Doctor's Life Simulator

Chapter 209 Qin Lang is going to be in the emergency department again
"Doctor Qin, have you really seen the cause of the patient? Is the patient appendicitis?"

Liu Peichun followed behind curiously, anyway, he didn't see anything at all, the lower abdominal rebound pain, tenderness, and the shadow of color Doppler ultrasound evidence, based on his experience, isn't this the most typical appendicitis, opened by Mai's incision It's fine if you have a bad stomach.

Qin Lang walked quickly: "It's appendicitis, but it's not appendicitis."

"what?"

Liu Peichun was completely dumbfounded.

After returning to the office, I checked the time and it was less than 10 minutes before the consultation.

"Qin Lang, help me set up the venue, prepare for the projection, and pour the tea."

Liu Peichun suppressed the puzzlement in his heart, and let's talk about the preparations first.

However, Qin Lang focused on studying the medical records. After all, after the consultation, he wanted to draw his own conclusions reasonably, so he was collecting evidence and formulating his own treatment plan.

Seeing this, Liu Peichun didn't bother Qin Lang any more, and he was looking forward to the consultation for a while.

Qin Lang had almost finalized his own strategy before getting up and helping Liu Peichun to arrange the conference room together. The efficiency of the two of them was naturally much faster.

After everything was ready, deputy director Pang and the second-line general surgery department were on duty, and the senior attending physician Li Ming also came to the office.

Li Ming looked at the four positions and four cups of tea prepared, and was a little puzzled: "Director Pang, Director Zhuang is also coming for this appendicitis operation?"

"No, it's just you and me, Liu Peichun, Qin Lang?"

When Director Pang saw Qin Lang who had completed the preparations and was helping Liu Peichun with the preparations, he was obviously a little surprised that he also participated in this consultation.

"Director Pang, Dr. Li, and Dr. Qin were invited by me. Dr. Qin has some accomplishments in the field of acute abdomen."

Liu Peichun still admires Qin Lang very much.

For this, Director Pang also acquiesced, and he was happy to see Qin Lang come.

Director Pang sat at the host's seat, turned on the computer, and Liu Peichun had already prepared the materials.

"Qin corridor?"

Dr. Li Ming from the general surgery department frowned. Of course, he had heard of Qin Lang's name, but he was just a resident doctor who had just become a full-time doctor. He was so young, and he was in the field of burns. This is the field of acute abdomen, and Li Ming is instinctively puzzled.

"In this consultation, even Liu Peichun is at most just listening in and putting forward some small ideas. There is something wrong with Qin Lang."

Li Ming said softly to Director Pang, after all, he is a senior attending doctor. Liu Peichun said that as a resident doctor with some qualifications, he still has some experience in appendicitis surgery. Shallow, it is a little inappropriate.

This is not common sense.

"Qin Lang still has some research on appendicitis. Of course, he mainly just participates and listens in. Dr. Li, let's start."

Director Pang himself only had some small doubts about this case, and basically communicated with Li Ming. Qin Lang came to participate in this consultation, and he agreed.

After all, this Qin Lang is a young man that Director Zhuang values ​​and takes care of by name.

At the same time, allowing Qin Lang to participate in the consultations of the departments is also to make Qin Lang and the emergency department team closer.

Of course, it would be best if Qin Lang could come up with some valuable ideas and suggestions, but he didn't expect too much.

Li Ming nodded slightly, but he didn't care about it in his heart. After all, it is simply a fantasy for a senior attending to believe that a tender newcomer can give constructive opinions in the department consultation.

In his medical group, even for the simplest cases of appendicitis surgery, senior residents are at least eligible to attend the meeting. As for novices, they are quite content to be able to serve tea and water.

"Then let's start."

Li Ming and Director Pang were naturally sitting close to the projection screen, one on each side.

Liu Peichun looked at the signs, took a blank notebook and shrank behind Director Pang to make an empty space.

Li Ming who was at the side naturally saw it from the corner of his eye, and smiled slightly, this soy sauce was not concealed.

Just when Li Ming was about to look at the projection screen, Qin Lang took a document and sat down in front of Liu Peichun, who was next to Director Pang.

Moreover, on the notebook, there was a piece of handwriting neatly written, and the whole person seemed eager to speak.

Li Ming picked up his own cup, took a sip of tea, and couldn't understand.

Is this Qin Lang really ready to make an opinion?

This kind of consultation between the deputy director and the attending physician, in essence, the resident doctor and the junior doctor are just salted fish shouting 666, and always watching the cup of the dry mouth and tongue that you say, before it is about to dry up. Quickly and obediently continue.

"Dr. Li, in this case, the symptoms and the color Doppler ultrasound showed very clearly that it was a typical appendicitis symptom, but when I was doing the physical examination and communicating with the patient before the operation, for some reason, I had a feeling that something was wrong. .But I can't think of a reason."

As Director Pang said, he slid the picture onto the color Doppler ultrasound:

"Dr. Li, look, there is a finger-shaped echo with a diameter of 8.5 mm in the patient's lower right abdomen, and there are dark anechoic bands around it. It is considered appendicitis."

Director Pang then slid the picture to the chest X-ray and ECG:

"The chest X-ray and electrocardiogram were normal, combined with the patient's right lower quadrant tenderness and rebound tenderness during the physical examination, so the initial diagnosis was acute appendicitis. I made a surgical plan, and performed a McBurney incision on the right lower abdomen with a 5cm incision."

Li Ming looked at the materials that Liu Peichun had sorted out, and then at the color ultrasound and pictures on the projection.

"Because I didn't go for a physical examination in person, based on the available information, I agree with Director Pang's initial diagnosis, which is also a very typical symptom of appendicitis. In fact, I am curious, why does Director Pang feel that something is not right? "

As a senior attending doctor, Li Ming has naturally experienced too many appendicitis operations:

"The patient's symptoms so far are actually clear enough and specific. Compared with some inexplicable causes of acute abdomen, or suspected acute appendicitis, it has become much clearer. Moreover, as an appendicitis operation, McBurney's incision, traditional laparotomy, Even in some minor cases, based on Director Pang's experience and response, I think further investigation during the operation is the best solution."

Regarding Li Ming's judgment, Director Pang naturally thought about it. If he came to perform the operation, there would be no problem, and there was no need to worry about it. But in this case, he performed the operation for Liu Peichun, so he needs to be more cautious in the early stage.

After all, the cultivation of young people in the department is also very important, especially the most common and basic appendicectomy.

Director Pang looked at Liu Peichun and thought for a while:
"If the incision is fixed, it is not impossible to wait for further exploration during the operation. However, this operation is not performed by me, but I still hope that we can brainstorm before the operation. First of all, let me explain why I feel something is not right. That is the path and timing of the metastatic pain reported by the patient, which is a bit weird."

Director Pang stood up, and then recalled the location of the pain and the path and time point of the change of pain transfer that the patient pointed out during the physical examination.

After moving his fingers a few times, Director Pang sat down and looked at Li Ming:

"Is there something slightly wrong? But if it is the path described by the patient, it is actually somewhat contradictory to the shadow on the right lower abdomen shown by the color Doppler ultrasound. But the color Doppler ultrasound and the final location of the pain are consistent."

Li Ming has rich experience. Naturally, when Director Pang described the trajectory, he also frowned. According to this trajectory, it doesn't look like an appendix lesion. It seems that something is slowly flowing from the upper abdomen to the lower abdomen, but obviously The appendix does not move freely in the abdominal cavity like this.

The metastatic abdominal pain of appendicitis is not due to the movement of the appendix itself, but because the pain at the initial stage of the onset is due to the strong peristalsis of the wall of the appendix in order to remove fecal stones or foreign bodies and to relieve the obstruction of the lumen, which reflexively causes visceral nerve dysfunction.

Therefore, the visceral nerve cannot accurately identify the exact location of the pain at the first time.

When the inflammation spreads to the serosa and mesentery of the appendix, the right lower abdominal wall peritoneum innervated by the receptor nerves is stimulated, and the location of the pain is determined, thus creating the illusion of classic appendicitis pain transfer.

But the scope of this metastatic pain is not like the long-distance "flowing feeling" described by the patient recalled by Director Pang.

Li Ming took a sip of tea, and Liu Peichun who was on the side quickly got up and came over to continue.

Li Ming rubbed his chin, suddenly thought of a possibility, and suddenly realized:
"Director Pang, the preoperative physical examination is naturally important, but don't ignore the deviations in the patient's own description. After all, they are not professional, and often the first statement of the patient deviates from the facts. It is still necessary to use color Doppler ultrasound, rebound pain and Comprehensive diagnosis of our experience."

Director Pang took a deep breath, and looked at the color Doppler ultrasound and other information. What Li Ming said was indeed reasonable. In many cases, patients' self-reports would indeed mislead doctors.

"I suggest performing laparotomy through McBurney's incision. In case there are some small problems, even if it is an ectopic appendix. Our experience is enough to deal with it. Continued investigation will delay the operation time. The patient's operation indications are clear, Director Pang Don't hesitate."

"And I suggest that this operation should not be performed by a subordinate doctor, just in case Director Pang will perform the operation himself."

Li Ming simply deprived the junior doctor of the right to be the chief surgeon.

Director Pang nodded: "Doctor Li is right, maybe I'm sensitive, so let's order Mai's incision. Liu Peichun, do you have any other opinions?"

Li Ming was ready to get up and leave. After all, Director Pang said that Liu Peichun and Qin Lang's opinions were just for show. After all, the two big bosses had made a conclusion. How dare these two small residents raise objections?That would be too ignorant of the rules.

Sure enough, Liu Peichun shook his head: "No objection, no objection, I agree with Director Pang's point of view, and my judgment is also typical acute appendicitis. There is nothing controversial."

"Qin Lang?" Director Pang naturally wanted to finish the procedure.

Li Ming had already stood up and was about to leave when he heard a voice of disapproval:

"I think this patient should have had a laparoscopic appendectomy!"

Qin Lang is so loud, I am absolutely sure!
Li Ming and Director Pang looked at Qin Lang in surprise.

Liu Peichun blinked his eyes, Qin Lang really wanted to do something again.

PS: Thank you for the reward of another 300 coins from the dangerous boss of the tunnel machine, happy and happy, thank you for your support~
(End of this chapter)