Doctor's Life Simulator

Chapter 171 Qin Lang, You're Too Cautious, It's Unnecessary

[Consume 1 life simulation point to start a single case simulation. 】

【Under the arrangement of Wei Guoqiang, you started to change your new life in the emergency department.You see the first patient in the emergency department. According to her symptoms, abdominal distension, vomiting, fever, and peritoneal irritation such as lower abdominal tenderness, rebound tenderness, and muscle tension, you judge that the patient is peritonitis with perforated appendix.At the same time as your examination, Dr. Liu also returned to the consulting room to observe your consultation process.Basically agree with your point of view. 】

[Because the medical history was simple and crude, and the physical examination was not meticulous, you did not find the real cause of the patient.You are a novice, so I understand.As a senior emergency physician, Dr. Liu has subjective assumptions and empiricism in order to behave in front of you. Perforated appendix and peritonitis are common multiple diseases, so he made a judgment based on symptoms and signs.Therefore, without further examination and analysis, the operation was carried out hastily. 】

[Dr. Liu is very experienced in appendicitis surgery and can do it at his fingertips.Therefore, surgery was immediately arranged for the patient.Peritoneal congestion and edema were seen during the operation, 400ML of thin light yellow liquid in the abdominal cavity, mild congestion and edema of the appendix, but no suppuration, gangrene, or perforation.Instead, the fallopian tubes have different degrees of congestion and edema.During the operation, the patient's right fallopian tube and ovary were covered with a little thick moss. 】

【Doctor Liu knew he had misdiagnosed, but it was too late.Immediately take pus specimens for inspection, suck the pus, rinse the abdominal cavity with metronidazole solution and normal saline, and place a soft drainage tube. 】

【Drug susceptibility test of peritoneal fluid culture after operation, and a large number of gonorrhoeae were seen.The real cause of the patient was gonococcal peritonitis.Afterwards, Director Zhuang personally organized and analyzed the clinical manifestations of gonococcal peritonitis and peritonitis caused by appendix perforation. They were indeed very similar, and they were often misdiagnosed and performed operations by mistake. 】

[Because the patient is too young, apart from the general medical history, he did not focus on his physiological characteristics, did not understand the shape of his leucorrhea, his life history, and his history of exposure to unclean niches. It should not be limited by the patient's age and marriage.After questioning the medical history afterwards, I found out that although the patient is young, he has many young partners, most of whom are social people, and they are secretive and unknown.Moreover, there were abnormalities such as increased leucorrhea a few days before the abdominal pain. 】

[Clinical recommendations For female patients with appendix perforation peritonitis who lack typical metastatic right lower quadrant pain, relevant auxiliary examinations should be selected, and it is best to invite a gynecologist for consultation. Neisseria gonorrhoeae grew in the secretions of the "month" tract, and diplococci were found to be negative on smear Gram staining, which can confirm the diagnosis.Absorb the pus, fully flush the abdomen and pelvic cavity, properly place the drainage tube, and take regular anti-infection treatment after the operation. 】

[Ding, the single case simulation is over, whether to retain the clinical experience of this case. 】

Qin Lang obviously did not expect that this patient was gonococcal peritonitis, no wonder the clinical manifestations were so similar to peritonitis caused by appendix perforation.

When Qin Lang was interrogating patients, Dr. Liu also came back from the toilet a long time ago. When he saw Qin Lang making a diagnosis, he just watched quietly from the sidelines. He also wanted to test Qin Lang's level, so he didn't come out. Voice.

After Qin Lang's basic consultation, and the patient's abdominal tenderness, muscle tension and other symptoms, according to his extensive experience, he already has a direction, and it is probably peritonitis caused by appendix perforation.

So far, Dr. Liu is quite satisfied with Qin Lang's consultation. After arriving here, he can basically confirm the diagnosis and arrange for the patient to go for surgery.

After all, appendix perforation complicated by peritonitis, the sooner the operation the better.

When Dr. Liu was about to interrupt and arrange for the patient to prepare for the operation, Qin Lang asked a question that he could not understand.

Qin Lang asked seriously, "Have you had any contact with unclean students recently, or do you have a boyfriend, and does your boyfriend have a history of traveling?"

The little girl's eyes flustered for a moment, but she calmed down soon, she shook her head innocently at Qin Lang, and said softly, "Doctor, I'm still a high school student, and I've never done anything like this before."

Qin Lang didn't expect that this little girl would lie without batting an eyelid at such a young age. If she hadn't passed the single-case simulation, she would have been fooled by her.

"Then have you had any abnormal leucorrhea or smelly ear canal discharge in the past few days?"

Qin Lang's tone was already a little blunt.

The little girl lowered her head slightly, obviously feeling a little confused, but she knew these things about herself and could not be known by others. If she was found out, she would notify the school and parents, and she would be finished.

Before the little girl came, she also checked on Baidu, and her illness was probably appendicitis, so it must have nothing to do with Brother Huang, Uncle Li, Manager Shi, Mr. Zhang, and Director Wen.

After thinking about it, the little girl raised her head and said pitifully, "Doctor, I don't have what you said."

"Oh, it hurts. My stomach hurts, doctor."

Qin Lang obviously didn't expect that the little girl's dishonesty may also be because she is a male doctor, so she has some concerns. It seems that the only way to get a gynecologist to come for consultation.

"Like this, you go to the observation room and wait. I'll have a gynecologist come over for a consultation later. We need to perform a smear on your ear and lunar canal, as well as a preoperative abdominal puncture."

The little girl lowered her head, clutched her abdomen, gritted her teeth, and did not respond.

Regarding Qin Lang's decision, Dr. Liu is obviously a little confused, and thinks that Qin Lang is making a big deal out of a molehill.For such an obvious perforated appendix peritonitis, a minor operation can be done directly.

"Sure enough, she's still too young, a little too cautious and indecisive."

However, in front of the patient, Dr. Liu didn't tell the truth, and gave Qin Lang some face.

After waiting for the patient to go to the observation room, I was talking to him well.

Soon, the little girl was sent to the observation room, and Qin Lang was going to get up to find a doctor from the gynecology team for consultation, and to do an auxiliary examination and secretion examination on the patient.

Dr. Liu stopped Qin Lang, with the calmness and preaching of someone who came here in his tone:

"Qin Lang, I have seen your consultation with the patient just now. In fact, it is very clear. The patient is a perforated appendix combined with peritonitis. It is a minor operation. Don't waste time to ask the gynecology team for consultation. As for the preoperative abdominal cavity Puncture tests, that's more of it."

If another senior resident doctor, even Peng Yun, who is in the same department as Qin Lang, Dr. Liu would not say anything if he proposed these examinations, he would respect the judgment and choice of his colleagues.

However, in front of Qin Lang, he naturally didn't think that this little doctor was more experienced than himself, and he saw something extraordinary.

Moreover, during the consultation just now, the little girl also told him very clearly that there was nothing abnormal. He was still so suspicious, so he was a little too cautious.

If you invite a gynecologist to come over for an examination, nothing can be found out. If the other party knows that he is there, the little doctor is timid and afraid of unnecessary actions. I can understand that he is an old hand, and even a small appendix has to be checked repeatedly. ?
"Qin Lang listen to me, just perform appendectomy."

Due to the directional thinking developed by specific positions in the emergency department, Dr. Liu has seen too many patients with this kind of abdominal pain, especially patients with lower abdominal pain accompanied by signs of peritonitis.Perforated appendix complicated by peritonitis, did not escape!

Moreover, he is also planning that when he is on the operating table, the facts speak louder than words, and he will educate this little rookie well.

(End of this chapter)