This doctor has a system

Chapter 214 212. My eyes are rulers

"Chief Mo, you are here." Dean Zhao of the Municipal Court nodded to him, "Do you understand Li Zhian from your department?"

"Li Zhi'an?" Mo Yunchang was taken aback for a moment, and it sounded familiar.

"Dean, are you talking about Lao Li?"

"Yes, he is an old man in our department, and he is very serious and responsible in his work." Mo Yunchang thought about it, "Did something happen?"

"Serious, responsible, or old?" Dean Zhao said, "Then why is the position still at the bottom?"

"Is he not educated?"

"The first degree is a junior college, a self-study adult bachelor's degree." Mo Yunchang replied honestly.

"The education is not low?" Dean Zhao was a little unhappy, "Then why haven't you been promoted?"

"What do you do as a section chief? Do you have so many outstanding talents in your department?"

Mo Yunchang is stupid, what does this have to do with me!

"Dean, I don't care if anyone in our political engineering department is promoted." He called out aggrieved, "And you know the situation of our department. There is only one advanced place in the unit every year. How can there be any promotion? Opportunity."

"I reported to Lao Li the year before last, and Vice President Pang approved it all, but in the end it was rejected."

"What?" Dean Zhao was furious, "Who said no, why?!"

Mo Yunchang looked at him and said nothing.

Dean Zhao was stunned for a moment, and then realized that there seemed to be only one person in the unit who could reject Vice Dean Pang's reply, and that was himself.

"You," he said anxiously, "it must be that your writing is not good enough. I have always been good at discovering and using talents!"

"That's right!" Chief Mo Ke nodded quickly, "My fault, I will correct it later."

"Don't do it later, change it now." Dean Zhao confessed, "You can deal with this matter when you go back. If we have a promotion quota this year, we will also report Li Zhian."

"Okay, Dean." Chief Mo was just about to go out, but was called back by Dean Zhao.

"Xiao Mo, how popular is this old Li? You won't encounter problems during the announcement, right?"

"No!" Mo Yunchang assured him, "Old Li has been working hard for more than 20 years, and no one can find any problems in promoting him."

Seeing Mo Yunchang go out, Dean Zhao felt a little uncomfortable. The employees have worked so hard for so many years without credit or hard work. Maybe no one told him face to face?
As for the fact that he vetoed Vice President Pang's signature, that's not his fault. At that time, Lao Pang was a little out of touch for some reason.

Anyway, he was right!
Mo Yunchang quickly returned to the department. He looked around but didn't find Father Li. "Where's Lao Li?"

"I'm sending documents to other departments." Lao Qiu in the department replied.

"Oh, come back and ask him to find me." Mo Yunchang turned and entered the office.

Dad Li is chatting with other people in other departments. He is very popular and has many friends in the unit.Low status is also good. When I go to work, I paddle and fly.

"Why did you come back? Chief Mo asked you twice." Lao Qiu said when he saw him enter the door.

What are you looking for?Father Li was a little puzzled. Their department was relatively free at ordinary times, and some work was given away by some energetic young people. The old guys were not good at computer games and had no ambition to go up, so they were happy to do so.

Mo Yunchang was also good to him. The other party had received his favor when he first came to the department. At that time, he was still Xiao Mo. When he sent documents to the leader, he made a mistake and was so scared that his face turned pale.

Father Li took the blame for him. For so many years, Mo Yunchang has always respected him, and he has reported to him several times as an advanced department. Although it is almost useless for promotion, there is a certificate that costs 500 yuan more.

"Section Chief, are you looking for me?"

"Yes, sit down quickly." Mo Yunchang said with a smile, "The dean just came to see me and said he would give you a promotion."

"It's been so many years, and you've finally come to your senses." He said with emotion, "It's just a little late."

? ? ?Dad Li

"The dean said he would give me a promotion?"

"That's right." Mo Yunchang felt a little strange seeing him confused, "Don't you know about this?"

"I seem to know what's going on." Father Li

"I didn't mention it." Gao Feng said, "I never read this Gu Xueshi again."

"That's probably the idea of ​​the people below." Father Li laughed, "Some people are good at doing this. This is called understanding the leadership's intentions in a timely manner."

He was a little emotional. When he was young, he was very aggressive, but he hit a wall everywhere, and the fire in his heart was extinguished after a long time.But lying down also has its benefits. Over the years, he has paid more attention to his family, and Li Xinyao's ability to get a doctorate has a lot to do with his careful training.

"Anyway, it's nothing special. No one will disagree with me when I move up half a level." Dad Li is very confident. After all, he has worked hard for more than 20 years. If anyone disagrees, it will be a shame.
10 a.m., doctor's office

"Let's take a look at my patient together." Qin Hao yelled, "Now I don't know what to do next."

Patient Jin Yiwei, male, 47 years old

The patient had a right lung nodule found in the physical examination six months ago, with a size of about 11mm×10mm, and no special treatment was done. 3 days ago, the patient developed hemoptysis without any obvious inducement, about 2-3 mouthfuls a day, with bright red blood streaks, and the amount was small, so he came to the Provincial People's Hospital for treatment.

Since the onset of the disease, the patient's mind is clear, psychiatric department, appetite and sleep are not affected, there is no abnormality in urine and stool, and there is no obvious change in physical strength and weight.

After Jin Yiwei was admitted to the hospital, Qin Hao checked his blood, which indicated that the inflammatory index was high, and he was given the antibiotic cefuroxime injection to control the infection, and at the same time, he was given Yunnan Baiyao capsules orally to stop the bleeding.

It is currently the fifth day of admission, the symptoms of hemoptysis have been completely relieved, and the patient is emotionally stable.

"Now the nature of this nodule cannot be clarified." Qin Hao was a little worried, "I did a bronchoscopy, but I didn't see anything under the microscope. I tried EBUS, but the position of the puncture was just blocked by blood vessels, so I couldn't get the tissue."

"Isn't it enough to do a percutaneous lung puncture?" Dong Qianqian said after looking at the film.

"It's too easy for you to say." Director Li shook his head, "The lesion is too close to the inside, the depth of the needle should be at least 7 cm."

"And the angle of the puncture is not easy to find. This layer is the best, but it happens to be blocked by the ribs." He pointed to the chest CT on the computer and said, "There is another layer that can be pierced further down, but it needs to be passed through." 3 blood vessels, the risk is too great."

Director Li is about to retire, and he has no experience. What he said is exactly the difficulty Qin Hao is currently encountering.

"you do not say!"

"Director Yu Yu in the CT room refused to wear it, saying it was too risky, so he sent him to another place." Qin Hao complained, "The patient's family members went to the capital to ask, and they told him the same, and now they don't know what to do. It's gone." Gao Feng sat down and watched the film carefully, "It feels like a vicious thing."

"Subpleural nodules in the dorsal segment of the lower lobe of the right lung, with thin and short spurs and pleural depressions around, and heterogeneous enhancement can be seen after enhancement. Peripheral lung cancer is more likely to be considered, and adenocarcinoma is the most likely."

"That's right, that's what Director Li of the Imaging Department said too." Qin Hao now admires Gao Feng very much, and the other party's ability to read films has surpassed his by several grades.

Although everyone thinks it is a malignant nodule, without the support of pathological results, follow-up treatment cannot be carried out, and imaging cannot become the gold standard for the diagnosis of lung cancer.

"Then can it be treated directly as lung cancer?" Jin Yiwei's wife asked.

Qin Hao resolutely rejected her. Who would dare to use anti-tumor drugs without a pathological basis? If the patient is finally confirmed to be not lung cancer, his career will be gone.

Unless there are very few cases, such as the patient is his own father, even godfather is not acceptable.

"Communicate with Director Yu Yu again." Director Li suggested, "The premise is that the patient can accept the risk. He does this everywhere in this situation. Director Yu's level can be achieved even in Beijing, Shanghai and Guangzhou."

"No!" Yu Yu flatly rejected Qin Hao, "The risk is too great, his blood vessels are so close together, when I manipulate it, it's the same as dancing on the tip of a knife."

"It is inevitable to form a pneumothorax after puncture, which is okay. But if a blood vessel is pierced, it will be troublesome if there is heavy bleeding!"

"The patient is so young, will the family members accept it if something happens?" Director Yu Yu asked, "I advise you not to be too fussy, let him go to another hospital and forget it."

Qin Hao thought for a while, and felt that what he said was right. After working for several years, he encountered a lot of things, including doctor-patient disputes, and every time he was exhausted.

Gao Feng didn't make a sound. After all, he was not a patient in their group. He was about to go to the bronchoscopy room when the system suddenly jumped out.

"Put the nail on the head: Boy, it's your turn to perform! Please use your superb lung puncture technique to show off the audience! You can get 30 skill points for completing the task, and 10 skill points will be deducted if you fail."

Crooked day, isn't this forcing me to add points!

Unlike county-level hospitals, lung puncture has always been done by the imaging department in large tertiary hospitals with a relatively fine division of labor, and few of their respiratory doctors have learned this.

"That Qin Hao, why don't I try?" Gao Feng asked.

"Are you sure?" Qin Hao was a little surprised. He now trusts Gao Feng's ability, and the results he has achieved since he came to the department have dazzled him.

Not now, but after I finish adding points and practice a few hundred times, I will be sure!

"I still have some experience in lung puncture." He said modestly.

His current percutaneous lung puncture skills are only at the entry level, and he only needs to spend 10 skill points for the basic level. But if he wants to upgrade to the advanced level, he must now be proficient in the system space and spend some skill points at the same time.

He can also see the meaning of the system, which is to force him to add some upgrades!
So rough!Gao Feng likes it a little bit.

"Director Yu, what do they mean?" A passer-by in the CT room of the Imaging Department was a little unhappy, "You told them that the risk is high, so you still have to do it."

"Isn't this showing off? Does anyone else have a higher level than you?"

"I do not believe!"

I don't believe it either, Director Yu Yu thought to himself, how long has he been immersed in this industry, and his level in the Provincial People's Hospital is "that Mubowan", no one will accept it.

"Don't say such things, it's not conducive to unity." Director Yu said.

As soon as Jin Yiwei lay on the CT machine, his expression changed.

"Are you swollen?" Gao Feng was a little surprised, it's not a problem yet.

"I have a urgency to urinate, so I have to go to the toilet." Jin Yiwei stood up.

"Last time!" Qin Hao glared at him. This man went to the bathroom twice on the way here, and there was a lot of feces and urine.

"Do you need a positioning aid?" Director Yu Yu walked in, "I made it myself, and it's very good to use."

"No need." Gao Feng said with a smile, not because he was confident, but because Jin Yiwei felt like he was in the system space last night.

? ? ?Jin Yiwei
"Just settle down."

You kid is very confident!Yu Yu was a little uncertain. When he performed this difficult piercing, he was not to say frightened, but cautious. Why did the other party look so calm?

"It's too pretentious!" Passerby A in the CT room was very upset.

Yu Yu felt that what he said was right, but he still asked the nurse to push the ambulance over, and the flat car was also ready. If there was bleeding, everyone still had to go together.

The main steps of CT-guided percutaneous lung puncture include confirming the location, anesthesia, and puncture.

Confirm the location: The location of the lung lesion is confirmed by chest CT before operation, and the puncture point that avoids the bone and is the closest to the location of the lung lesion is usually selected;
Anesthesia: Prone position or supine position is generally adopted, and lidocaine is used as local infiltration anesthesia clinically;
Puncture: The puncture is performed under the guidance of spiral CT. When passing through the pleura, the patient should hold his breath, and then resume calm breathing.When the puncture needle reaches the lesion, a puncture biopsy is performed, and enough tissue is punctured with a puncture gun as needed, generally 1-3 needles, and the inspection is completed after the needle is pulled out.

Common side effects are generally pneumothorax, hemopneumothorax or hydropneumothorax, and severe bleeding may occur.

Jin Yiwei has a high probability of hemorrhage. When the puncture needle reaches the lesion site, it needs to avoid three blood vessels that are very close together. In addition, the lesion is very deep, so the angle of needle insertion should not deviate too much.

"From now on, you can't move anymore. You can speak softly under any circumstances, but remember not to move!" Qin Hao emphasized to Jin Yiwei.

"Can I go to the bathroom one more time now?"

"No, it's really not possible, put it in your diaper pocket."

Jin Yiwei

After the CT scan, Gao Feng made a mark on the patient. In Director Yu Yu's eyes, his technique was a bit rough.

"Okay, let's start." Gao Feng signaled Dong Qianqian to start disinfecting and laying towels.

"I don't mean anything else." Director Yu Yu couldn't help it, "Should we measure the depth and angle of the puncture needle?"

"No need." Gao Feng said, "My eyes are the ruler."

He couldn't help but pretend.

My God, your eyes are like rulers!Director Yu just wants to slap him in the face with a liquid at 37 degrees Celsius.

(End of this chapter)