Gou is practicing medicine in the clinic

Chapter 148 Jaw abscess, a man's difficulty

"Do you have night sweats, diarrhea, or nausea?"

Li Jingsheng asked calmly.

"My appetite has not been very good. It is true that I have a little diarrhea recently. Is there any problem with this?"

she asked nonchalantly.

"Wait a minute." After Li Jingsheng finished speaking to the patient, he turned to look at the counter. "Sister Tang, please come over and check the lymph nodes of this female patient."

"Ok!"

She said something to the customer who was buying medicine, and then walked over quickly.

Maybe he was in a hurry to go back to the counter to sell medicine. After gesturing to the young female patient, he reached out to touch her neck.

"Hey, wait! Put on the gloves, it's more hygienic!"

Li Jingsheng quickly stopped and handed her the transparent film gloves.

Patients usually wear rubber gloves during surgery, which are also very thin, but they still affect the touch of the hands.

Membrane gloves are thinner, have little effect on finger feel, and are very inexpensive.

The only downside is that it is fragile.

However, the medical examination used to make the body surface is completely competent.

Tang Ping nodded knowingly, put on gloves to check the lymph nodes in the patient's neck.In fact, most warm-blooded animals with fur have the most abundant cervical lymph nodes.

For example, chickens and pigs that are often eaten are like this.

If conditions permit, try to eat less chicken neck skin and pig neck meat, also known as trough meat.

If you really want to eat, you can remove the lymph before cooking.

Because lymph is an important part of the immune system, it is the most brave warrior and the main battlefield against the invasion of various viruses, germs, and toxins.Accumulated for a long time, the lymph will become the accumulation station of toxins and harmful substances.

After eating, it is definitely harmful to human health.

When Tang Ping checked the lymph nodes in the patient's neck, the patient cried out in pain.

"There is bilateral cervical lymphadenopathy."

Tang Ping looked at Li Jingsheng.

"Check her axillary lymph nodes again."

Li Jingsheng's expression became much more serious.

When Tang Ping checked the patient's armpit, she laughed again and again, "Giggle, itchy, I'm afraid of itchiness..."

"Be patient a little bit, the inspection will be over soon."

After the inspection, Tang Ping's expression became more serious.

"Boss, I checked her just now, and the lymph nodes in the neck and armpit are both swollen."

"Go get busy!"

Li Jingsheng nodded.

"Girl, please register your name and contact number."

"Why do you need to register for oral ulcer medicine? I don't need to register when I buy it in a pharmacy!"

The patient appears very vigilant.

"You also said that it is a pharmacy, and ours is a clinic, which is equivalent to a hospital's outpatient clinic. The nature must be different. Don't worry, we just let patients register routinely according to the regulations of the superiors, and we will never disclose the privacy of patients. "

The ledger that Li Jingsheng took out contained the names and contact information of many patients, and even their addresses.

Clinics have some disadvantages compared to hospitals.

For example, if a patient registers, no matter what the disease is, the hospital can only see a doctor if he registers.As long as the patient registers, the patient's ID card information can be obtained.

It is very difficult for clinics to obtain patient ID information.

Especially this small clinic.

She is still struggling on the food and clothing line. If a patient comes in to buy a mouth ulcer medicine, you have to ask her to register her ID card information, and she will probably turn around and leave.

What Li Jingsheng can do is to try his best to get the patients to cooperate.

The female patient finally filled in her name and phone number.

In order to prevent the information from being wrong, Li Jingsheng took out his mobile phone and tried to dial the above number on the spot.

The phone rang on her.

The ringtone is also a very touching love song "There is a kind of love called letting go".

Young men and women often have beautiful longings for love, and naturally yearn for beautiful love.

"Please understand, I'm just verifying that the phone number is correct."

Li Jingsheng naturally would not say that some patients did not fill in their real numbers.

"Can I have my medicine filled now? Also, what is the cause of my swollen lymph nodes?"

"I suspect that your disease is not a simple oral ulcer. I suggest you go to the Center for Disease Control and Prevention immediately for further examination. There are free medicines available there."

"What disease is that?"

The girl looked blank.

"We won't know until the disease center conducts tests. My initial suspicion is that it is a bad virus infection."

"Do I have to go to the CDC? Can the community health station treat it?"

"I guess no matter which hospital you go to, you will eventually go to the Center for Disease Control and Prevention. They are better at treating this disease. It is best not to delay and go now, because this virus is somewhat contagious."

"Okay then! Thank you!"

The girl is gone.

After going out, she saw her standing on the side of the road and hailed a taxi, heading towards the west end of the old street.

The west end leads to the city center, and the city CDC is in this direction.

It seems that she should have listened to the persuasion and took a taxi to the disease control.

Li Jingsheng called to report the incident according to regulations.

Because he has no way to obtain the patient's ID card and other information, the follow-up work can only be left to the disease control department.

"Boss, what's wrong with that girl?"

Tang Ping knew that the girl's illness was definitely not simple.

Otherwise, the boss will not let her wear gloves to check.

"It might be Xiao Ai."

Li Jingsheng's tone was quite heavy.

"Xiaoai" is a secret word among medical staff, and it is a secret name for AIDS.

Such as syphilis, will be called 'Xiaomei'.

If it's cancer, it's called CA, or sometimes a mass.Few doctors and nurses would say the word cancer in front of patients.

This is done to avoid patient stress.

"It's such a pity to be infected with Xiaoai at such a young age. Many girls don't know how to protect themselves."

Tang Ping shook her head and sighed.

"I'm afraid she doesn't know it at all. When the results of the disease control test come out, she may collapse."

Li Jingsheng also sighed.

Illness is always so ruthless, never showing mercy because of the patient's age or gender.

"Boss Li, the signboard has been installed for you, please check it. If there is no problem, I will come to pay the bill in the evening."

The advertising shop owner came in and said to him.

Many business people are superstitious and only go in and out in the morning.The first business opened in the morning, even if it doesn't make money, is willing to close as long as it can keep the capital.

The owner of the advertising store proposed to check out in the evening because he was worried that he would make the customer unhappy when he asked the customer to check out in the morning.

Li Jingsheng went out to have a look, he was fine.

"The boss's craftsmanship is very good! I will pay you the final payment now, and there is no need to make you go again."

He settled the bill on the spot.

He doesn't believe it.

Just as the owner of the advertising shop was sent away, another patient came.

A 37-year-old middle-aged woman entered the door holding her right face.

"Doctor, my right cheek is very painful, can it be cured?"

Even when she spoke, she showed a pained expression.

"How did it happen? Did it suddenly start to hurt?"

Li Jingsheng found that the woman's right cheek was very red and swollen.

First of all, it is natural to suspect that she was beaten by her husband.

Women are afraid of marrying the wrong man.

Some women marry very violent husbands, who will grab the woman and beat him up if things go wrong.This kind of thing is not uncommon.

"I don't know what's going on. Four days ago, I felt a little pain here when I ate. I thought it would be better in two days, but I didn't expect it to get worse. Today, I feel a rancid taste in my mouth. These two days When I brush my teeth, I dare not touch this piece at all.”

She points to the position of the molars on the lower right jaw.

This disease should have seen a dentist.

But to Li Jingsheng, every surgical patient is extremely precious.

They have already come to the door, if you can eat it, you must be welcome.

"Let me check it out for you first."

He reached out and pressed the woman's right cheek and jaw.

"Ah...it hurts, it hurts so much!"

The woman immediately let out a cry of pain.

"I feel a lump, let me look inside again! Open your mouth!"

Li Jingsheng took out a small flashlight.

The woman's expression was painful when she opened her mouth, and she could only open it to about two-thirds of its normal width.

It can be seen that there is obvious swelling between the buccal muscle and the mucosa.

Dental caries in the lower right first molar.

Inflammation and swelling of the mouth like this is mostly related to gingivitis.

Considering the large volume of the swollen area, there is likely to be pus inside, and the effect of antibiotic treatment is probably not ideal.

Li Jingsheng now possesses small-scale drug efficacy and pharmacokinetics. When formulating treatment plans for patients, these two medical skills have brought him great convenience.

As long as you look at the situation, you can estimate the approximate treatment effect in your heart.

The proficient level of general surgery diagnosis is also very useful at this moment.

The best way to determine whether there is an abscess in the red and swollen area of ​​the patient's right mandible is to puncture.

The patient felt a rancid smell in the mouth in the past two days, and there is likely to be pus overflow.

If an abscess does exist, surgery is required.

"Surgical drainage combined with antibiotics to control inflammation should resolve the abscess. If the molars were to be extracted, it would not be able to."

He quickly made a prediction in his mind.

It seems that it is just a redness and swelling of the cheeks, which is a minor problem, but to treat it requires the attending doctor to have various medical skills.

Medication, general external diagnosis, oral diagnosis, surgical incision, separation, hemostasis, suture, etc.

It is not difficult to meet.

For specialist doctors in large hospitals, handling this case is a trivial matter.

But Li Jingsheng needed to use all his strength.

The patient's first molar was missing due to dental caries.

The periodontal redness and swelling are extremely obvious, indicating that the cheek redness is caused by this molar.

After careful inspection, it does not look like molar apexitis.

He found a wound next to the root of the tooth, which seemed to be pierced by something.

Because of the swelling of the cheek, the wound was located on the periphery of the molar and was almost overlooked.

"Did you get stuck in your gums by a bone when you ate something a few days ago?"

"Yes. When I was eating chicken, I was pierced by bone fragments. It hurt a little at the time, and I thought it was nothing, so I ignored it. My face is swollen like this, is it related to it?"

the patient asked.

"I can't be sure for the time being. I feel that it has something to do with the puncture of the gums. It just so happens that this tooth is another carious tooth. After the injury, it caused infection and inflammation, resulting in molar apexitis."

Li Jingsheng can only roughly infer.

I can't say for sure.

"What should we do now? Can you treat it here?"

When the patient heard multiple disease names, he became a little anxious.

Who would have thought that eating a chicken could cause such a big problem.

"I suspect that the inside has been suppurated. I need to take a B-ultrasound. The cost is 100 yuan. Can you see it?"

"Can you disagree? Take a picture!"

The woman is not that stingy.

The money that should be spent must be spent.

If you are sick, you must be cured!
Guided the patient to pay the fee, Li Jingsheng took her to take a B-ultrasound to see the situation.

He is not good at oral diagnosis.

Suppurative parotitis is also possible.

There is also an abscess that is unknown, which must be investigated clearly.

The facial nerves and blood vessels are very rich, and the risk of surgery is still quite high.

Fortunately, his current sewing level has improved.

In case it is necessary to incision and drainage of pus from the face, the suture scar after surgery must be considered.

Especially for women who love beauty, they should pay more attention.

After ultrasonography, Li Jingsheng found that the boundary of the lesion was not clear, the internal echo was uniform, and the lesion area was more than 5*7.

There are three stages of an abscess.

Pre-abscess, abscess formation and abscess absorption.

It is currently in the early stage and the formative stage.

If left untreated, the lesion area will continue to expand, and eventually ulcers will appear in the mouth or face, and pus will flow out.Such a large abscess already presents a serious risk of poisoning.

and the possibility of sepsis.

After checking the ultrasound, after she came out, Li Jingsheng took her temperature with an infrared ear thermometer, and it was a low fever.

37.4 degrees.

Measure again, 37.5 degrees.

Fluctuations in temperature measurements are normal.

The patient developed a low-grade fever.

A rise in body temperature also means that the body's immune system is triggered to fully fight the abscess lesion.

Ordinary small abscesses, such as the most common acne, do not cause a rise in body temperature.

The patient's body temperature rose by nearly one degree, which is the initial manifestation of the body's immune system launching an all-out war.If sepsis occurs, the body's immune system cannot resist, and the patient will have high fever, chills and other reactions.

"Is my condition not serious?"

the patient asked.

"It's quite serious. There's an internal abscess, and it's quite large. You don't have symptoms like chills right now?"

"No."

The patient denies it.

"Just now I gave you a comprehensive check-up. Only injections will definitely not solve your situation. My suggestion is to incision and drainage of pus. It may be necessary to do a larger operation to separate the lesion tissue of pus. Then cooperate with injections to reduce inflammation. , Anti-infection, the disease should be under control within three or four days.”

Li Jingsheng really hoped to win this business.

Not only to make money, but also to increase experience in diagnosis and treatment in this area, and at the same time improve the level of surgery, the life value earned should not be too small.

There are many benefits, and he is naturally positive.

"I need surgery, can you do it here?"

When the patient heard that the operation was going to be performed, he immediately hesitated.The level of the small clinic is really hard to believe how good it is.

"Can do."

Li Jingsheng answered firmly and forcefully.

"Our boss's surgical skills are good! Here, this young man has a big gash on his waist, which is so long. After our boss treated him, he has basically recovered."

Tang Ping pointed to the young man who came to review to help Li Jingsheng show up.

The young man smiled honestly.

"Then... I'll call my husband first, how much will this operation cost?"

"The total cost is estimated to be about 2000. If the drainage effect is not good and the operation needs to be expanded, the cost is estimated to reach about [-]." Li Jingsheng can only give an approximate cost estimate.

In larger hospitals, it costs more than 700 yuan just to suture a skin flap, purely for the operation fee.

The operation for this patient is definitely not small, and the risk is quite high. He also needs three to five days of hanging injections, and 800 yuan is really not much.

Li Jingsheng knows that the only advantage of the small clinic is that there is no queue, the cost is low, and it is convenient.

It's still in its infancy, don't think about how much you can earn, you have to eat the business first to have a chance to expand your reputation.

Many people don't even know that he can perform surgery here.

The woman stepped aside to make a phone call.

Li Jingsheng checked the wound of the young man who had scratched his waist, and the wound was healed to the best grade A.

No inflammation, no infection, no rupture, no pus.

It can be seen that the initial wound healing is basically complete.

"In two days, you should be able to come over and have the stitches removed. You don't need to come here tomorrow."

Li Jingsheng prescribed an erythromycin ointment for him and asked him to go home and apply it on the wound.

The fact that such a long wound healed so quickly also gave Li Jingsheng greater confidence.

If he is allowed to return to work in the First Hospital now, the task of suturing the skin is guaranteed to be as good as the attending doctor.

As for the excellent Gui Peisheng, a resident doctor, his suturing skills are definitely not as good as his.

At this time, a new patient came in.

"Doctor, I brought my wife here, please take a look."

The door just opened that morning, and the man who asked if he could set the bone came with a thin woman.

This woman was very thin, with withered and yellow hair, and she walked quite slowly.

Her movements are not as agile as some old people.

"Did you break your right wrist?"

Li Jingsheng motioned for the woman to sit down.

"Correct."

She carefully rolled up the sleeve of her right hand, her right wrist looked quite slender, like an ancient weak lady.It's really the kind of powerless.

The skin is duller.

Diagnosed with the naked eye, there is no obvious redness and swelling, only a little abrasion on the wrist and palm.

Wrestling is something that no one can avoid.

Needless to say, children are naughty, active, trying to make some dangerous moves, and wrestling is commonplace.

Adults are generally more stable and will not fall easily.

But after an unfortunate fall, the injury is often much more serious than that of a child.

This woman was too thin and seriously lacked the protection of the fat layer. When she fell, her bones were almost there to carry her hard.

"It's just that this hand can't use force, especially when holding a basin, holding a bowl, etc., it will be very painful."

She took the initiative to describe the symptoms to Li Jingsheng.

"I'll check it out for you."

Li Jingsheng used his small-level bone-feeling skills to touch her bones.

The expression is always serious.

The man's husband is standing next to him, grabbing his wife's hand and touching it around, so it can't cause any misunderstanding.

He is not bad at all. The male doctor in the nail and breast surgery department of the hospital is dangerous when he encounters female patients with breast lesions.

I saw that his movements were gentle but precise, and very stable.

Compared with the proficient bone touch technique, it is obviously a great improvement.

The three main points of stability, accuracy and lightness can already be achieved.The technical points such as two light and one heavy, and three fixed points when touching the bone have basically been integrated.

The judgment of bone image has also made great progress.

In the past, only the density of bone can be judged, but now there is a clearer tactile judgment on the toughness, density, and whether there is a disease of the bone.

Even the vitality of the bones can be felt.

After touching it, he had a bottom line in his heart.

Nothing major, just a partial misalignment of the wrist bones and a slight fracture in one.

"Can it be cured?"

"The problem is not too big. It seems that there is a fracture. I need to take an X-ray to see."

Li Jingsheng must take a picture of her before he dares to treat her.

In case something happened, taking a picture would be the best evidence.

"It turns out that the bone is broken, no wonder it hurts so much! Help me take pictures!"

When the woman heard the fracture, a frightened expression was evident on her face.

"Fractures are divided into multiple levels. Your bones are not completely broken. For example, if you break a small wooden stick hard, there will be cracks, but it is not broken. That's probably what it means."

Li Jingsheng explained.

"How much does it cost for a checkup?"

The woman's husband is more concerned about the cost.

"One hundred dollars."

"Can I not take pictures?"

"That's definitely not possible! This is just the most basic examination. If you go to a big hospital, you may be asked to take a CT scan, which is much more expensive."

Li Jingsheng found that it is really not easy for a small clinic to make money.

For a 100 yuan examination, the patient still wants to bargain.

There is no such thing in large hospitals. For routine examinations, doctors prescribe them directly, without consulting patients at all.

(End of this chapter)