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Chapter 1183: Differentiating Internal Medicine and Surgery

Chapter 1183: Differentiating Internal Medicine and Surgery

"The ventilator’s adjustment parameters start with the four major settings: tidal volume, respiratory rate, inspiratory-expiratory ratio, and airway peak pressure (PIP). Further refinements include flow magic, inhalation oxygen concentration, alarm settings, ventilator sensitivity, and Positive End-Expiratory Pressure (PEEP). These parameters must be adjusted continuously based on the patient’s weight, respiratory symptoms and causes, variations in blood gas analysis, and other biochemical indicators. If the parameters aren’t properly adjusted, inappropriate mechanical ventilation can most easily lead to ventilator-induced injuries, particularly barotrauma."

"When an alarm goes off, the first step is to identify its root cause: Is it high airway pressure or low airway pressure? Is it insufficient ventilation or overventilation? Could it even be that the patient has stopped breathing entirely, leading to immediate asphyxia? Or maybe the ventilator itself is malfunctioning and issuing false alarms? Some issues can be resolved by inspecting the ventilator’s operation and ensuring the tubes are unobstructed; others can be addressed by adjusting the ventilator parameters. In some cases, additional treatments may be needed beyond relying solely on the ventilator, as ventilation alone might not resolve the problem."

A crowd had unknowingly gathered at the entrance to the ward. Among them were nurse aides, patients and their family members out for a walk, medical students who had just started their shifts, and passing doctors. Each was drawn to listen to the crisp voice coming from inside the room and stared at Xie Wanying’s face, all wondering the same thing: Is this person a teacher? Is she giving a lecture to students?

Xin Yanjun glanced back and noticed the expressions of the onlookers at the door. She smiled. Truth be told, the new Student Xie was speaking exceptionally well—almost like she was giving a classroom lesson.

"Let’s go; it’s time for the shift handover meeting." Xin Yanjun pulled Xie Wanying’s arm, heading back toward the doctor’s office. "Afterward, if we have time, I’ll let you personally adjust the ventilator parameters for a patient."

Teacher Xin was quick to let her take charge.

Such a prodigious student being placed in their department for an internship—there wasn’t much need to speculate. The hospital leadership clearly intended for them to give her ample opportunities to practice. If she were sent to a larger department, crowded with students, she’d likely miss out on hands-on experience; after all, she was a surgical student. Xin Yanjun and the doctors in Pulmonary Medicine understood the hospital administration’s strategy all too well, and it so happened that their own plans aligned with it.

Having such a promising student—why keep her sidelined? Not utilizing her talents would be downright foolish.

The handover meetings in Internal Medicine were far more detailed than those in Surgery. Unlike Surgery, which was constrained by daytime surgical schedules, Internal Medicine meetings could afford to run longer.

Once the meeting concluded, with no surgeries planned and an experienced professor providing guidance, ward rounds in Internal Medicine might easily stretch to an hour or two. Patients were thoroughly interviewed, students were questioned right at the bedside, answers were discussed, and instructions were given back in the doctor’s office for prescribing medications. Patient medical records could be reviewed slowly and deliberately whenever time allowed.

Compared to Surgery, Internal Medicine was noticeably more relaxed. In the afternoons, aside from those on call, teachers with no departmental obligations could arrange their schedules however they pleased.

This slower-paced environment left Xie Wanying feeling that even her typing speed on the department’s computer had slowed down. Her hand instinctively touched the stethoscope in the pocket of her white coat, checking that it was still there.

Internal Medicine and Surgery differed significantly. Internal Medicine doctors often carried stethoscopes on their person—it was practically standard equipment. In Surgery, it depended on the specific department. For example, Teacher Tan, as a general surgeon specializing in gastrointestinal cases, rarely used a stethoscope; when he did, he often couldn’t remember where he had placed it and would borrow one from someone nearby in a hurry. Senior Tao, in Hepatobiliary Surgery, would stuff his stethoscope haphazardly into the pocket of his white coat, but it was rarely seen in use. Senior Cao from Neurosurgery seemed to favor flashlights over stethoscopes.

The reason surgeons from specialized departments didn’t commonly use stethoscopes is that their work frequently required direct physical examination. For many specialized conditions in Surgery, palpation was often more effective than auscultation.