Doctor's Life Simulator

Chapter 173 Qin Lang is amazing, the inspection result is out!

After Qin Lang and Dr. Tan came in, they saw Director Zhuang and Dr. Liu in the observation room, in front of the patient's bed.

Dr. Liu's face was a little embarrassed and ashamed, he was really belated.

Fortunately, Qin Lang persisted for a while, otherwise, if he rashly performed an appendectomy, the consequences would be disastrous.

Zhuang Tong was very surprised that Qin Lang had made the same judgment as him, and was going to inquire after a while.

"Doctor Tan, I would trouble you to take the patient for some auxiliary gynecological examinations and smears of the ear and moon."

Director Zhuang ordered Dr. Tan first, and Dr. Tan nodded. Qin Lang had already explained to him the specific inspections needed.

In fact, she was also a little surprised. How did Qin Lang make these judgments, or was it purely cautious?

However, now that Director Zhuang has issued the same order, she just needs to follow it, and she can't help feeling admiration for this little doctor, Qin Lang.

At a young age, he already has the demeanor of a senior doctor.

Dr. Tan brought the patient into the big curtain and started the examination.

Only Qin Lang, Director Zhuang, and Doctor Liu were left.Dr. Liu scratched his head, and asked with some embarrassment:

"Doctor Qin, how did you make these judgments just now?"

Zhuang Tong was also a little curious, how did Qin Lang think of it, after all, this gonorrhea peritonitis is really too similar to the clinical manifestations of appendix perforation combined with peritonitis.

Is this kid really coming to the emergency department on his first day of rotation?

Qin Lang explained:
"Appendix perforation peritonitis, the initial abdominal pain is mostly around the umbilicus and upper abdomen. The typical manifestation is metastatic right lower quadrant pain. Abdominal pain is the first symptom. With the development of the disease, a small number of patients are accompanied by low-grade fever. If it is complicated by perforation, high fever may follow .”

"But the patient had a fever first, followed by abdominal pain, and it was high fever. The initial part of the abdomen was the lower abdomen, and the ulna went up. Although the lower abdomen was tender, it lacked the typical metastatic lower abdominal pain. So, I was wondering if it was gonococcal peritonitis. .”

After Qin Lang's deduction came out, Dr. Liu suddenly realized:
"So, both you and Director Zhuang will ask the patient whether he has a history of contact with unclean niches. And whether there is any abnormal leucorrhea?"

Qin Lang nodded: "Although the patient is only 17 years old, I have reasonable doubts from her makeup and old-fashioned posture. Moreover, female patients may deliberately conceal relevant medical history when seeing a doctor, so I still Insist on inviting Dr. Tan for an examination."

Hearing Qin Lang's clear and assertive analysis, Dr. Liu felt a little admiration in his heart.

"Doctor Qin, I didn't expect you to think so meticulously and thoughtfully. I admire you."

Director Zhuang also looked at Qin Lang, feeling a little emotional, no wonder Wei Guoqiang paid Qin Lang so much attention, and even asked him to take care of him.

"Qin Lang, welcome to our emergency department rotation."

Director Zhuang's impression of Qin Lang improved a bit.

After a while, Dr. Tan came out with the patient. Director Zhuang looked over and nodded in admiration when he saw Dr. Tan:

"The preliminary judgment is consistent with Dr. Qin's guess. The patient's leucorrhea is obviously abnormal, and accompanied by purulent secretions. The leucorrhea increases and has a bad smell. I have arranged for a smear examination. Next, Director Zhuang needs to arrange for the patient to Do a paracentesis, confirm."

Listening to Dr. Tan's words, Zhuang Tong nodded. It seems that the situation is almost the same, but a abdominal puncture is still needed to confirm.

Zhuang Tong looked at Qin Lang, wanting to have a comprehensive understanding of Qin Lang's situation: "Qin Lang, do you know how to perform abdominal puncture?"

Since he just came to the emergency department, Qin Lang really didn't master paracentesis, so he shook his head: "Director Zhuang, I haven't learned paracentesis yet."

Liu Peichun on the side heaved a long sigh of relief, it seemed that he had not lived in vain for the past few years.Although this doctor Qin is amazingly talented, but after all, he has little experience and still has a lot of surgical techniques to master. He can't do it today and catch up with him in the next surgery.

Thinking about it this way, Dr. Liu's mentality finally recovered, which also increased the confidence of some emergency department elderly.

Zhuang Tong thought for a while and then said to Dr. Liu:
"Then you are responsible for taking the patient to do a paracentesis. Qin Lang, you can follow Dr. Liu to observe and study. Since you have come to my emergency department, in addition to the surgical procedures in the field of burns, some conventional emergency surgical procedures are also available. Need to master."

After all, during the six-month rotation period, with Qin Lang's clinical talent and basic surgical skills, Zhuang Tong naturally didn't want him to be wasted, and planned to focus on training.

"If you can't ask for it, then I will trouble Dr. Liu."

Of course, Qin Lang is very happy to learn from Dr. Liu. Although the simulator can gain clinical experience and surgical techniques, it is different from what he learned in the real world.

Paracentesis is often used to check the nature of peritoneal effusion, to help determine the cause, or to administer intraperitoneal administration. When a large amount of effusion causes dyspnea or abdominal distension, symptoms can also be alleviated through puncture and drainage.

The emergency department has its own independent operating room, so soon Dr. Liu brought Qin Lang to start the operation.

Since paracentesis is a very routine operation in the emergency department, a paracentesis kit is specially prepared.

Dr. Liu also specially introduced to Qin Lang:

"Qin Lang, it's not that I rely on the old to sell the old. Although there is a specially equipped abdominal puncture bag, we still have to check carefully before the operation."

Qin Lang agrees with this very much, and his tone is also very modest: "Doctor Liu, what you said is right. After all, I am still a newcomer in the emergency department, and I will ask you a lot for advice in the future."

Regarding Qin Lang's attitude, Dr. Liu is still very comfortable:
"The abdominal puncture kit should have syringes, abdominal needles, specimen bottles, hole towels, etc. It should also be equipped with a tape measure, 50ml or 20ml sterile syringes, 7-9 injection needles, and 3-4 clean glass test tubes. Bacterial culture is required and a sterile culture tube is prepared."

After Dr. Liu's introduction, it is time to measure before the operation, mainly the patient's blood pressure, pulse, abdominal circumference and check the patient's abdominal signs.

"Qin Lang, there is another thing that needs to be paid attention to. Before the puncture, the patient must empty the bladder to prevent damage during the puncture."

"Okay, Doctor Liu."

Qin Lang memorized them all.

Afterwards, the two of them officially started the puncture and put the patient in the supine position.

"The next step is the selection of the puncture site. There are several methods for the puncture point. Today we use the most commonly used method. This method is less likely to damage the abdominal wall arteries."

While introducing to Qin Lang, Dr. Liu made a cross mark at the middle and outer 1/3 intersection of the patient's left lower abdominal navel and the anterior superior iliac spine.

".Disinfection hole towel"

Dr. Liu covered the patient's puncture site with a sterile drape, and performed local anesthesia with 2% lidocaine from the skin to the parietal peritoneum.

His left posterior fixation punctured the skin, and his right hand pierced vertically through the anesthesia into the abdominal wall.

"Qin Lang, when the needle tip resistance suddenly disappears, it means that the needle tip has passed through the parietal peritoneum, and the peritoneal effusion can be extracted."

As soon as the words fell, the yellow-white, thin, purulent fluid was sucked out, and Dr. Liu skillfully kept the sample for later inspection.

After the liquid was drained, the puncture needle was pulled out and covered with sterile gauze. Dr. Liu began to compress it with his fingers, and after a few minutes, he fixed it with adhesive tape.

"Qin Lang, this is the whole process of paracentesis. If a large amount of fluid is drained, finger pressure alone is not enough, then a multi-headed abdominal belt is needed to prevent a sudden drop in abdominal pressure, dilation of visceral blood vessels and blood pressure drop or shock."

Although Liu Peichun sometimes seems a little showy and likes to show off in front of the little doctor, he really imparts his own experience and is very selfless.

[Ding, the host's blessing is so spiritually mobilized. Under Dr. Liu's careful introduction, you have comprehended paracentesis, and because of your perfect basic surgical skills, your paracentesis is better than blue. Congratulations to the host for getting: paracentesis ,advanced! 】

Qin Lang obviously didn't expect that, just watching it once, he surpassed Liu Peichun in paracentesis.

Qin Lang is already looking forward to meeting the next patient soon, so that he can try this newly mastered emergency medicine skill!
After the two of them completed the paracentesis, they left the operating room and returned to the consultation room. Peng Yun was still on duty. Seeing the two of them coming back, they went to the duty room to rest.

While several people were waiting, the results of the patient's smear test came out!

Visible a large number of gonorrhoeae!

(End of this chapter)