My medical skills add experience

Chapter 165 The Cause Is Found, Medication Difficult

Dr. Chi didn't pay much attention to it at first, because Zhou Can was just a trainee.

He thought it was a doctor from the intensive care medicine department who summoned Zhou Can over to learn about the patient's diagnosis and treatment.

"The patient was examined and found to have intestinal bleeding, can you describe the details?"

"At that time, angiography was performed on the patient, and the bleeding was mainly concentrated in the colonic segment of the large intestine. Multiple, diffuse bleeding." Dr. Xia Ping introduced the situation at that time.

He is the treating doctor and the patient's attending physician, and he knows the patient's situation best.

Diffuse bleeding generally occurs in the most dangerous intracranial.

It spreads the bleeding area like smoke.Often refers to multiple points of bleeding at the same time, chronic more common.This bleeding is often associated with superficial capillary lesions or dilatations.There is sepsis, the most common.

"What about the other intestines? Is there any bleeding?"

Zhou Can continued to ask.

Make this phone call, the harvest is very big.

At least he has initially asked what he wanted to know.

"There is almost no bleeding in the cecum, and there is a little bleeding in the rectum. There is also no bleeding in the anorectum. Later, I couldn't stand the family's repeated pleadings, and I took the risk of doing a colonoscopy treatment on the patient. Consistent with the results of angiography, the bleeding was mainly concentrated In the colon segment. There is also a small amount of bleeding in the rectal segment. Treatment with thrombin, cryotherapy, the effect is not good."

"Through observation and comparison, I also found that the position of the bleeding point found during endoscopy is different from that found during angiography. I am sure that the position of the bleeding point in patients is constantly changing."

Dr. Xia described all his discoveries.

After hearing this, Zhou Can was even more convinced that there was something wrong with the small intestine.

The details learned from Xia Ping are too precious.

"Do you think it is possible that the malignant tumor infiltrated the intestinal wall and caused bleeding?"

Zhou Can made the final elimination.

If malignancy can also be ruled out, he can narrow the diagnosis even further.

"The possibility of malignant tumors is extremely small. At least colon cancer and rectal cancer can basically be ruled out."

Xia Ping is quite conservative in speaking.

This is also an experienced doctor who was forced to practice speaking skills during various beatings.

Unless a doctor is really capable and has full confidence in the field he is extremely good at, he dares to speak with certainty.

Otherwise, it is generally a skill that can retreat and advance.

"Doctor Zhou, who is your superior doctor? Did he ask you to inquire about the patient's condition?" Xia Ping seemed to hear something wrong, and began to question Zhou Can in turn.

"My superior doctor is Hu Yiba from the Department of Intensive Care Medicine. Dr. Hu doesn't know about this, but I want to know the patient's situation, so I take the liberty to bother you."

Zhou Can didn't dare to talk nonsense.

Many of the doctors in the hospital know each other, and they can tell if something is true as soon as they inquire about it.

He dared not bear a charge of dishonesty.

"So that's the case! I'm busy here. If there's nothing else, let's stop here!" Xia Ping heard that it was Zhou Can's own idea, and his attitude immediately became much colder.

The superior doctor often encounters a novice like Zhou Can who asks questions.

Like a curious baby, he always asks the superior doctor to ask various questions.

The superior doctors may have a little patience in the face of the subordinate doctors they are in charge of teaching.This is basically the attitude towards those junior doctors who have nothing to do with them.

"Can you tell me about the specific treatment you have done for the patient?"

Zhou Can still wants to know more.

Especially the treatment methods used by the treating doctor, as well as the effect after treatment, and the reaction of the patient.

These data are very valuable and can help him better diagnose the cause of the patient.

Why is it difficult to diagnose some intractable diseases?

Just because the common causes were ruled out one by one.It is necessary for the doctor concerned to try it out himself like a pony crossing the river, and find out a road that no one has ever traveled.

"You can check the medical records directly for the specific treatments you have had. I have something to do here. Goodbye."

The words fell, without waiting for Zhou Can to say anything more.

The other end of the phone hung up directly, and there was a busy tone to end the call.

This doctor Xia is really realistic.

Zhou Can was speechless for a while.

Fortunately, a lot of key information has been asked, and the harvest of this trip is not bad.

"It's a good thing for novice doctors to study hard and ask questions, but they should pay attention to moderation. Our attending physicians are often very busy, and few of them are willing to spend their spare time answering some miscellaneous questions."

What Dr. Chi said to Zhou Can was more of a warning.

No malice.

Just tell Zhou Can not to be so aggressive next time, it is very disgusting to disturb the superior doctor casually.

Zhou Can didn't argue with him.

Instead, he thanked him and left quickly.

Now it is basically confirmed that the patient's lesion is in the small intestine.

As for the specific cause, after eliminating items one by one, a flash of light suddenly flashed in his mind.

Could it be a parasite?And this parasite is not in the large intestine, but hiding in the small intestine.

[Pathological diagnosis experience value +1.]

The experience points have already been credited, which shows that his diagnosis is correct.

In order to make a final diagnosis, further examinations must be performed on the patient.

Zhou Can was excited for a while.

The hard work paid off, and the diagnosis of this patient finally took another big step forward.

At this moment, the cause of the disease has been basically clarified.

There are parasites in the patient's small intestine.

As for the method of causing trouble, it can be further dialectical.

The patient's stool has been routinely tested, and if there are parasites, they can usually be detected.At least eggs can be found.

However, no parasites or eggs were found during routine bowel movements, which meant that the parasites were probably hiding in the small intestine while frantically absorbing the patient's nutrients, and then producing substances that could cause the large intestine to bleed.

It could be larvae, or it could be some kind of hormone, harmful substance that stimulates intestinal bleeding.

Considering that the patient had diffuse bleeding, and concentrated in the colon segment.

Zhou Can prefers that the parasites lurk in the small intestine, absorb the nutrients they need from the intestinal juice, and then excrete irritating and harmful substances that can cause bleeding in the large intestine.

After the small intestine fluid enters the large intestine, the cecum section is very short and its function is similar to that of the small intestine. It mainly absorbs the nutrients and impurities that have not been absorbed by the small intestine.

Those small intestinal fluids spend less time in the cecum.

On the contrary, the colon is as long as 1.1m.When food passes through the stomach and small intestine and reaches the colon, it secretes some alkaline substances to protect the intestinal mucosa and lubricate the intestinal tract.At the same time absorb water, sodium and other electrolytes.

After the food residue reaches the colon, it is absorbed by water and slowly forms stool.

With the continuous peristalsis of the colon, the stool is discharged into the rectum.

Finally, it is excreted through the anorectum and anus.

It can be seen from here that the liquid discharged from the small intestine stays in the colon for the longest time.

And it also has the process of turning feces from liquid to solid.

In this process, those harmful substances that can cause intestinal wall bleeding are absorbed by the intestinal wall, thus causing telangiectasia and diffuse bleeding.

The diagnostic thinking has reached this step, and it is already very clear and definite.

That harmful substance can cause telangiectasia in the large intestine.

Probably because the irritation is not particularly strong, it only causes mild chronic bleeding.

[Congratulations to you for successfully diagnosing a super-difficult case, and the experience value of pathological diagnosis is +100. 】

At this moment, the truth is revealed to the world.

After Zhou Can clenched his fist hard, he raised his arm.

The heart is extremely excited.

Not only was he rewarded with 100 pathological diagnosis experience points, but he could also save a life.

This thing is so meaningful.

Now that it has been confirmed that it is a parasite and it is causing trouble in the small intestine, taking anthelmintic medicine should be able to quickly stop the gastrointestinal bleeding of the 7-bed patient.

Although the cause of the disease has been diagnosed clearly, how to convince the superior doctor is still a problem.

The superior doctor was extremely cautious in medication, and the patient was already extremely weak. If something happened, no one would be able to bear the responsibility.

He decided to call the superior doctor Hu Yiba first.

When he first entered the Department of Critical Care Medicine, Zhou Can only got acquainted with Hu Yiba a little bit.

He took out his phone, luckily he saved Hu Yiba's phone number when he got off work.

Dial directly over.

After two rings, the call was connected.

"Which one?"

It seems that Dr. Hu did not save his number.

From this point, it can also be seen that the doctors actually look down on the "relationship households" who are greeted by someone above them.

Zhou Can is much stronger than those related households with background but no ability.

At least because of his strength, he was cultivated by Vice President Ye.

But in the eyes of Dr. Hu, the status is still very low.

"Hello, Doctor Hu, I'm Zhou Can, Gui Peisheng, who was just assigned to you today."

Zhou Can introduced his name with a very humble attitude.

"Oh! It's Xiao Zhou, what's the matter?"

Dr. Hu's attitude is still gentle.

"After trying hard to argue, I consulted the superior doctor, and it seemed that I found the cause of the bleeding of the patient in the seventh bed."

Zhou Can knew that his qualifications were low, and it would be difficult for Dr. Hu to believe him if he didn't use two unwarranted superior doctors as tiger skins.

"Hehe, you found the cause of the bleeding so quickly? Tell me."

Dr. Hu obviously didn't take it seriously.

He even felt that Zhou Can was a little eager for quick success, thinking of doing meritorious service when he first entered the intensive care medicine department.

The 7-bed patient has been consulted by many doctors in the Department of Gastroenterology, including director-level physicians.After being admitted to the ICU, Dr. Hu, Dr. Shi, and the Chief Physician of the Department all learned about the patient's condition.

So many people have not found the cause of bleeding.

On his first day in the intensive care unit, Zhou Can told him that the cause of the patient's bleeding had been found.

Dr. Hu only felt that this young man was naive and superficial.

Of course, he won't point it out in person.

"I consulted Dr. Xia, the attending physician of this patient. The patient mainly had diffuse and widespread unexplained hemorrhage in the colon segment. The location of each bleeding was different. Various common gastrointestinal bleeding diseases could be ruled out. After Dialectically, we believe that the patient's real lesion is likely to be in the small intestine. And it is possible that the excrement of the parasite causes telangiectasia in the inner wall of the large intestine, which eventually causes bleeding..."

Zhou Can could tell that Dr. Hu didn't pay much attention to his diagnosis.

He still tried his best to describe his diagnostic thinking.

He even told Dr. Xia that he had gone to see him.

"Well! I will pay attention to your diagnostic opinions. I am off work now. If there is any problem, let's discuss it at work tomorrow!"

Dr. Hu's words are purely clichés.

Most of them are perfunctory.

"The patient's condition is critical. If it can be diagnosed early and treated with drugs, it will definitely be of great significance. Do you think it can be handled today?"

Zhou Can bit the bullet and asked.

Judging by Dr. Hu's tone, he definitely didn't take it seriously.

After finally diagnosing the cause, the superior doctor did not trust him, and the follow-up treatment could not be implemented.

This made Zhou Can extremely unwilling.

The rewards of the experience point system are already in place, and his diagnosis must be correct.

I didn't expect to be stuck at the level of the superior doctor.

"Xiao Zhou, newcomers should avoid rushing for quick success and quick gain, and must be calm. Every patient living in the ICU is dying. According to what you said, insecticides are likely to be used. All insecticides are spraying medicines. It will have a certain impact on the body. Normal people can tolerate it and may not even notice any symptoms. But for critically ill patients, even a little bit of adverse effects on the body may be multiplied.”

"You said that parasites are causing trouble in the small intestine, you can't just rely on inference! There must be a scientific basis for diagnosis. It is extremely irresponsible to use insecticides on critically ill patients based on inference. A doctor can bear the possible adverse consequences."

Dr. Hu criticized him very tactfully.

These words are all reasonable.

This is the reason.

But doing everything according to the rules and procedures is somewhat dogmatic.

This arbitrary approach will definitely delay the treatment of patients.

"Of course, your spirit of daring to explore and diligently studying is very worthy of encouragement. Let's talk about the diagnosis and treatment of patients with 7 beds tomorrow. Now the regular departments of the hospital are off work, and they can't start their work. Rest early Bar!"

After speaking, Dr. Hu hung up the phone.

Zhou Can froze in place.

Filled with joy and excitement, being poured with a basin of cold water.

Taking two deep breaths and adjusting his mood, he decided not to hit the south wall and not look back.

Go directly to the duty room of the intensive care unit to find the taciturn Doctor Shi.

To do so requires great courage.

Because it is very likely that things will not be done in the end, and it will be a mess.

A man needs a face, and a tree needs its bark.

Being continuously rejected and criticized by superior doctors, I believe that no doctor is willing to do such thankless things.

Zhou Can has always been a bit 'stupid' when it comes to treating patients.

He walked directly to the door of the intensive care unit.

Ring the doorbell.

The door opened quickly.

A nurse stood inside.

It looked familiar.

Nurses work on a 12-hour system in the ICU.In fact, it is often necessary to work more than 13 hours.

Zhou Can got off work, and the nurses didn't take over.

"Doctor Zhou, aren't you off work? Did you forget something?"

The nurse asked him with a smile.

"I want to ask Dr. Shi to give some feedback about the situation of the 7-bed patient."

Zhou Can walked in directly.

"Doctor Shi happens to be in the duty room, just change your clothes and go find him."

"Thank you."

Zhou Can changed into the isolation suit and walked into the duty room.

Several doctors and nurses were discussing the patient's treatment and condition inside.Dr. Shi seemed to be prescribing a doctor's order for the patient, constantly operating on the computer, frowning and thinking from time to time.

When Zhou Can entered the duty room, he did not attract much attention from other doctors and nurses.

"Doctor Shi, may I bother you?"

Zhou Can walked up to Dr. Shi to say hello.

Doctor Shi looked up at him and recognized him.

"Aren't you the regular trainer under Dr. Hu? What do you want from me?"

There was no smile on his face, and his tone was quite indifferent.

Zhou Can gritted his teeth, bit the bullet and told about the patients in the seventh bed.

Dr. Shi has been listening silently, the expression on his face has not changed much.

Gui Peisheng, who was sitting next to him, showed an imperceptible expression of disdain at the corner of his mouth.You may feel that Zhou Can is just looking for trouble.

After listening to Zhou Can's narration, Dr. Shi didn't change much in expression.

His eyes were still cold and his face was serious.

Standing by the side, Zhou Can was very anxious. If Dr. Shi still didn't pay attention to his diagnosis opinion, he might have to wait until tomorrow to find a way to persuade Dr. Hu.

The cause of the disease has been diagnosed, but the treatment of the patient has become the biggest problem.

No doctor would dare to take that risk.

And there is really no basis for checking.

Dr. Shi pondered for a moment, but didn't say a word.Then continue to operate the computer and continue to prescribe medical orders to patients.

Zhou Can stood there, looking very embarrassed.

It's not right to go, it seems more embarrassing not to go.

It seemed to be regarded as air by Dr. Shi.

After seven or eight minutes, Dr. Shi finally finished prescribing the doctor's order.

This period of waiting was really a torment for Zhou Can.Other doctors and nurses cast strange glances from time to time, which made him feel even more uncomfortable.

It felt like a clown standing there being looked at.

"Did you come up with these diagnoses?"

Doctor Shi didn't forget him, he turned slightly and looked up into Zhou Can's eyes.

"Yes!"

Zhou Can couldn't lie, because the other party's eyes seemed to be able to penetrate people's hearts.

It's even more difficult if you don't speak frankly.

Bite the bullet and admit it is the best way.

"As soon as I heard it, I knew it was your own reasoning. Why did you have to involve a non-existent superior doctor? Experienced superior doctors, the diagnostic thinking is step by step, and every step is based on inspection data or symptoms. Your The way of diagnosis is more like a powerful and unconstrained style, a child's scribbles."

Doctor Shi looked taciturn, but he didn't expect his insight to be so perverted.

A burst of cold sweat broke out on Zhou Can's back.

"However, it is your alternative thinking of breaking the rules and jumping out of the shackles that gave me a glimmer of hope. I urgently need to go in to treat patients, and I will come out in about half an hour to an hour. If you want, you can wait here Me, when the time comes, I will have a good discussion with you about the patients in bed 7."

Doctor Shi said.

(End of this chapter)