Doctor's Life Simulator

Chapter 236 It is recommended that such patients at risk of medical trouble be transferred to another hospital

Lai Meiyun reported that she had experienced severe pain in her upper right abdomen 2 times in 3 years. The previous 4 times were after practicing dance for a long time. The pain relieved on its own in about 5-[-] hours. Since she hadn’t made her debut at that time, she didn’t seek medical treatment in order not to affect her future selection.

Due to self-relief, I didn't pay too much attention to it. I had another pain half a month ago. The symptoms were more serious. After seeking medical treatment, I received intravenous infusions of cimetidine and floxacin for 1 day.

Then, the most recent time, I had abdominal pain for 4 consecutive days, accompanied by a body temperature as high as 38.5°C, no nausea, no vomiting, no diarrhea.

With the clinic intravenous "ceftriaxone sodium", "tinidazole" 1 day without improvement.

Since the physical examination data had to be sorted out to Professor Huang, Qin Lang naturally conducted a routine physical examination and consultation, and carefully recorded in the medical record:
Patient: Lai Meiyun, female, 20 years old

Brief medical history: The main cause was right upper quadrant pain for 4 days, accompanied by fever and admission.The body temperature was as high as 38.5, no nausea and vomiting, no diarrhea, and "ceftriaxone sodium" and "tinidazole" were given intravenously in the clinic for 1 day without improvement.

Physical examination: conscious, flat and symmetrical abdomen, right upper quadrant tenderness, mixed muscle tension, rebound tenderness
After doing this, wait for the ultrasound and abdominal CT to come out.

Two hours later, check it out:
Auxiliary examination: white blood cell 10.05×109/L, neutral 0.93, blood amylase 30U/L, urine amylase 108U/L, prothrombin time 17.3s, international normalized ratio 1.45, activated partial thromboplastin time 51.3s, kidney Performance: creatinine 154.4umol/L, blood urea nitrogen 13.65 mmol/L.

Ultrasound showed acute cholecystitis and gallstones, with two abdominal CT pictures attached.

Clinical diagnosis: acute cholecystitis, gallstones

After finishing these, Qin Lang packed up the sorted materials and sent them to Tang Qichen, who then forwarded them to Professor Huang's team.

Half an hour later, Professor Huang's team replied: In order to make a more accurate judgment, please cooperate with your hospital in performing contrast-enhanced ultrasound and enhanced CT.

After receiving the reply, both Qin Lang and Li Ming were a little surprised!

Especially Li Ming, his face was a little unhappy. The contrast-enhanced ultrasound and enhanced CT were not so simple to do.

And, is it really necessary?

The so-called contrast-enhanced ultrasound requires the use of GE Logiq E 9 color Doppler ultrasound diagnostic instrument equipped with real-time imaging function, and there is only one instrument for the entire emergency department, so many patients are waiting to use it, generally for cholecystitis This kind of minor surgery is not used.

As for enhanced CT, GE Light Speed ​​VCT 64-slice spiral CT should be used. From the perspective of effect, these two examination methods have a good role in differentiating gallbladder sediment-like stones and thick-walled gallbladder benign lesions.

Compared with conventional ultrasound, CEUS can provide more information for differential diagnosis because it can dynamically display the blood perfusion and microcirculation characteristics in the lesion in real time.

The effect is good, but the cost is naturally high. Like Hecheng No. [-] Hospital, double-enhanced surgery is rarely needed.

This is the hospital in the capital city of Hangzhou, and only professors are used to using double-enhanced films.

"The patient's condition has actually been diagnosed through ordinary color Doppler ultrasound and CT. I don't think it is necessary to do double enhancement, which is not very meaningful. Moreover, to be honest, the operation is going to be tomorrow, and today's schedule may not be in time. .”

Li Ming called Tang Qichen directly to communicate.

"Doctor Li, this was specifically proposed by Professor Huang. I think we still respect Professor Huang's opinion."

How could Tang Qichen dare to say no to Professor Huang? He had devoted a lot of energy to this operation, and he didn't want to make Professor Huang's team unhappy because of these things.

"OK then."

Li Ming finally compromised. After all, Professor Huang's status and identity are placed there, and he can only do his best to cooperate with his request.

After putting down the phone, Li Ming began to arrange for contrast-enhanced ultrasound and enhanced CT.

It’s just that this kind of temporary arrangement increases the examination, and it is extremely demanding for contrast-enhanced ultrasound and enhanced CT. It is impossible to be so fast. In addition to the equipment, there are also doctors.

The only way is to let the doctor who does the examination get off work overtime to help after work through personal relationship.

But Li Ming is just an attending physician after all, and his energy is limited.

"Qin Lang, is there anything you can do?"

Of course, Li Ming didn't have too much hope, after all, Qin Lang is a resident doctor, and he hasn't been in the city's first hospital for long.

"I remember that the burn department purchased a brand new GE Logiq E 9 color Doppler ultrasound diagnostic instrument when Director Lu Yu started a new project. Director Lu is also very good at enhanced CT and contrast-enhanced ultrasound."

Qin Lang turned on his mobile phone and called Lu Yu.

Before, Qin Lang helped Lu Yu's uncle heal a severe burn. Lu Yu always remembered this kindness, so he arranged everything for Qin Lang immediately, and even said that he would do it himself.

"It's done! Director Lu said that she will work overtime today, and we will be there at 06:30 in the evening."

"real!"

Li Ming obviously didn't expect Qin Lang to get it done with just one phone call, and a deputy chief physician worked overtime for Qin Lang himself.

He has also heard about Lu Yu's name, but the elite talents introduced from Jishuitan Hospital in the imperial capital, the general surgery department and the burn department still have many intersections, so he also respects and admires Lu Yu very much.

"Young people today are amazing."

Li Ming, of course, had a lot of brainstorming, and thought of the importance that Director Zhuang and Director Wei place on Qin Lang, this will solve the enhanced CT and contrast-enhanced ultrasound that gave him a headache.

This Qin Lang made him a little confused. It seems that he can't just be treated as a talented young man in the future.

When Lai Meiyun's operation was proceeding step by step.

Hu Jie, whose cholecystitis caused myocardial infarction before, was sent back to the General Surgery Department from the Cardiothoracic Surgery Department after treatment, and continued to undergo the next cholecystectomy.

And very coincidentally, Hu Jie was assigned to Li Ming's group, because the patient had just been rescued and had acute myocardial infarction.

So for this cholecystectomy, Li Ming invited Chen Feng, another attending physician of the General Surgery Department. Dr. Chen mainly studies the field of liver, gallbladder and pancreas, so he is very accomplished in cholecystectomy.

Of course, Qin Lang was also stayed by Li Ming to participate in this small consultation.

As the organizer of the meeting, Li Ming released the patient's information as soon as possible, and at the same time turned on the projection, and introduced Hu Jie's situation in detail.

Looking at the information, Qin Lang knew that what was supposed to come would always come, so he explained:
"I diagnosed this patient together with Liu Peichun. At that time, I proposed to let her have an electrocardiogram and a color ultrasound of the heart. However, the patient was so uncooperative that acute myocardial infarction was caused during the fluid rehydration process."

Qin Lang reported the previous incident to Li Ming and Chen Feng.

"That's disgusting. It's difficult for such a patient to file a complaint if he doesn't cooperate with the treatment."

Li Ming frowned after hearing this, and he was a little reluctant to undergo the operation.

"Since the patient has just been rescued, the risk of cholecystectomy is still very high. In view of the behavior of the patient and his family, it is necessary to communicate with them well before the operation. If the patient and his family continue to mess around, then I suggest that they be directly transferred to the hospital for treatment. Our department does not accept it."

Li Ming, as an old Jianghu, of course, has already analyzed it from Qin Lang's introduction. Such patients and their families are the most disgusting to doctors.

You have done a lot of things and assumed a lot of responsibilities, but the patients and their families not only don't appreciate it, but also beat them back, and you may even make a big fuss.

Reports of family members stabbing and stabbing doctors to death due to medical disputes are not uncommon.Therefore, treating some garbage people is not worth the candle.

"Dr. Li is right. We first formulate the operation plan and communicate with the patient and family members. In view of the special situation of the patient, the possibility of danger during the operation is very high, so we must ask them to sign a waiver statement in advance, otherwise something will happen later. Accidents, in their character, are very bad for us."

Chen Feng also spoke from the side, all the doctors worked together to deal with such bad patients.

"For cholecystectomy, the traditional method is laparotomy, which is obviously not suitable for this patient. There is also four-port laparoscopic cholecystectomy, but due to the poor physical condition of the patient, he has repeated cholecystitis all year round. In addition, just after first aid, there may be deterioration and new problems, and further diagnosis cannot be confirmed. Only in the operation can the real diagnosis be made. Therefore, the difficulty and risk are very high."

Li Ming put forward his own opinion.

Chen Feng nodded slightly, and fell into deep thought. If it was an ordinary patient, they would naturally be willing to try and take risks.

But now it is obvious that for this patient and his family members, if there is an accident during the operation, there will be a great possibility of medical disputes in the future.

Chen Feng pondered for a few seconds. After all, it was arranged for Li Ming: "In view of the risks of the operation and the hidden dangers of medical disputes between patients and their families. If Dr. Li is sure, we will operate. If the risk is too high, then we recommend that the patient be transferred to another hospital." .”

(End of this chapter)