My medical skills add experience

Chapter 261 The relationship between acupuncture and puncture, it is not easy to be an expert with special needs

Based on Zhou Can's experience, this patient probably died of sepsis in nine out of ten cases.

"The patient's current physical condition is extremely poor. The risk of liver puncture is very high, and the puncture technique is also very strict. It must be successful once, and no mistakes can be made. I am afraid that Director Tan from our internal medicine department will be required to do it himself. "

Director Luo has certain concerns about this.

The essence of liver puncture is thoracic puncture, and patients in good physical condition can certainly withstand it.But the patient himself was dying, like a candle flickering in the wind.Any wind and waves may cause the fire of the patient's life to be extinguished.

Zhou Can was going to grab this opportunity to puncture, but after hearing what Director Luo said, he stopped talking.

In case something goes wrong, when the patient cools down, he has to cool down with him.

Director Luo called Director Tan on the spot.

After hanging up the phone, Director Luo said with a relaxed face, "Director Tan promised to come and help right away."

Zhou Can felt a little curious, is Director Tan's puncture technique very good?
To put it bluntly, the four major puncture techniques are injections.

Doctors do puncture, as long as they have practiced, their level is not too bad.

Nurses have a high level of injections, but they are not familiar with puncture operations.Therefore, even a head nurse with a very high level of injection skills cannot do puncture.

Not long after, Director Tan arrived in a hurry.

I haven't seen him for nearly a year, but Director Tan still looks ruddy, clear-eyed, and in excellent mental and physical condition.

"Yo, Xiao Zhou is here too!"

As soon as Director Tan entered the consultation room, he was the first to greet Zhou Can when he saw Zhou Can was there.

That kind of love for Zhou Can from the bottom of his heart made other doctors envious.

"My teacher couldn't get away, so he sent me over for a consultation. I haven't seen you for nearly a year, and you seem to be younger than before." Zhou Can was not flattering him, but telling the truth .

Director Tan must have taken good care of his body.

"Haha, is that right! It seems that what I learned about Chinese medicine's Qihuang technique still has some effect." Director Tan replied with a happy smile.

The chief physicians of the Department of Cardiovascular Medicine didn't change much when they heard this, but Zhou Can said with a look of surprise, "From what you said, it seems that you have a deep knowledge of Chinese medicine research and study! It's really amazing. People are surprised!"

"What? Don't you think that those of us who study Western medicine can't learn Chinese medicine? Foreigners deliberately suppress our Chinese medicine in China. We can't be fooled. Western medicine and Chinese medicine have their own methods, and there are things worth learning. Let me say In other words, Chinese medicine is more profound, and the discussion of pathology and pharmacology is more in-depth and more extensive. It's a pity that our descendants can only learn a little superficially because of insufficient talent and effort."

In such a public occasion, Director Tan actually publicized the benefits of Chinese medicine.

Zhou Can was really surprised.

It is true that there are too few truly qualified Chinese medicine practitioners these days.

Medicine and surgery are very different.

The surgeon worships Western medicine very much. Whether it is surgical instruments and equipment, the use of drugs, or some surgical standards, they all learn from Western medicine.

Unexpectedly, internal medicine has developed to a certain level, and the emphasis is on traditional Chinese medicine instead.

"Doctor Zhou probably doesn't know yet. Director Tan's acupuncture level has been commended by the Association of Traditional Chinese Medicine! This time, Director Tan is invited to perform chest puncture on the patient himself, because of this high-risk task. Only Director Tan can do it." .”

Director Luo saw that Director Tan was so affectionate to Zhou Can, so he became more warm and friendly to Zhou Can.

"I heard that acupuncture and moxibustion are extremely difficult to learn, but I didn't expect Director Tan to blossom in many fields." After hearing this, Zhou Can suddenly realized.No wonder Director Tan's puncture skills are so good.

Acupuncture is more advanced than ordinary injections.

Especially its thorn point, I heard that the shortest silver needle is also an inch long.The longest gold needle is nine inches long.

One inch is equal to 3.3cm, and nine inches is almost 20cm long.

It is terrifying to think about piercing such a long needle into the human body, leaving only the tail of the needle outside.

At least Zhou Can now has a fifth-level injection technique and has reached the level of deputy director, but he still has no confidence in piercing a silver needle as thin as a cow's hair and more than ten centimeters long into the patient's body.

But some powerful Chinese medicine practitioners can do it.

Whether it is using silver needles to puncture points or dredging collaterals, they can do it easily.

This is exactly the mystery of Chinese acupuncture and moxibustion.

"Hey, my ability is not worth mentioning. I remember Xiao Zhou's puncture skills are very good, right? The puncture of this patient should not be difficult for you. How about you doing the puncture later?"

Director Tan actually knew Zhou Can's strength clearly.

It seems that Zhou Can is paid less attention to.

"Director Tan, this patient's condition is critical, but he can't stand it! Can you ask Dr. Zhou to exercise later?"

Director Jiang became anxious when he heard this.

He doesn't know much about Zhou Can's level.

"You, you still don't understand the skills of this young man Zhou Can! I can assure you that he is absolutely capable of this level of puncture. And as far as I know, he has done more difficult punctures in surgery, and More than one instance."

Director Tan is confident.

Director Tan really knew about Zhou Can's work in the surgery department.

"Is he... really that good? Piercing is easy to learn but hard to master. There are too many doctors who can do the four major piercings, but there are very few who are proficient in it. Dr. Zhou is so young, and piercing is an unpopular medical skill. I'm afraid there is no such thing as you." Say it so well!"

Director Jiang did not dare to show any disrespect when speaking to Director Tan.

It's just that this patient is being treated by him. In case of any accident, he is not easy to deal with.

That's why he said something that might displease Director Tan.

"Hearing is believing, seeing is believing. Will it be clear after watching him operate?"

Director Tan was very determined.

At this moment, a young intern rushed into the consulting room with the examination report.

"Director Jiang, Director Jiang, the results of the patient's sputum culture are back! It indicates that the patient's lungs are infected with Klebsiella... Uh, hello, Director Tan."

The intern entered the consultation room, only to realize that something was wrong with the atmosphere.

Taking a closer look, Director Tan of the Department of Internal Medicine was on the scene.

He was so scared that he hurriedly greeted Tan Liuren.

"The young man has a positive work attitude, not bad!"

Director Tan praised with a smile.

"It turned out to be a Klebsiella infection. It seems that Dr. Zhou's diagnosis is correct. The patient may have developed sepsis." When Director Jiang heard the test results reported by the interns, he felt mixed.

The etiology has basically been clarified.

The subsequent chest puncture was only to further clarify the etiology.

What he has to think about now is the problem of treatment.

"From Director Jiang's words, Zhou Can seems to have made a lot of contribution to this diagnosis!"

Director Tan was not surprised by this.

It's just that he was curious about Zhou Can's diagnosis process and thinking.

Director Luo took the initiative to explain Zhou Can's performance in the consultation.Hearing this, the smile on Director Tan's face became stronger, and the look in Zhou Can's eyes became more friendly.

"Come on, let's go to the ward for liver puncture first!"

Director Tan paid more attention to Zhou Can after learning about Zhou Can's contribution to the diagnosis.

When a group of people came to the ward, the patient's condition was already quite serious, which made people worry.

Since this puncture needs to be completed under the guidance of B-ultrasound, the patient was brought into a special operating room.

"Xiao Zhou, are you sure you can complete the puncture?"

"Have!"

Zhou Can answered one word briefly and forcefully.

At this time, the nurse has taken the initiative to untie the patient's clothes and disinfect the skin.

Zhou Can began to perform liver puncture on the patient.

I saw that he first found out the right location, and then the needle was in place, and punctured directly into the swollen area of ​​the right lobe of the liver.A biopsy specimen was successfully removed and sent for testing.

He also gained 101 injection experience points.

One hundred of them are rewards.

It will take a certain amount of time for the puncture to be sent for histopathological examination and bacterial culture.

Zhou Can was ordered to come to the Department of Cardiovascular Medicine to participate in the consultation this time. Not only did he not discredit Director Shang, but he also earned a lot of face for the Department of Gastroenterology.

Before leaving, Director Jiang apologized to him three times in succession.

He kept praising Zhou Can, whether it was his diagnostic ability or his puncture ability, which made him amazed.

"Thank you, Dr. Zhou, for your contribution to our Department of Cardiovascular Medicine, and I'll send you off." Director Luo saw that the patient's condition, which had deteriorated rapidly, had successfully diagnosed the cause of the disease, and a stone in his heart was lifted.

Next, as long as the symptoms are treated, it is believed that the patient will improve soon.

The key to sepsis is early detection and early treatment.

It's not too late.

When passing by the front of the nurse's desk, the eyes of the three nurses widened in disbelief.

"This, this...isn't it the regular training doctor sent by the Department of Gastroenterology to participate in the consultation? Why did Director Luo personally send him away?"

"Shouldn't you go to the Department of Gastroenterology with him to inquire about the crime?"

"I really admire you. Director Luo is smiling all over his face, talking and laughing with that young doctor, how can it be like asking a teacher for a crime?"

"Hey, hey, did you see the expression on Director Hong's face when he left the Department of Endocrinology not long ago? He also came to attend the consultation, but Director Hong left early, and no one saw him off. Tell me, is Director Hong here? Didn't make any contribution during the consultation?"

"It must be. Otherwise, why would Director Luo send a doctor Guipei himself, but not Director Hong? That young Guipei is really handsome, and I don't know if he has a girlfriend?"

"You've become a nymphomaniac again. You've really convinced me when you see a young and promising handsome doctor and try to get someone else's advice."

Zhou Can heard a lot of the nurses' whispered discussions.

He shook his head secretly, the doctor broke his leg, not as good as the nurse's mouth.

These gossiping women.

……

Back at the Department of Gastroenterology, he checked the patients he was in charge of to see if it was still early, and there was nothing wrong with them.So he hurried to the outpatient clinic to find Director Shang.

Still, I can learn more things by attending the consultation with Director Shang.

Today was delayed by many things.

It's almost eleven o'clock now, and I can only sit with Director Shang for an hour at most.

Zhou Can knocked on the door and walked into the consulting room.

The three graduate students and Dr. Huang Xinggui were there.

Huang Xinggui should be one of the key training objects selected by Director Shang, so whether it is surgery or consultation, he can be seen studying behind Director Shang.

"Doctor Zhou came back from the consultation so soon!"

Director Shang greeted him with a friendly smile.

"The consultation went well, so it didn't take long to end. At present, the patient has basically been diagnosed with sepsis, and the initial judgment is that the cause is bacterial infection caused by infusion. After the sepsis occurred, he was treated effectively when there was no emergency. It further developed into sepsis. The liver and lungs were all abscessed."

Zhou Can fed back the results of the consultation to Director Shang.

"Who diagnosed it?"

Director Shang asked.

"Does it need to be said? I guess it must be diagnosed by Dr. Zhou."

Shailene interjected, laughing.

"Hehe, Dr. Xie thinks too highly of me! When I went, they had already done a sputum culture test. But the diagnostic opinion I gave has a certain effect."

Zhou Can played a role in this diagnosis, but to say that it was completely diagnosed by him would be to underestimate the chief physicians in the Department of Cardiovascular Medicine.

They were also confused by the sterile results of the previous blood culture and infusion liquid culture.

This is why the cause of the patient was not diagnosed in time.

However, with the results of sputum culture, they will definitely consider sepsis.

"Your boy has always been too modest. If you say it has a certain effect, then it must be a big effect. It doesn't embarrass me, and it's fine if you don't embarrass the Department of Gastroenterology. Next time which department invites me to consult, you will go instead of me."

Director Shang tasted the sweetness and got out of hand.

Said that Zhou Can will continue to replace him in other departments for consultation in the future.

"Aren't you afraid that I will discredit you and ruin your reputation?"

Zhou Can has followed so many teachers, but he has never seen such an 'irresponsible' senior doctor.

He is now equivalent to a student on the mountain who has not yet completed his studies, but the head of the sect keeps driving him down the mountain to deal with various important affairs, and uses him as a disciple who has left the mountain.The heart is really big.

"I believe you have the ability to win glory for me instead of smearing me. Besides, who hasn't grown up step by step, even if you make one or two mistakes occasionally, isn't this a normal thing? From now on, you can go boldly, Don't have any psychological burden."

Director Shang told him the whole story.

Even if something goes wrong, don't blame him.

"You came back just in time. This patient's condition is quite complicated, with an enlarged spleen, long-term irregular fever, and night sweats. The treatment in the two hospitals has not worked, and the real cause of the disease has not yet been clarified. You are helping the staff."

When Zhou Can came in, he saw the patient and his family members.

The chat between him and Director Shang and others seemed to be a lot, but in fact it was just a few short sentences.

During this period, the patient and his family looked at Zhou Can curiously.

They weren't stupid either. From Director Shang and Xie Lin's words, they could tell that the young doctor who just came in was very powerful.Can replace Director Shang to participate in consultations in other departments.

The level must not be low.

Zhou Can picked up the examination done by the patient in another hospital, as well as the copied medical record information to check.

The first hospital was a county-level hospital. Blood tests were performed on the patient, and the white blood cell count was normal. The patient was treated with a variety of antibiotics to no avail.The patient's symptoms of systemic poisoning were mild, and the possibility of bacterial infection could basically be ruled out.

Seeing that the patient's treatment was getting worse, the family members questioned the medical level of the county-level hospital, and asked to be discharged from the hospital, and changed to a large hospital for treatment.

The second hospital checked the patient's chest X-ray, which indicated that the chest image was normal.

The patient complained of fatigue, night sweats, weight loss, and chronic irregular fever.

During the physical examination of the patient, the doctor found that there was a broad bean-sized lymph node at the base of the patient's left neck, which was medium in hardness, and the patient had no obvious pain.

Do B ultrasound showed enlarged spleen.

Check the patient's ESR 50ml/ at the end of the first hour.This erythrocyte sedimentation rate is quite fast.

The blood test data suggested that the globulin was significantly elevated.

After a comprehensive diagnosis, the doctor in this large hospital diagnosed a high probability of tuberculosis.

So the patient was treated with isoniazid, rifampicin and streptomycin triple anti-tuberculosis drug.

After more than a month of treatment, the patient went to the hospital for reexamination by B-ultrasound and found multiple solid masses in the spleen and enlarged abdominal lymph nodes.The result of follow-up consultation in this hospital was concurrent splenic tuberculosis.

The family members saw that the treatment was getting worse and worse, and the disease was not under control. Instead, many new problems appeared, and they lost information about the second hospital.

Finally, he took the patient to Tuya Hospital for treatment.

After all, it is a well-known hospital among the top three provincial hospitals, with a high reputation, and patients come here with great hopes.

Seeing this, Zhou Can finally understood why Director Shang was frowning because of this disease.

Patients like this who have been treated in two or three hospitals but have no effect are generally particularly difficult.

It's not that easy to be an expert.

The opening of the special-needs expert outpatient account means that at least [-]% of the patients received every day are patients who have not been treated in other hospitals.

(End of this chapter)