Auto chess in the operating room

Chapter 72 Rare Spontaneous Bladder Rupture

Song Luo, the attending physician in the emergency department, is 37 years old. He has a horse face, a thin body, slender lips, and some wrinkles on his forehead. He has a melancholic temperament.

The patient's initial condition has been discussed with his family, and now he is initially suspected of having an acute abdomen. With Song Luo's many years of clinical experience, he is naturally confident that he can control the condition. Acute abdomen is complex, but it is also the most common disease.

Song Luo did not have [-] cases, but also [-] cases.

When I saw Tanglou coming, I naturally wanted to take a test.

After all, being able to score 81 points in the first nine rounds of the emergency training camp is already comparable to the best score in history. Song Luo is naturally extremely curious.

Moreover, the clinical diagnosis of patients in the ward is part of the teaching of interns and residents.

The superior doctor will ask a question when he is happy, and he will ask a question when he is unhappy. It is normal for the junior doctor to make a fool of himself when he asks the question.

This time, asking Tang Lou to cooperate with the diagnosis was originally part of the assessment of the emergency training camp. Naturally, Tang Lou was required to participate in the whole process to assess the capabilities of this young man who overwhelmed Yang Ming.

"Tanglou, help me diagnose the patient's condition. The first step of communication with the family has been completed. The patient, male, 34 years old, suffered from sudden abdominal pain for 12-3 hours after excessive drinking for 4 hours, and was sent to the hospital by his family. The pain continued to worsen. .Now you assist me in the physical examination, do you know the process?"

Tang Lou nodded, and looked at the patient. With diagnostic skills in hand, he naturally wouldn't waste too much time on physical examination and the patient's opportunity for treatment.

[Patient: Liu Dishi, male, 34 years old

Symptoms: Lower abdominal pain 3-4 hours later, the pain continues to worsen and is not radioactive

Vital signs: T 37 ℃, P 6 times/min, R 110 times/min, BP 22/140 mmHg,

Acute disease appearance, no obvious abnormality on cardiopulmonary auscultation, abdominal distension, no intestinal type stomach pattern, and whole-abdominal tenderness

Diagnosis: The patient had a rare spontaneous rupture of the bladder.

Special reminder: The patient’s symptoms can easily be misdiagnosed as acute abdomen. If the operation is performed directly according to the acute abdomen, a large amount of urine will appear during the operation, which will delay the treatment.

The best treatment method is to perform peritoneal puncture and routine biochemical examination before operation, which is more conducive to early diagnosis and treatment. 】

After seeing the diagnosis, Tang Lou was also very surprised, why he always encountered such rare cases.

There are generally three types of bladder rupture:

1. Extraperitoneal rupture, often occurs in the anterior wall of the bladder, close to the bladder neck, and the urine extravasates into the peribladder tissue and the retropubic space, reaching the subcutaneous area of ​​the anterior abdominal wall; or along the pelvic fascia to the pelvic floor, or along the ureter Loose tissue spreads to the kidney area, and urine extravasation is susceptible to infection, causing serious complications such as cellulitis, suppuration, and tissue necrosis.

2. Intra-abdominal rupture often occurs at the weakest part of the top of the bladder. The rupture is connected to the abdominal cavity, and urine can flow into the abdominal cavity, causing peritonitis.

3. Rupture inside and outside the bladder, which is caused by multiple ruptures in the bladder wall, often caused by gunshot wounds.

However, this patient ruptured spontaneously without any trauma on his body. The rupture of the bladder caused the urine to fill the abdominal cavity, causing abdominal distension and persistent pain.

If you don't have systematic diagnostic techniques, you won't think about it, it's just too unbelievable.

Tang Lou's direct mention of the spontaneous rupture of the bladder is of course unconvincing, and it is also too miraculous.

However, if the routine procedure is followed and the investigation is carried out step by step, Tang Lou also understands that it is definitely impossible to infer the symptoms of bladder rupture.

"How to do?"

And this is the last round of assessment. The attending doctor asked himself if he was familiar with the process, obviously he had to follow the standard process and check the body step by step.

Seeing the painful expression of the patient lying on the bed, Tang Lou couldn't care less.

Go straight to palpation, skipping the useless parts.

Seeing Tang Lou's actions, Song Luo's expression changed slightly. This guy actually took action directly?Do you know the rules?
Song Luo stopped Tang Lou immediately after the physical examination of the abdomen, and his tone was a little angry.

"Tang Lou, are you sure?"

In the review room, the directors who watched Tang Lou's performance were also very puzzled.

"Xiao Tang, what's the situation, this step is wrong! No one can come up and palpate directly."

"For a normal abdominal physical examination, the entire abdominal area should be exposed first, from the upper part of the abdomen to the lower part of the pelvis, the front and side are the abdominal wall, and the back is the spine and psoas muscles."

Niu Bolin explained with some dissatisfaction, and he also said it to the players in the back row,

"The next step is to inspect the skin first, to observe whether there is rash on the skin, whether there is mottled, whether there is external abdominal hernia, whether there is incision scar, the shape of the abdomen, the shape of the stomach and intestines, peristaltic waves, and abdominal pulsation. After completing this step, Palpation can only be started after some causes have been ruled out!"

"Didn't Xiao Tang speak very clearly in the last level, the theory is so solid, and he made such a low-level mistake. If it continues like this, this round, I think he will fail!"

Calmly said angrily, naturally the greater the expectation, the greater the disappointment!
In the diagnosis room of the emergency department, Tang Lou was stopped by Song Luo and wanted to tell the reason directly, but it was too unbelievable after all.

After thinking about it, since I couldn't skip the steps, I could only follow the process, and sighed.

He completed inspection from the beginning and then started palpation, but he moved very quickly and did not waste time on unnecessary things.

".Patient Bloating"

After finishing, Tang Lou directly performed percussion, especially strengthened his tone, and guided the attending physician. If Song Luo still couldn't think of it like this, then Tang Lou directly said that it was necessary to perform puncture and aspiration before the operation:
".The patient has moving dullness in the abdomen, and it is suspected that the abdominal cavity is filled with hydrops."

Naturally, Song Luo couldn't comprehend Tang Lou's implication, and suspected acute abdomen preconceivedly, so naturally he didn't think of the rare automatic bladder rupture.

After all, acute abdomen is a clinical syndrome, not a single disease.

Internal medicine, gynecology, neurology and systemic diseases can all cause acute abdomen.

Diagnosis of acute abdomen is difficult in itself. Patients suffer from acute onset and pain, with varying degrees of pain and various pains.

Song Luo obviously only classified according to the routine, judging based on experience, so far Tang Lou's physical examination results have not been able to determine a specific category, so the most conservative way is to press the painful part to check.

For another reason, he also hoped to discuss with Tang Lou's symptoms to create a relaxed atmosphere, thereby infecting patients and their families.

Song Luo continued to ask the question very easily: "The patient's initial diagnosis is acute abdomen. Can you sort out the diseases corresponding to the abdominal pain in different parts of the acute abdomen?"

Song Luo raised this question quite well.

The directors in the review room are also very satisfied. After all, it is very classic to infer possible specific inflammations through the pain of the pressure site.

When Song Luo raised this question, he also intended to guide Tang Lou to discover specific symptoms.

Tang Lou's complexion was a bit ugly, he was naturally aware of Song Luo's intentions, and generally speaking, it was indeed the most reasonable, but in this special case of a patient, it was useless and would only waste time.

"Doctor Song, I think abdominal pain compression, that is, the disease map of the nine divisions of the abdomen, is not a panacea. Of course, a preliminary diagnosis can be made, but the anatomy of each patient is different, so it should not be too rigid. We still continue to auscultate."

Naturally, Tang Lou wanted to target the disease of hydroperitoneum, so as to guide the puncture and aspiration first.

"Xiao Tang, since you know the disease map of the nine divisions of the abdomen, you should understand that although patients have different anatomies and cannot be applied too rigidly, it is still very practical for beginners like you. So, I hope you still follow this Press to the side."

Song Luo's tone was a little serious. As a superior doctor, he naturally had his considerations. It's not good for an intern to be ambitious.

Where are so many rare cases?

90.00% of the cases in the operating room can be detected by the most conventional methods.

This is Song Luo's experience for so many years, the most classic is the most practical!
The disease map of the nine divisions of the abdomen is the experience summed up by countless ancestors, and it can basically deal with 90.00% of common acute abdomen.

Therefore, Song Luo believes that abdominal pain screening is the most effective preliminary diagnosis at present. The first city hospital is not a county hospital. The hierarchy is deep and strict, and the authority of the superior doctor is unquestionable.

So far, Tang Lou's performance has been substandard. He is very dissatisfied, too impatient, and too unruly!
(End of this chapter)