Since 1981 Health School

  Chapter 74 No fracture line on X-ray film

  In fact, it was beyond Chen Qi's expectation that things had developed to this point.

  He just reminded a patient and pointed out a hidden open fracture, which is actually a very simple matter. How did it cause a sensation in the entire department now? I'm afraid it will spread throughout the hospital, right?

   And he was a little wronged, thinking that a group of doctors big and small like you are all blind?

  With such an obvious history of head trauma, subcutaneous bruises, even panda eye features, and cerebrospinal fluid flowing out through the nasal cavity, why didn’t you know it was a skull base fracture?

  Okay, even if you didn't expect it at first, now that things have come to this point, he has reminded you, why haven't you reacted yet?

   This made Chen Qi a little puzzled. Facing Li Jun's fierce accusation, he was also a little uneasy. He even said that he would return to school, so he had to make it clear.

  Director Jin Laifa also frowned, dissatisfied with this new intern.

   "Student, since you are so sure, then tell me your reasons. We who are engaged in clinical work must seek truth from facts in everything, and don't make random comments without factual basis."

  This is such an obvious accusation.

  Zhu Huoyan still watched with cold eyes, ready to watch a good show.

  Lan Lijuan and the others looked at Chen Qi with concern that they couldn't hide.

  Chen Qi coughed lightly. Although he was dissatisfied in his heart, he said seriously on the surface:

   "Teachers, in fact, to judge whether there is a skull base fracture, the best basis is whether the patient's nasal cavity is nasal mucus or cerebrospinal fluid, right?"

  Zhu Huoyan nodded: "That's the truth, but how do you judge? The experiment of dropping a few drops of snot on gauze is not enough."

   Chen Qi continued to explain:

"As we all know, most of the nasal mucus is a kind of goblet cell in the nasal mucosa glands, which secretes a lot of mucin. When the mucin is released to the outside of the cell, it absorbs a large amount of water, thus forming a nasal mucus, so it is definitely sugar-free. .

The cerebrospinal fluid is mainly produced from the choroid plexus in the lateral ventricle, which needs to deliver nutrients to the brain and spinal cord, so the ingredients include sugar, adenosine deaminase, protein, etc. The normal value of glucose is 2.5-4.4mmol /L.

  Then we only need to do a very simple experiment, take a urine sugar test strip, and measure the glucose content. "

   Chen Qi's words were well-founded, and he blurted out all kinds of medical terminology, which immediately stunned many big shots in the ward.

  Everyone, look at me and I look at you. I think this seems to make sense. Could it be that this kid really discovered a hidden fracture?

  Of course Li Jun was not convinced, but he wanted an explanation, and of course he wanted to give others a chance to prove his innocence, so he huffed and remained silent.

  A little doctor hurriedly brought a urine sugar test strip, took the patient's "snot sample" himself, and then tested it with the test strip.

  Everyone's head stretched out.

   In less than 5 minutes, the result came out. This "snot" did contain glucose, and many doctors in the ward began to discuss it.

  Obviously, it is impossible to be positive for glucose in nasal mucus.

  Li Jun couldn't bear it anymore, and objected loudly: "This is too arbitrary, just rely on such a test strip? What if the patient's blood sugar is high?"

  Jin Laifa also moved his eyes:

   "It is indeed difficult to draw a conclusion through this urine sugar test. Even if this is not nasal mucus, what if it is an inflammatory secretion caused by otitis media? It may not be positive for glucose."

  Zhu Huoyan remained silent, feeling that both sides had a reason.

  Li Jun yelled again at this time: "This patient had a head X-ray when he was admitted to the hospital. I will go get it now and ask several directors to consult to see if there is any fracture. The image is the gold standard."

  Chen Qi hurriedly interjected: "There is only a 50% chance of a skull fracture in the X-ray film, and the shooting position is very important, so it is better to bring the CT film, which can be seen most clearly."

  The doctors now cough a few times.

   Jin Laifa said speechlessly: "CT machine? How can our hospital afford CT? Now in Haidong Province, only the First Affiliated Hospital of Hai Medical University has a CT, and it was just imported this year."

  Chen Qi slapped his forehead, and instantly figured out everything.

   No wonder the group of surgeons at Yuezhong People’s Hospital didn’t even know the most basic clinical manifestations of skull base fractures. It turned out that it was because of the lack of CT. Domestic surgery has not yet studied this far, and no relevant literature has come out.

   Without CT, there is no way to make a diagnosis, so there is no way to identify a large number of skull fractures clinically, let alone such occult fractures.

  No wonder everyone doesn’t know that panda eyes are a characteristic manifestation of anterior cranial fossa fractures.

  Li Jun came and went quickly, not necessarily coming in with an X-film in a short while: "Director Zhu, Director Jin, look, this is the X-ray film taken when the patient was admitted."

  A group of doctors immediately began to study the film with Zhu Huoyan as the center, facing the light from the window.

  The female patient and her husband also watched helplessly, not to mention how nervous they were.

  As for the patients outside the window, watching a group of white coats commenting on an X-ray film, their eyes are full of holy awe, look, what is an intellectual?

   Others watched it lively, but Chen Qi felt a little numb.

   Skull fractures, the most advanced X-rays in the previous life can only take more than 30%, let alone the oldest CR machine in 1981?

  After a consultation with several senior experts from different departments, after looking at it for a long time, but no fracture line could be seen, Zhu Huoyan handed the film to Chen Qi:

   "This is the X-ray of the patient admitted to the hospital, you can see for yourself."

  As soon as Chen Qi got the film, he knew it was going to be bad at a closer look. As expected, there was no trace of any fracture line on the X-ray film. No matter how many times he looked at it, it was a normal head image.

  Li Jun snorted coldly:

   "Student, what else do you have to say now? No matter how many small experiments you do, it will be a show of strength. What we pay attention to most in surgery is imaging diagnosis. You have also seen this film. What else do you have to say now?"

  He was really relieved, the game is over now, he is innocent, his level is reliable, and the diagnosis is correct, so all the pressure is on Chen Qi's side.

   Facing the distrustful eyes of doctors, patients, and onlookers, Chen Qi sighed and raised his hand:

"Director Zhu, Director Jin, Teacher Li, as I said just now, the probability of a normal X-ray film showing the fracture line of the skull is less than 30%, and there are certain posture requirements when taking the film, so I apply for another X-ray Light sheet, I operate it myself."

  (end of this chapter)