Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

But as long as it is intestinal perforation, if it is discovered early, it is better to have surgery in time.

If it is discovered late, there are many kinds of bacteria in the intestinal tract, and once it flows into the abdominal cavity, it will cause serious infection.

Thus causing the patient's septic shock, persistent high fever, increased lactic acid and other symptoms.

Seeing that Lin Yi finished examining the patient, he was silent in thought.

Yin Liang looked at him and couldn't help asking:
"Brother Yi, what's the condition of this patient? What do you think?"

Lin Yi looked at him and said:
"The source of infection in this patient is in the abdominal cavity. I think he has a perforated colon."

"what?"

And Yin Liang was stunned immediately after listening.

As for Lin Yi's claim that the patient had a perforated colon, which was the root cause of the abdominal infection, Yin Liang had some doubts.

It's not like he didn't examine the patient.

This patient has also undergone abdominal color Doppler ultrasound and abdominal CT, and did not see any major problems.

How could Lin Yi judge that this patient had a perforated colon?
Yin Liang stared at Lin Yi, and then asked:
"Brother Yi, the abdominal color Doppler ultrasound I did for this patient only showed that he had cholecystitis, and cholecystitis would not cause such serious symptoms, and there was not much hint on the CT. Are you sure he has a perforated colon?"

Lin Yi said affirmatively:
"I consider this patient to be perforation of the colon, and the greatest possibility is perforation of the sigmoid colon, because perforation in this part is relatively common."

Yin Liang shook his head after hearing this and said, "Brother Yi, isn't your diagnosis a little too arbitrary?"

Lin Yi smiled and said:
"This patient, when you do abdominal CT and abdominal color Doppler ultrasound, can you see fluid in the abdominal cavity?"

Yin Liang nodded immediately.

"Yes, but the peritoneal effusion found is very little, it should be caused by inflammatory exudation, and this does not explain anything!"

Yin Liang firmly believed in his own ideas, and still did not consider the possibility of colon perforation.

And Lin Yi pointed to the patient's stomach and said: "If you don't believe me, you can puncture the peritoneal fluid, and you will understand after a test!"

Seeing how confident Lin Yi said, Yin Liang's heart began to waver.

After all, the patient's condition is more serious now, and the cause has not been found, which makes him very anxious.

If the cause cannot be found out, the patient's condition cannot be cured, and the patient's life may not be saved.

Now that Lin Yi has given him a direction, he should investigate further.

Furthermore, after he saw this patient, he also considered whether it was abdominal infection.

However, since the results of the inspection did not match, he did not consider the issue further.

But now that Lin Yi firmly proposed it again, Yin Liang had to think carefully again.

Yin Liang thought for a while, then said: "Okay, Brother Yi, just as you said, I will puncture the peritoneal fluid to see what it is."

"If it really is a perforated colon as you said, I'm afraid this patient will have to undergo an exploratory laparotomy immediately."

Since it is considered that the patient has a perforated hollow organ, an exploratory laparotomy should be performed immediately.

Only by thoroughly finding out the cause and cleaning up the source of infection can the patient survive.

Otherwise, if the patient's disease is not eliminated, no matter how good the medicine is, it will not be able to save the patient's life.

Since the paracentesis was going to be performed, Yin Liang immediately went to the treatment room and brought the medical instruments used for the paracentesis.

He wants to perform abdominal puncture on this patient himself.

In general, paracentesis is a simple technique.

Even an intern can learn this operation with a little effort.

Simple operations like this are usually performed by interns or fellow doctors.

And now, as the attending physician, Yin Liang actually does this operation himself.

It can be seen how much he attaches importance to this patient.

I saw Yin Liang go into battle in person, demonstrating the paracentesis operation.

Several interns from the nearby emergency department immediately gathered around to study.

Seeing many interns gathered around to learn how to operate, this inspired Yin Liang's idea of ​​showing off.

He first arranged the prepared medical equipment, and then put on sterile gloves.

Using iodophor gauze, begin to disinfect the patient's abdominal puncture site.

While disinfecting, he explained seriously.

"Look, what we are doing today is the paracentesis, the first step is disinfection, you must master the disinfection steps."

"Because the puncture site is a clean part, when we sterilize, we must sterilize it from the inside out. It is best to sterilize it three or four times to prevent the abdominal cavity from being incompletely sterilized during the puncture."

After Yin Liang explained to the interns, he also sterilized the virus.

Start by picking up the sterile hole drapes and drapes.

Yin Liang continued to explain.

"Look, the paracentesis we are going to do is first of all to locate. Does anyone of you know how to locate the paracentesis?"

After Yin Liang laid out the hole towel, he looked at the interns around him and asked a question.

An intern stood up and replied: "The most commonly used site for paracentesis in clinical practice is the patient's lower left abdomen."

"That is, the middle and outer third of the line connecting the navel and the left anterior superior iliac spine. Puncture at this point has fewer viscera in the abdominal cavity, and the damage will be minimized. It is clinically divided into diagnostic puncture and treatment. Sexual piercing."

After the intern answered, he didn't look at Yin Liang, but at Lin Yi.

Seeing Lin Yi nodding slightly to her, she smiled happily.

Yin Liang picked up the syringe and began to concentrate on giving the patient local anesthesia.

He first gave an anesthetized Pichu on the patient's left anti-Mabsonian point.

In fact, it is no longer necessary for a patient in such a deep coma to receive anesthesia or not.

However, Yin Liang was going to do a teaching demonstration, so he received local infiltration anesthesia as usual.

Yin Liang fixed the skin of the puncture site with his left hand, and held the puncture needle in his right hand, and pierced the abdominal wall vertically through the anesthesia site.

When the sense of needle resistance suddenly disappears, it indicates that the needle tip has passed through the peritoneal wall.

Yin Liang continued to insert the needle, pulled back with negative pressure, and soon pumped out about 5 milliliters of light yellow turbid peritoneal fluid.

Then pull out the syringe, and stick a sterile patch on the puncture site.

Yin Liang raised the light yellow turbid peritoneal fluid to his eyes, frowned, and meditated.

The peritoneal fluid in this syringe is light yellow and slightly turbid. According to the color, it looks like a kind of thing, that is, feces.

Seeing the color of the peritoneal effusion, Yin Liang had a bad feeling in his heart.

But at the same time, Yin Liang began to recognize Lin Yi's judgment in his heart.

I think this patient is likely to have an abdominal infection caused by intestinal perforation.

Because the stuff drawn out of the abdominal cavity looks like feces.

Under normal circumstances, there will be no fluid in the abdominal cavity, let alone light yellow turbid things.

But now, this light yellow turbid liquid has been pumped out of the abdominal cavity. What does this mean?