This doctor has a system

Chapter 172. Chapter 170.

"Where's Gao Feng?" Director Zhao came to the department early in the morning. She was in a good mood during this time, and picked up a corresponding author of Nature in a daze.

Even Director Shen almost got pink eye.

"There is a patient in Deng County whose situation is quite complicated. The Health and Medical Commission over there led a multi-institution consultation. Our respiratory department asked me to go. You can come with me." Director Zhao has long stopped treating Gao Feng as a newcomer Yes, she was greatly shocked by the other party's performance in the multidisciplinary consultations these few times.

"Why don't you just transfer the patient over?" Gao Feng asked curiously, "Multi-institution consultation? I haven't heard of this yet."

"I've never participated in this kind of thing." Director Zhao smiled, "Whatever, people have already sent a letter, we just follow the arrangement."

This time it was a business trip, the hospital sent a car, accompanied by a director of the Gastroenterology Department, surnamed Ji, and Director Li of the Imaging Department, who also said hello to Gao Feng.

"What's the matter?" Director Li started chattering as soon as he got in the car, "I'm a radiologist, why don't you join in the fun, can't you just watch movies remotely?"

"I don't know, I don't know the patient's condition yet." Director Zhao said.

"It seems to be a patient with intestinal obstruction." Director Ji of the Gastroenterology Department said, "It's quite complicated, and I didn't go into details."

"People have also gone to the First Affiliated Hospital." Director Li of the Imaging Department said suddenly.

"What?" Director Ji frowned, "What are you doing? Then let us do it? What if everyone disagrees?"

"Never mind him, what to say when the time comes." Director Zhao felt it didn't matter.

"Deng County is our territory, and he is a cooperative hospital with us." The more Director Ji thought about it, the more he felt wrong, "No, I have to shake someone else."

The driver had no choice but to turn around and go back.

"Old Ji, isn't it necessary?" Director Ding of the Gastroenterology Department looked helpless, "I have something to do in the afternoon, so it's different if you go by yourself."

"You have much more experience than I do." Director Ji couldn't help but pull him into the car, "This time the situation is different, the First Affiliated Court got involved for some reason, and if you say no, it's declaring war on us!"

Director Ding is very helpless, this old Ji is like this all day long, what others do is to declare war on him, a typical persecution delusional personality, he deserves to be called a fighting chicken (Ji).

I have to say that the standard of this consultation was quite high. The director of the local health and health committee personally greeted me. The welcome scene in the hospital was quite big. The leader’s speech and photo taking were delayed for almost 2 hours until 11 o’clock. We just saw the doctor in charge of the patient.

It was a middle-aged female doctor who was a bit nervous, "Hello, experts and teachers, I am Zhou Mengli, the doctor in charge of the patient, and I will introduce the patient's situation to you first." She opened the PPT that had already been prepared.

"That's Hu Liang from the Respiratory Department of the First Affiliated Hospital." Director Zhao whispered to Gao Feng, "He was quite handsome when he was young."

"Why are you bald now?" She was a little taken aback, "I saw him 2 years ago, it wasn't like that then."

"Maybe it's because you're working too hard." Gao Feng

"The patient is a 61-year-old male. He was admitted to the Department of Gastroenterology of our hospital because of upper abdominal pain and discomfort. No obvious abnormal signs were found during the physical examination on admission."

"Gastroscopy was performed after admission, and no obvious abnormalities were found. Abdominal plain films showed no obvious abnormalities. Symptomatic and supportive treatment and gastrointestinal motility drugs were given: domperidone tablets and mosapride tablets were taken orally, but the patient felt abdominal distention gradually increased."

".A week later, re-examination of the abdominal upright plain film showed that there was air-liquid level. Auscultation bowel sounds were normal, and there was no sound of air and water. It was considered paralytic ileus, and the blood potassium was normal. The patient was instructed to fast and given intravenous nutrition. Gastrointestinal decompression was performed with a lower gastric tube. After one week, the symptoms were still not relieved. Another upright plain film of the abdomen was performed, and the gas-liquid level increased compared with the previous one, and hiccup symptoms appeared.”

"Fever occurred 6 days ago, and the body temperature was 38.4°C, accompanied by runny nose and sore throat. At that time, I thought it was a cold. I gave compound acetaminophen capsules orally, but the effect was poor. Cough and yellow sputum gradually appeared. I did it 2 days ago. A chest CT scan showed left pneumonia and partial consolidation."

"This is the result of the patient's test, the first day."

I have to say that this PPT is really good. The patient's data is relatively detailed. Only from the introduction of the doctor in charge, I can have a relatively comprehensive understanding of the patient.

"Let's take a look at the patient."

A group of people went to the ward in a mighty way. The patient's mental state was not very good. Anyone who didn't eat for half a month would be listless.What's more, he was still suffering from pneumonia in the hospital, and he had a severe cough in the past two days.

"Am I dying?" The patient suddenly cried, "If you can't, take me home, I don't want to die here."

The family members quickly wiped his tears with a piece of paper, "What are you talking about, this is an expert hired for you, and he came all the way from the province."

"Yes, Old Su, you control your emotions, and the experts are watching you." The doctor in charge said.

"Woooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooom to do this!"

The patient's wife was very helpless, so she had to whisper in his ear, "It's not that my son is about to be transferred back to be the deputy county magistrate. I didn't tell you, for fear that you would show off everywhere. You have always been like this. "

……

"Strange intestinal obstruction: Su Weiguo has always been in good health. He never thought that he would have such a embarrassing moment. One can imagine the depression and worry in his heart. Please help him find out the cause. After completing the task, he can get 20 skill points point."

"Amazing four: You are no longer that fledgling little doctor. With the medical assistance system, you are destined to become a legend in everyone's mouth in the future! Now, please use your comprehensive and professional knowledge to shock these little guys! Done You can get 20 skill points for this task."

Little one?
System, you are so arrogant, I like it so much!Gao Feng thought to himself.

Gao Feng was the last patient to see. Everyone thought he was a student led by Director Zhao. He conducted a careful physical examination of the patient. This is a good habit developed under the systematic training.

"Which one of you will express your opinion first?" The director of the medical department of Dengxian County Hospital saw that everyone had returned one after another, and picked up the microphone and said.

"Let me throw bricks to attract jade first." Director Ji, who had delusions of persecution, spoke first.

"Ileus can be divided into three categories according to etiology: mechanical ileus, acute ischemic ileus, and dynamic ileus."

"First of all, according to the medical history, physical examination, and various inspection data, mechanical intestinal obstruction can be ruled out."

"Acute ischemic intestinal obstruction is not considered. When suffering from this disease, there will be severe abdominal pain. In the early stage, there may be symptoms such as hyperactive bowel sounds, intestinal ischemic spasm, and accelerated intestinal peristalsis. In the later stage, intestinal necrosis may cause There was coffee-colored gastric juice and stool discharge, and bowel sounds disappeared due to intestinal necrosis."

"I think it can be considered in terms of non-operative paralytic ileus caused by heavy metal poisoning, various systemic or intra-abdominal inflammations, and hypothyroidism."

Just as Director Ji finished speaking, someone said, "What you said is too absolute. Acute ischemic intestinal obstruction also has mild abdominal pain. I encountered a few cases in 04, and the abdominal pain was very mild."

The person who spoke was a director named Xue from the First Affiliated Hospital, who was also in the Department of Gastroenterology.

Director Ji was furious, how dare you step on me!He was just about to turn into a fighting chicken and have a fight with the other party, when Director Ding spoke.

"It is indeed possible, but generally speaking, acute ischemic intestinal obstruction will have symptoms of infection and poisoning such as elevated blood counts. On examination, there will be symptoms of peritoneal irritation such as tenderness and rebound tenderness, which are much more serious than this patient, and The condition changes very quickly, and intestinal necrosis will occur quickly without proper treatment, and this possibility can be ruled out for this patient."

Director Xue of the First Affiliated Hospital nodded in agreement, and said again: "I think pseudo-obstruction should be considered."

Intestinal pseudo-obstruction, organic lesions in the intestinal lumen that do not cause obstruction, is caused by intestinal muscle motility disorders caused by lesions such as intestinal smooth muscle or myenteric nerves.

"I met a patient with intestinal smooth bowel disease before, and the symptoms of this patient are very similar. I think we can focus on this aspect."

"It's best to rule out small bowel rest disease and lipid sensation." Director Ding added.

The doctor in charge quickly wrote it down.

"The teacher of the respiratory department should also say a few words." The host said.

"Let me go first." Director Hu Liang of the First Affiliated Hospital said, touching his shiny forehead, "This patient is hospital-acquired pneumonia. His diagnosis is very clear, and the inflammation site is also very intuitive on the chest CT. , I think the current antibiotic is levofloxacin injection.”

"This drug is widely used in gastroenterology and respiratory departments, and it is a broad-spectrum antibiotic."

"However, it may not be suitable for this patient. First, the patient's electrocardiogram showed QT prolongation, which is a relative contraindication for quinolones."

"In summary, I suggest that the antibiotic be adjusted to piperacillin-tazobactam 4.5g every eight hours."

"What should I do?" Director Zhao was a little annoyed, "This bald guy told me everything I thought of."

high wind.

"I agree with Director Hu's opinion." Director Zhao said, "The patient had hypoglycemia once in the previous 2 nights, which may also be related to the adverse reaction of levofloxacin. His current nutritional status is not good, so he is not suitable for this drug. "

Director Li of the imaging department also said a few words, to the effect that according to the abdominal CT, the patient does indeed have obstruction, but it is a bit different from the typical intestinal obstruction...

A director of the Gastrointestinal Surgery Department of the First Affiliated Hospital was more radical, "Exploratory laparotomy! It must be exploratory laparotomy! All patients are like this, why don't you open your stomach to see?!"

Many people thought he was right.

Gao Feng had been holding back for a long time. He always wanted to speak, but today there were too many people, and everyone kept talking non-stop, which made him anxious.

If someone gave the correct diagnosis, his 40 skill points would be lost!

"And it will be noon soon! Everyone must be hungry in a while, and this will definitely affect the effect of my skills." Thinking that Gao Feng could no longer sit still, he directly raised his hand.

"Hey, this guy... the young expert seems to have something to say." The host was very curious.

　Today is still 7000 words short.

　　
　
(End of this chapter)