My medical skills add experience

Chapter 325 A perfect cure, neurofibroma and café au lait spots

"Doctor Zhou, what kind of cold does my granddaughter have? Why doesn't the medicine work?"

She asked Zhou Can who was measuring the little girl's physical signs.

While speaking, she also took out the cold medicine for Zhou Can to check.

"You don't think it's a counterfeit medicine? At that time, my granddaughter got sick at night, and I bought the medicine at the nearest small clinic."

Patients who take the medicine and it doesn't work, most like to wonder whether the medicine they buy is a counterfeit medicine.

The probability of 'winning' does exist.

Especially nowadays, in order to increase profits, many pharmacies will choose to buy medicines from small manufacturers for sale.In terms of quality, it is not as guaranteed as the medicines of big manufacturers.

After all, it is not easy to create a brand, and the high cost of making mistakes by big manufacturers makes them afraid to stand up and take risks.

In order to survive, small manufacturers sometimes play some sloppy eyes and do some stupid things.

Zhou Can took the cold medicine that the patient had taken and checked it carefully.

"There is no problem with the medicine. They are all medicines produced by regular manufacturers, and they are symptomatic."

If his words are heard by the owner of that small clinic, he must thank him.

The bosses and pharmacists of some small clinics are basically medical students who have studied pharmacy or even clinical medicine.Or they yearn for freedom and don't want to stay in a big system like a hospital to intrigue and be idle, so they choose to go it alone.

Therefore, these people have certain professional knowledge.

It is even more impossible to sell drugs indiscriminately.

In case something happens to the patient after taking the medicine, the clinic or pharmacy will have to follow suit.

"Your granddaughter has a moderate fever and a fast heart rate. Judging from the symptoms, it does look like a cold, but it may also be other diseases. Is her bowel movement normal for the past two days?"

"I really don't know about that." The old lady shook her head.

The granddaughter is already eight years old, and adults rarely pay attention to things like defecation.

The little girl felt the gazes of her grandmother and the doctor on her face, and said a little embarrassedly, "It's just a little diarrhea, everything else is fine!"

Diarrhea is also one of the most common symptoms of a cold.

Zhou Can has almost got the basic information of the patient, and the next step is to think about which inspection items to prescribe.

In her case, both blood and urine tests are necessary.

There is no need to do a chest X-ray for the time being, and you can wait for the results of the blood and urine tests before further checking the relevant biochemical items.Zhou Can quickly sorted out the diagnosis ideas in his mind.

Now he finally understands why the Ministry of Health has to stipulate the number of outpatient and emergency doctors in a single day.

Because there are too many patients, the doctor's mind will be confused.

If you see more than 100 patients a day, you will definitely not be able to remember the patient's information and condition.Many patients even meet each other, chat for a while, and then they will be sent away after an examination.

In this case, the quality of diagnosis and treatment can be imagined.

It is almost an open secret that doctors are severely overloaded in the inpatient department and operating room of the hospital.Especially the interns and regular trainees are the hardest hit areas.

It's just that I didn't expect that the outpatient clinic also has overloaded work.

This is by no means a good thing.

Doctors and nurses suffer, patients cannot receive high-quality medical services, money is wasted, time is wasted, and the disease has not been cured.

When doctors are too tired, the probability of misdiagnosis and missed diagnosis will also increase greatly.

Zhou Can dare to assert that if any hospital can come up with a proper solution to these problems.The competitiveness of that hospital will kill other hospitals in seconds.

"Let's do a routine blood test and urine test first! I'll see what's going on."

After checking the basic situation of the patient, Zhou Can issued an application for examination.

"Okay! When we get here, we will definitely listen to you."

The old lady readily agreed.

Holding the list from Zhou Can, the old lady took her granddaughter out.

This is also the first difficult case that Zhou Can has encountered since his consultation today.

Before he had time to take a sip of water to rest, the door of the consulting room was pushed open again, and a new patient came in.

He could only brace himself to cope.

This is the fifth patient received today, and less than an hour has passed.

The momentum is gratifying!
It seems that in Tuya Hospital, thanks to the advantage of the home court, the outpatient and emergency volume is completely different from that of Xinxiang Maternity and Children's Hospital.

The fifth patient was a half-grown child with a dislocated left arm. He was only nine years old and was already over 1.7 meters tall.

Zhou Can is very good at dealing with this kind of bone injury.

It is much easier than diagnosing and treating those intractable diseases.

However, he still inquired about the injury in detail to understand what happened to prevent missed diagnosis.Sometimes, some inconspicuous injuries may be ignored by patients, but they will seriously threaten the lives of patients.

In the news, there are often traffic accident victims who choose to go private, and there was nothing serious at the time.As a result, after returning home, one or two days later, or four or five days, he died suddenly.

This kind of thing sounds scary, but it is actually preventable.

If after a traffic accident, you can go to the hospital to ask a professional doctor to diagnose and find out hidden dangers, you can control the injury as soon as possible to prevent serious consequences of death.

Thanks to Dr. Xu's strict teaching, Zhou Can has a very good style in medical safety.

No matter how common the disease is, he always maintains a high level of vigilance.

After finishing the physical examination for this big boy, no hidden dangers were found, and he was given an X-ray examination and sent away.

After the patient and his family left, two patients came in at the same time.

One is a new patient, and the other is the first patient received today—the girl who sprained her foot while dancing.

"Doctor Zhou, we finished the examination."

The girl's mother brought him the test results.

"Please wait a moment, they are the first patients to come to my clinic in the morning. I will help her deal with it first, and then I will diagnose and treat you."

Zhou Can explained to the family member of another patient.

"Okay! They come first, so they should be dealt with first."

This family member is reasonable and easy to talk to.

After Zhou Can comforted the other party, he calmly began to check the little girl's video.

"Little girl, you should take it easy next time you dance! You directly dislocated your right ankle this time. Fortunately, you didn't cause a fracture. This is luck among misfortunes."

After Zhou Can read the patient's X-rays, he already had some calculations in his mind.

There is no open wound or bone fracture like this one, just a dislocation of the ankle joint, which can be completely reset by manipulation.

"Did you hear what Dr. Zhou said? Your body belongs to you. Don't be so violent next time you practice dancing." When the girl's mother scolded her daughter, it was clear that she scolded her daughter three times and loved her seven times.

After training her daughter, she looked at Zhou Can with a flattering expression, with a trace of worry in her brows.

"Doctor Zhou, what should I do about my daughter's injury?"

"I tried to reset her manipulations, which is much better than surgery. But you must pay attention to rest. Then I will prescribe some anti-inflammatory and pain-relieving medicines for her."

Zhou Can gave a treatment plan.

"All right, all right, I'll listen to you. We were afraid of having an operation, so we came to you specially for treatment. It seems that we have come to the right place." The girl's mother was obviously greatly relieved when she heard that the technique could be reset. .

For family members, no need for surgery means that the cost of treatment is greatly reduced, and the child can suffer less.

Surgery is risky. If the operation is not done well and the right foot is disabled, there is no place to cry.

"You can't be too happy too early. The success rate of manual reduction is not 100%, and there is also the possibility of failure. I can only say that I will try my best to reduce the burden on the family members and give priority to the most affordable and effective treatment plan."

Zhou Can may not have realized that when he communicated with his family members, he gradually mastered the communication skills of chief physicians.

Create a good positive image to the greatest extent so as to gain the gratitude and trust of family members.

"Sit down! The manual reset will definitely hurt a bit. Don't be afraid, the pain lasts for a very short time." Zhou Can squatted down while explaining the precautions to the little girl, and began to reset the manual for her.

In order to prevent accidents, Zhou Can looked at the girl's mother.

"Or, you'd better support her."

"Row!"

The family members walked to the little girl's side and supported the little girl.

The little girl didn't dare to look at Zhou Can's hand.

She turned her head and closed her eyes tightly.

Zhou Can just started to slightly adjust the angle of the manual reset, and the girl started to cry "Ah yo" in pain.

He ignored the girl's cries of pain, but after finding the best angle for the ankle joint to reset, he sent it forward slightly.

"clatter!"

There was a clear sound of bones groaning, and the little girl also let out a scream.

"It's okay, it's normal to have pain! You can try to raise the toe of your right foot again."

Zhou Can comforted the patient.

In the seemingly short treatment time just now, Zhou Can has successfully helped her complete the ankle joint reset.

The girl tried to raise the toes of her right foot.

"Wow, I can really do it!" The girl said to her mother in great surprise.

"Great! Dr. Zhou's medical skills are excellent, and he really helped you reset your manipulation successfully!" The girl's mother smiled happily.She looked at Zhou Can, "Thank you, Dr. Zhou, thank you!"

"You're welcome! It's what our doctors should do to save lives and heal the wounded. I'm actually happier than anyone else if I can successfully help her reset her hand. If such a young girl is operated on, she will definitely leave ugly scars. The recovery time also needs to Much longer. It's all right now, you and I can breathe a sigh of relief."

After Zhou Can checked her carefully, he confirmed that the ankle joint had indeed been successfully reset, and then sat back in his seat.

"I'll prescribe some medicine for her. Celecoxib can relieve pain and prevent joint inflammation..." His current pharmacology and syndrome differentiation skills are at the fourth level, which is more than enough to deal with such a small situation.

When prescribing to patients, we can accurately use the most suitable drugs and dosages for the patients.

This ability seems simple, but many residents have to struggle until they are promoted to attending, or even longer.

Even senior resident physicians are very careful when prescribing medical orders to patients, and they have to look up information from time to time to consult superior physicians.The difficulty lies in prescribing.

Medication errors can directly lead to rapid deterioration of the patient's condition.

If the dosage of the drug is too large, there will be drug injury.Too small to reach therapeutic effect.Even the method of administration is particular.

For example, most novice doctors do not know about the most common infusion. Some patients need to keep the temperature of the infused liquid at about [-] degrees during infusion.

Zhou Can only mastered the in-depth experience of these infusions after three months of regular training in the Department of Critical Care Medicine.

Some patients are admitted to the intensive care unit because of major physical problems, poor blood supply, heart failure, and poor circulation in the body. The maintenance of body temperature requires a large amount of energy stored in the patient's body.

The cold liquid is injected into the blood vessel, and the number of drops is slow, but if the infusion is rapid, it is very easy to cause the patient to burp directly.

During the regular training of the intensive care medicine department, many superior doctors told Zhou Can about this.

Anesthesiologist Dr. Feng also mentioned it.

After the medicine was prescribed, the little girl with a sprained right foot was treated.

Doctors in outpatient clinics seldom reset patients by themselves.

Because this is already a special skill.

Mainly other doctors do not.

Usually, patients who need manual reduction must go to the manual reduction room of orthopedic surgery for treatment.

In the outpatient room of the Pediatric Department, Zhou Can directly resets the patient's manipulations, and he doesn't know if the rules will be broken.

But from the perspective of patients, they must especially like this one-stop solution for medical services.

Otherwise, after the examination in the pediatric department, the family members have to take the examination results to the orthopedic surgery department to register again.

The young mother took her daughter and left with gratitude.

She is very satisfied with the treatment effect.

Zhou Can has accumulated another 'iron fan'.

The accumulation of fame needs to be like this, gathering sand to form a tower, and accumulating water to form a river.

"Doctor Zhou cured the disease with his hands. It's amazing! Please help my nephew. He has been complaining about his legs, especially his knees, recently."

It appears that the temperamental 35-year-old woman is not the boy's mother.

There are many causes of leg pain, ranging from leukemia and malignant tumors to arthritis and rheumatism.

After Zhou Can learned about his condition and medical history in detail, he gave him a physical examination, and then prescribed three examination items, blood routine, B-ultrasound, and X-ray.Every inspection has his profound intention.

It can quickly find out the direction of the patient's disease.

……

The child with macrodactyly called Lele came back after the examination.

After Zhou Can saw the examination results, he was basically determined to be type Ⅱ neurofibromatous macrodactyly.The incidence of this neurofibromatosis is one in three thousand, which belongs to chromosomal dominant inheritance.

Most of these patients will die in the womb, or they will be found to have deformed fetuses in the womb, and they will eventually be removed by induced labor.

In the early years, the birth rate of disabled babies in China was very high.

Many children are born stupid, physically handicapped, congenital with major defects or diseases, and so on.It was not until recent years that my country's medical technology and level have made great progress, multiple screenings have been added to the pregnancy test, and the marriage of close relatives has been eliminated, which has greatly reduced the birth rate of disabled babies.

The vast majority of mothers who have been pregnant should know about Down's screening and four-dimensional color Doppler ultrasound.

Take the screening of Down's syndrome as an example. This disease is also called congenital stupidity or Down syndrome.

A disease caused by a chromosomal abnormality.This kind of fetus has one more chromosome 21 than normal people. 60% of the children were aborted early in the womb, and the survivors had obvious mental retardation, special faces, growth and development disorders, and multiple deformities.

Screening for this disease is most beneficial around 12 weeks in the first trimester.

After detection, the pregnancy can be terminated by abortion immediately, which greatly reduces the loss of parents and the harm to the family.Just imagine, if such a stupid fetus is born, the parents need to raise him/her for a lifetime.I believe it is a huge disaster for any family.

Many couples who were originally in a good relationship, after bearing such a heavy burden, the relationship broke down and the family disintegrated.

"I need to take his clothes off and check the kid's body."

Zhou Can said to the patient's grandmother.

There are several ways to diagnose neurofibromatosis.

At present, only X-ray examination and B-ultrasound have been done to the child.

X-rays can clearly see the patient's skeletal deformities, as well as long stripe-shaped images.These features are consistent with neurofibromas.

Also, he found a café au lait spot on the child's neck during the sugar examination.

I didn't think much of it at the time, I thought it was a birthmark.

Now after seeing the test results, he thinks that the plaque may not be a birthmark.

After the child's clothes were taken off, multiple café-au-lait plaques of different sizes were found on his body.

The largest diameter exceeds four centimeters.

Usually, as long as there are more than six café-au-lait plaques on the body, it can be used as the basis for the diagnosis of neurofibroma.However, this cannot become the gold standard, it is only a superficial basis for diagnosis.

Genetic testing finds NF1 or NF2 mutations, which can become the gold standard.

In addition, X-ray, ultrasound, CT, and MRI examinations can also provide diagnostic basis.

For example, the patient's X-ray showed bone deformities and streaked images, which is a basis for diagnosis.

Diagnosing the real cause of disease is originally such a one-by-one verification. Finally, a comprehensive diagnosis can be made based on the symptoms, examination data, patient medical history and other information before the diagnosis can be made.

(End of this chapter)