Auto chess in the operating room

Chapter 162

"Doctor Fang, we have all the basic information, why don't we go see the patient together."

Qingping suggested.

"Okay, then let's go to the patient again, maybe there are new discoveries."

Fang Qing nodded. After all, the information has limitations. Only by communicating with the patient in person can we understand the condition more comprehensively.

And sometimes, due to the patient's personality, illness and other reasons, the doctor only answers after asking a question, and many details are ignored, and these small details are often life-saving for experienced doctors. key.

The three attendants got up, Qingping took a few steps, hesitated: "Wait a minute."

Yan Ruoyun was a little puzzled: "What's wrong?"

Qingping rubbed his nose: "Let Tang Lou go with him, maybe he can help."

Yan Ruoyun thought for a while, then nodded her head in agreement, Tang Lou is indeed very smart in diagnosis, and in the current foggy situation, it is always good to have more hope.

When Qingping called Tang Lou over, Fang Qing was a little surprised. Of course he had seen Tang Lou, but he didn't have much contact with him, and he was not in the same department. young.

However, since he had a request for general surgery, Dr. Qing and Dr. Yan brought it up, so he couldn't lose face by bringing an assistant to record the medical records.

Soon a group of people rushed to the ward.

Seeing three attending doctors followed by a young doctor, the contrast was particularly strong, and the family members of the patients were a little surprised.

After all, it was the three senior experts in front who really solved the problem.

"Doctor Fang, my father still has a high fever and has persistent pain in his upper abdomen."

The patient's daughter just complained to Fang Qing, her tone was very anxious.

"The pain in the upper abdomen should be caused by the heart problems left after the old myocardial infarction bypass surgery, sinus tachycardia, and the left side of the heart circle. There will be persistent pain. This can only be relieved by prescribing medicine."

Fang Qing explained the cause of the pain in the lower and upper abdomen. As for the high fever, of course, there was still no suitable reason.

Qingping took out the patient's chest X-ray and looked at it, auscultated the patient's chest, and discussed with Fang Qing: "There is a reaction in the left pleura, you can see that it is a bit whitish here. The breath sounds in both lungs are rough, and there may be a lung infection." .”

"It's not that lung infection has not been considered, but the patient has no nausea, vomiting, diarrhea, and only some yellow phlegm. If it is pneumonia, it doesn't make sense."

After all, Fang Qing is a physician, very experienced, and immediately ruled out pneumonia infection.

When the three attendings were in dispute, Tang Lou directly used diagnostic techniques on the patient:
[Patient: Wu Qingxuan, male, 63 years old

Symptoms: Poor eating in the past 2 days, persistent pain in the upper abdomen (fat blockage), accompanied by swelling of the back, a small amount of yellow phlegm, less drinking water, and more urination.No fever, chills, nausea, or vomiting
Diagnosis: Type 2 diabetes mellitus, diabetic ketosis, coronary atherosclerotic heart disease, old myocardial infarction, coronary artery bypass surgery, sinus tachycardia, left-sided heart block, acute cholecystitis
Special reminder: Since the patient had previous myocardial infarction surgery, diabetes, and old myocardial infarction, it is easy to ignore the real cause of upper abdominal pain.The patient ate a lot of greasy food at night 3 days ago, which caused acute cholecystitis.

Due to many symptoms and poor physical fitness, the patient could not bear cholecystectomy, and it is recommended to perform percutaneous transhepatic gallbladder puncture and catheter drainage]

After knowing the reason, Tang Lou breathed a sigh of relief, and then he had a headache again, how to explain the cause to the three big brothers.

Tang Lou really wanted to learn from Conan, so he stunned Qingping directly.

However, his strong and slender body has no place to hide, and the second is that he did not imitate Qingping's speaking skills.

When Tang Lou was deep in thought, Qingping noticed Tang Lou's abnormality, and asked directly: "Tang Lou, what do you think about the cause of this patient?"

Yan Ruoyun also looked at Tang Lou, feeling slightly expectant in his heart, after all Tang Lou had surprised him several times.

Only Fang Qing frowned slightly, but his body moved aside, giving Tang Lou a chance to observe the patient closely.

Tang Lou shrugged helplessly when he heard Doctor Qing's words: "Many of the symptoms of this patient are in the field of endocrinology, and I don't know much about it."

Qingping and Yan Ruoyun were slightly disappointed, but it was expected, after all, even they couldn't tell, it's normal for Tang Lou not to know.

Fang Qing nodded slightly. Indeed, the symptoms of this patient belong to the field of internal medicine, and it is indeed difficult for others to find a surgeon.

Just as the three of them were about to continue their discussion, Tang Lou said something next: "So I might not think so comprehensively like Dr. Fang. After all, due to my limited vision, I just follow the routine acute abdomen. Symptoms to guess. Among the patient's symptoms, I only noticed that one is the patient's persistent upper abdominal pain, and the other is the patient's elevated body temperature."

"In terms of the upper abdomen, from the perspective of acute abdomen, it may be the liver or the gallbladder."

Fang Qing and the others were also taken aback by Tang Lou's way of thinking. Leaving aside so many more important symptoms, they treated them directly as acute abdomen.

But after another thought, after all, Tang Lou had only practiced in general surgery for a few months, and he was also exposed to acute abdomen, cholecystitis, and appendicitis.

After all, they have limited vision, so they can't look at problems as comprehensively and comprehensively as they do.

"Tang Lou, your opinion is quite interesting, but I still insist that the patient's persistent pain in the upper abdomen is caused by a heart problem. You see, the pain was slightly relieved after we applied Voltaren to the patient, and his blood ejection The score is only 33%, which all support my conclusion.”

Fang Qing still praised Tang Lou for his daring to speak out, but after all, Tang Lou was inexperienced and didn't know much about old myocardial infarction and heart disease.

Yan Ruoyun and Qingping also support Fang Qing from experience, but Tang Lou's conjecture is not completely impossible.

If it is cholecystitis, it is also possible to have persistent pain in the upper abdomen, high temperature, and loss of appetite.

If Tang Lou did not have a systematic diagnosis, he must have been persuaded by Fang Qing. After all, under the systemic disease of the patient, there are too many interference items, and the symptoms caused are very close. The conventional thinking must be the heart that is easier to see and identify. The problem is off track.

After thinking for a while, Tang Lou walked towards the patient again: "I want to ask, how has the patient eaten these days?"

The patient's daughter recalled: "In the past three days, I ate very little, just ate a little noodles, and drank very little water. Basically, I just kept my mouth moist."

Fang Qing nodded, he had confirmed the information several times.

"What about three days ago?"

Tang Lou kept asking questions, staring at the family members with very sharp eyes.

"I didn't pay attention to this." The patient's daughter looked at her father and lowered her head, "Dad, what did you eat three nights ago? Do you remember?"

The patient slowly turned his head to his daughter, then looked at the doctors Tang Lou and Fang Qing, and took a few seconds to say: "Fried radish pancakes. Braised pork intestines. Braised pork."

After speaking, the old man turned his head slowly, closed his eyes slightly, and fell into silence.

The expressions of Fang Qing and Qingping on the side changed.

The patient's daughter also remembered: "It seems that after eating that night, nausea and vomiting occurred. Then the next day began to feel uncomfortable in the upper abdomen. After coming to the hospital, due to the old myocardial infarction and bypass surgery, I was worried that it was a heart problem, so I went to the outpatient department of cardiology.”

"Why didn't you say before that you ate such a greasy thing at night."

Fang Qing also did not expect that there was such a detail.

The patient's daughter felt aggrieved: "Dr. Fang, you didn't ask. Is this important?"

"Of course it is important. Because it is too greasy, it will cause the liver to secrete bile and the gallbladder to store and discharge it. Liver and gallbladder problems may occur."

Qingping spoke aside, then went straight forward, lifted the patient's quilt, lifted the patient's top to his chest, put his hands on it, and his face changed slightly: "The patient's abdomen is hot."

Yan Ruoyun also did not expect that Tang Lou's analysis might point directly to the truth, and she was so excited that she said, "The truth will be revealed after an abdominal ultrasound and CT scan."

Fang Qing nodded and hurried to arrange the examination. The patient's family members were also anxious and somewhat expectant.

The next step is to wait for the results. Qingping, Yan Ruoyun and Tanglou all returned to the office.

An hour later, Fang Qing excitedly ran into the general surgery office with the test results: "Dr. Qing, Dr. Yan, it's confirmed, it's confirmed!"

(End of this chapter)