, please.
Nurse: OK. I am passing the transducer over your abdomen now. Ah, here we are. There is  the baby. Can you see it?
Mrs Murphy: It’s not very clear.
Nurse: well, there is the head. Can you see that?
Mrs Murphy: Oh, yes.
Nurse: And there’s a hand . five fingers. And there is a foot . can you see?
Mrs Murphy: Yes.
Nurse: Can you see the heart beating? The baby is alive and looks good. Yes, everything is normal. And look – a penis. It’s a boy.
Mrs Murphy: Really? I wanted a girl.
Nurse: You did? Just a moment. Well you are not going to be disappointed – you  are going  to have twins- a boy and a girl.
A preparation that is commonly used in general anaesthetics comes from the drug curare. It is the paralysing poison South American Indians use on the tips of the arrows.
The thing about general anaesthetic that frightens everyone is the idea of waking up in the middle of an operation. the anaesthetist's hob is the prevent this from happening by monitoring the patient every step of the way.
The patient is given a general anaesthetic in three parts. The first part is a drug that puts you to sleep. It works very fast. You are told to count backwards from 100, and you are usually asleep before you reach 95. From that point onwards, you brain waves are monitored by an electroencephalogram, which will warn if you are waking up.
The second drug paralyses the muscles, so you need a ventilator to breathe. The percentage of oxygen in the air is controlled by the ventilator. An alarm will sound if it drops too low.
The heart still works under general anaesthetic, and your heart rate is recorder by an electrocardiogram. The anaesthetist also monitors the percentage of haemoglobin in the blood and level of carbon dioxide. Body temperature is constantly measured because hypothermia can occur under general anaesthetic.
Despite the effects of the paralysing drug, the brain also still functions. So if you wake at the wrong time, you may be able to hear surgeons and nurses talking, and understand what is going on. You will be unable to call out, open your eyes, or move, because your muscles will be paralysed. However, you will feel no pain because of the third part of the anaesthetic - a painkiller, such as morphine.
The drugs of a general anaesthetic are powerful and can cause hallucinations, which may explain the "near death" experiences described by people who are given general anaesthetic. Many of them say the same thing - they rose out of their body and went down a corridor towards a bright light, and sometimes they have reported hearing a voice telling them to return.
The scientist Sir Humphrey Davy [1378-1829] discovered the anaesthetic properties of nitrous oxide. When he breathed in the gas, he began laughing uncontrollably before losing consciousness. He named it "laughing gas".
One of the first women to give birth painlessly using chloroform named her new baby Anaesthesia.