Auto chess in the operating room

Chapter 94 Department Consultation
Qingping continued to introduce the condition: "After discussions in the local hospital, the cause of the fever was not clear. A review of chest and abdominal CT showed no obvious fever lesions. As of yesterday, five days later, the patient's high fever persisted, and his family asked to be transferred to our hospital in the afternoon. .So I invite you all to come over and discuss the condition together."

After Qingping finished speaking, he threw bricks to attract jade:
"Let me tell you my opinion. According to the situation of abdominal cavity exploration, the situation of ileocecum, appendix and peritoneal exudate shown in the picture, I don't think the appendix is ​​the cause of the patient's high fever and abnormal blood routine. The patient has no history of chronic diseases, and the stool condition is normal , First rule out enteropathy, abdominal infection caused by perforation caused by intestinal tuberculosis. Looking at these films, the patient's ileocecal tumor may also be ruled out."

After analyzing his opinion, Qingping ruled out some possible reasons, but he couldn't confirm the diagnosis, so he sat down after speaking.

After hearing this, Cheng Jian nodded and looked at Song Yang, the other chief of the general surgery department.

Song Yang is 1.6 meters tall, with a pair of big earlobes and some Buddha statues.

Song Yang walked to the notebook and began to swipe the profile picture on the screen:
"Based on the current information, I can't diagnose what is causing the high fever during appendicitis surgery. There are many possible situations. I would like to put forward some of my humble opinions for your reference."

"I don't know if other parts of the digestive tract were carefully explored during the operation? Was there any pus left for culture? Have you checked for abnormal changes in the ileocecal intestine such as thickening, stiffness, etc., whether it was flushed during the operation? How to choose the antibiotics for the operation? , Is there a lung infection? Is there a possibility of fungal infection? How is the erythrocyte sedimentation rate? Is there any infection of the incision or abdominal wall? The shape of the appendix and the terminal bowel can’t be seen clearly in the intraoperative photos.”

Song Yang raised some of his doubts and provided some directions for follow-up inspections.

After listening to some questions and suggestions from Song Yang, Qingping, as the organizer, naturally responded immediately:
"I can answer some of Dr. Song's questions right away, but some of them really need reexamination. First of all, I will first discuss what I know, and I can rule out abnormalities in the ileocecal bowel. There is no problem with the flushing during the operation. As for the erythrocyte sedimentation rate, further inspection is needed. "

After Qingping answered, Song Yang revised it again, temporarily considering the direction of lung infection and fungal infection.

After Song Yang, it was the turn of Fang Qing, a senior attending physician in internal medicine. Fang Qing was in his forties, with a short hair and dark skin. He liked to carry a wolfberry cup with him.

After taking a sip of tea, Fang Qing steadily turned his notebook to the first page of the record, walked to the computer, and slid the profile picture to the page he needed.

"You see, the patient's blood picture is abnormally elevated and PCT is high. I suspect sepsis. During the operation, the appendix was slightly swollen and there was no purulent coating. So Dr. Qing and I agreed to rule out appendicitis. First of all, after Qing The doctor's discussion preliminarily rules out infection caused by surgical complications. Then I would like to suggest whether the patient has other systemic infections and whether the patient is immune deficient? Third, abdominal CT shows that the patient's ileocecal intestinal wall is thickened and the mesangial lymph nodes are thickened. Is the swelling possibly caused by inflammatory bowel disease, non-specific intestinal infection, or blood system diseases such as lymphoma?"

After Fang Qing finished his analysis, he walked back to his place and continued to make tea.

"The reversal provided by Dr. Fang is also very possible. I will arrange a physical examination later."

Qingping nodded in agreement.

After the others finished their presentations, Cheng Jian, as the director, naturally made his finale appearance.

After looking through the information Qingping gave him, and combining the analysis of the previous three people, Cheng Jian added:

"Dr. Qing, in addition to the screening items listed by Dr. Fang and Dr. Song, I personally recommend supplementing the gastroduodenum, 1cm ileum, and ascending colon examination. At the same time, the patient's abdomen is washed and a drainage tube is placed. As for, antibiotics are given during the process. Treatment: cefoperazone, sulbactam + metronidazole for two days, then Taineng, and add Levoxine after Taineng for two days.”

Cheng Jian said while Qingping recorded that although after the consultation, he could not be determined immediately, but there were several directions, and the next step was to investigate one by one.

After the bosses finished speaking, Qingping summarized a few more words and announced the end of the consultation. As for Ma En Tanglou and others, naturally they were not qualified to speak at the meeting.

After deciding on the next treatment and investigation policy, Song Yang and Fang Qing left first.

Cheng Jian called Qingping to the corridor and asked, "How is the recent appendicitis project going?"

Qingping reported truthfully, and especially put forward an amazing plan for the subsequent training of Tanglou.

"Are you sure? Tanglou can do the job?"

Although Cheng Jian admired Tang Lou, he didn't expect Qing Ping to approve of it so much that he would choose Tang Lou as the surgeon for the navel cavity technique.

"Tanglou's talent, potential, and learning ability are the best I have ever seen in my career. Appendicitis surgery is not a difficult surgery. As long as you train for a period of time, you can be competent. But..."

Qingping paused, a little hesitant.

"But what? Is the Qingping I know the one who farts quickly and is squirming?"

Cheng Jian arrived bluntly.

Qingping said with some depression: "This little guy is smart, but he is a little disobedient. The first time he performed appendicitis surgery, he happened to encounter a case of appendix perforation, which shocked me. Thinking of that kind of recklessness, I still feel a little scared."

Qingping looked at Cheng Jian with a wry smile.

After Cheng Jian listened, he recalled the first time he saw Tang Lou in the operating room of the county hospital. No one would have thought that he was an intern. It was the first time he had performed those surgeries.
Cheng Jian patted Qingping on the shoulder: "This boy is indeed a bit arrogant, and his arrogant look makes people hate him. But that's why I fell in love with him in the first place. Not everyone can be so bold in the operating room. Stay calm and adapt to circumstances.”

"So, please pay more attention."

Cheng Jian looked at Qingping, Qingping nodded and smiled: "Isn't this already punishing him for performing ten appendicitis operations?"

"But don't overdo it."

Cheng Jian gave another instruction.

Qingping remembered the gossip about the department, and asked curiously: "Understood, teacher, so you start to feel sorry for your son-in-law?"

"roll!"

Cheng Jian cursed, and after Qingping walked away, he touched his chin: "Would you like to go back and ask the girl, if it's true... Tang Lou is not bad..."

After Qingping returned to the office, he called Ma En over.

"Ma En, after today's patient, you will be mainly in charge of various inspections, and report to me as soon as each inspection comes out, and check the vital signs every three hours until the illness is found."

Ma En nodded quickly. Anyway, Qingping was in charge, and he just followed up with some routine examinations, and followed up the patient's condition, so naturally there was no pressure.

There are too many patients like this whose cause cannot be detected. After all, the human body is too complicated, and the pathogenic factors are also strange. Two people with the same symptoms may have different causes.

"Doctor Qing, can I take charge with Dr. Ma, maybe I can help."

Tang Lou said on the side, although through various examinations, the photos and materials could not draw any conclusions at his level, but if he was allowed to see the patient with his own eyes, he might be able to diagnose it, so Tang Lou didn't care about being "greedy".

Hearing Tanglou's words, Wang Daquan and Tian Linsheng on the side were naturally a little dissatisfied. Why does this Tanglou have to participate in everything?
Qingping was also a little angry, thinking about Cheng Jian's entrustment, and said earnestly: "Tang Lou, are you still busy with things now? You still have three patients with dressing changes on hand, and ten appendicitis operations in the future. You Where do you get the time and energy? Don’t think that you are just a little clever, so you want to try everything. Calm down and study appendicitis surgery seriously.”

"Oh." Tang Lou had no choice but to agree. After all, he has diagnostic skills that can't be explained. He can only find a chance to see the patient. Of course, it is also possible to find out the cause immediately after consultation with the department.

"Wang Daquan, your burn patients are still being screened. If there is no rush, you and Ma En will be mainly responsible for this patient."

"Tian Linsheng, apart from the daily ward rounds, you will seriously cooperate with Tang Lou's appendicitis operation."

"it is good!"

"Ah."

Wang Daquan glanced at Tang Lou proudly, it is impossible that all good things are yours.

Tian Linsheng obediently agreed, asking what to do.

(End of this chapter)