Gou is practicing medicine in the clinic

Chapter 173 Diagnosis and meritorious deeds are really not making things difficult
Damage to blood vessels during surgery, leading to blood clots?
There is this possibility, but it is obviously inconsistent with symptoms such as high fever.

The patient's operation site is on the lower limbs, and there are not many reasons that can cause high fever in a short period of time.

It takes at least several days or even longer for wound infection to suppurate and cause sepsis.

While Li Jingsheng was thinking hard, he only felt that his knowledge and experience were still too little.

"By the way, the ecchymosis under the conjunctiva is just an accidental phenomenon?"

Subconjunctival ecchymoses are a good breaking point.

The most common causes of subconjunctival ecchymosis are sepsis, gonococcal conjunctivitis, and subacute infective endocarditis, and these causes can basically be ruled out.

Li Jingsheng's cardiovascular internal medicine diagnosis level is not high, but he has some experience in the diagnosis of infective endocarditis.

At this time, Director Hua and the others had already discussed a result.

"Considering that there is a certain purulent lesion at the junction of the patient's tibial head and joint, although debridement has been done, it is still suspected that sepsis may have been caused."

Many of the patient's current symptoms are indeed highly consistent with sepsis.

Now there are pathogenic factors again, Director Hua and others almost unanimously support this diagnosis conclusion.

Li Jing just mastered the Department of Skin Immunology not long ago, and he has some deeper insights and understanding of immunology.

In addition, the diagnosis of cardiovascular medicine also has a certain level.

General surgery diagnosis also has a good basis.

These are all closely related to the Department of Infectious Diseases.

He believes that the possibility of the patient being sepsis is very small.

The time should not be so short.

Of course, it is not ruled out that the patient had sepsis before the operation.

But this possibility can also be ruled out.

Don't do all the preoperative checks?
Unless the Second Hospital is an empty air, there are major problems in management.

If it was really that bad, it wouldn't be able to survive now.

Therefore, the possibility of sepsis is basically ruled out.

"Beauty, can you check the patient's armpits to see if there are bruises?"

Li Jingsheng looked at the nurse in charge of the bed.

Originally, it was better to call Teacher XX, but Li Jingsheng didn't know her very well, and he didn't even know her name, so it was better to call her beautiful.

Now, beauty has basically become a generic term for young women.

"can."

She nodded yes.

But judging from her disapproving expression, she also felt that Li Jingsheng was a little busy.

The chief physicians have discussed the diagnosis results, why are you a resident physician messing around here?
Are you showing off?
After examining the patient, she could not help exclaiming, "There is a large amount of ecchymosis in the patient's left armpit." Then, she checked the right side.

"What about the right side?"

Director Hua asked impatiently.

Obviously, this is a major discovery.

Considering the patient was a lesbian, no one even bothered to examine her armpits.

"There was also extensive ecchymosis in the right armpit."

This result made everyone look at Li Jingsheng with admiration.

Director Hua, Professor Wu and others couldn't help rethinking the possible cause of the patient again.

After Li Jingsheng learned that the patient also had a lot of ecchymosis in his armpits, he immediately thought of a possibility.

"It's a fat embolism, it's probably it!"

Although there is a diagnosis, what is the cause of the fat embolism?
The pathological mechanism has not been sorted out, and Li Jingsheng dare not draw conclusions rashly.

"Director Hua, I suggest that the patient should be given a urine test and blood routine immediately, focusing on checking for fat particles. It is best to push the ventilator over and get ready. The patient's lungs should have severe edema and the condition is progressing. It's so fast, I'm afraid that when the time comes... I will be in a hurry."

Li Jingsheng spoke more tactfully this time.

"Xiao Li actually suggested this to me once just now, but I don't think it's been adopted yet."

Professor Wu may be worried about hurting face, so he explained.

After all, even a fool can see that the new doctor Li Jingsheng is very unusual.

Although they haven't come to a diagnostic conclusion yet, but the fat particles in the urine and blood are checked, which is obviously a diagnostic result.

And definitely not sepsis.

In addition, whether Li Jingsheng asked the patient whether the urine output decreased or the ecchymosis under the armpit, he always said what he said.

This ability to analyze and judge is enough to instantly kill Dr. Ruan Xiaoqin and others present.

Even Professor Wu felt ashamed.

At this time, the orthopedic surgeon's office was almost in full swing, as long as there were no clinical tasks for the time being, all came.

Director Hua was directing the rescue at the scene, so he wanted to show his performance and at least learn some rescue experience.

After all, there are very few critically ill cases that need to be rescued in orthopedic surgery.

Ou Qinglan was already fair-skinned and beautiful, but after wearing a white coat, she looked even fairer.Standing there seems to be a beautiful landscape.

Looking at Li Jingsheng's first day at work, he was as powerful as a veteran in the battlefield, and his limelight even faintly overshadowed the two chief physicians present.When she looked at Li Jingsheng, she couldn't help but be amazed.

This is the man she admires.

Don't back down when facing the gangster.In the face of urgent and critical cases, he is courageous and resourceful, and has strong medical knowledge, and his performance is extremely outstanding.

It's so good.

Xiao Jing's eyes were a little sour, more shocking.He didn't expect that the new Dr. Li would not only know how to set bones, but also be so good at diagnosis.

Dr. Qin was the most depressed.

He has publicly declared that he wants to compete with Li Jingsheng, and wants to grab Ou Qinglan as a beauty.

In terms of wealth and family background, he is confident that he can kill Li Jingsheng in seconds.

In terms of work, he thought he had a great advantage before.Now that he was actually on the battlefield, he realized how big the gap with Li Jingsheng was.

And it's not that he is strong, but that Li Jingsheng is much, much stronger than him.

"Check the urine and blood immediately, and borrow the ventilator. Doctor Qin, go and borrow the ventilator, hurry up."

Director Hua's eyes locked directly on the young doctors standing behind.

In the end, Dr. Qin became the unlucky guy who ran errands.

"Which department do you want to borrow?"

Dr. Qin was very depressed, he was a hospital chief after all, why didn't he ask Xiao Jing to do errands?
"Go to the respiratory department! Hurry up."

Director Hua looked impatient.

When Li Jingsheng talked about preparing the ventilator, his expression and tone were very serious, which made Director Hua feel a little bit of pressure.

It was precisely because Li Jingsheng's performance in all aspects was excellent that Director Hua realized that Li Jingsheng would definitely not talk nonsense.

Now I am afraid that something will happen to the patient.

"Okay! I'll go right away."

Doctor Qin didn't dare to neglect, and immediately ran to the Department of Respiratory Medicine.

"Director Hua, if possible, I suggest that you immediately prepare some emergency medicine for fat embolism. The patient's breathing rate increased three times per minute in this short period of time. And even after inhaling oxygen, the blood oxygen data did not change significantly. .I am worried that the time left for us to rescue is getting less and less.”

Li Jingsheng once again gave a more pertinent suggestion.

Nearly a year of clinical experience has made him calm and wise.

Doing things is also thoughtful everywhere, not fighting unprepared battles.

These abilities, let alone young doctors in their twenties.Even a 40-year-old doctor may not be able to have it.

"Doctor Ruan, you should prepare immediately. Do you know the emergency medicine for fat embolism?"

"clear!"

If Ruan Xiaoqin can't even do this well, it's really useless to take care of him.

"Dr. Li, tell me about your reason for suspecting that the patient has a fat embolism or your diagnostic thinking."

"The reason is quite sufficient. I haven't figured out the way of diagnosis. Let me think about it again?"

Facing the stares of the two chief physicians, several young doctors, two nurses, and family members, Li Jingsheng was really uncomfortable.

"No problem, you think about it slowly, and tell me and Professor Wu when you think about it."

Director Hua handed him the patient's examination materials directly.

"To check the patient's medical records and treatment plans, you can go directly to the computer in the office to check."

"Ok, thank you."

Li Jingsheng can feel that Director Hua thinks highly of him.

"Old Wu, which one do you think is more likely, fat embolism or sepsis?"

Director Hua ignored him, and started a new discussion with Professor Wu directly in the ward.

Even if the patient didn't turn the corner, Director Hua didn't dare to leave.

"Cough... Well, the probability of fat embolism is indeed higher."

Professor Wu's old face was a little feverish.

It is undeniable that he was taught a lesson by this young doctor today.

Li Jingsheng's performance is too dazzling.

"Long-term fractures are more prone to fat embolism. If this patient really has fat embolism, the pathology must be investigated clearly to prevent similar cases in the future."

……

Seven or eight minutes later, the ventilator had not been borrowed back, and the patient suddenly had limb convulsions.

Blood pressure dropped rapidly again.

His face, fingers, and lips were even more cyanotic at a speed visible to the naked eye.

Professor Wu hurriedly increased the oxygen concentration, but the effect was not good.

He wanted to increase the oxygen concentration again, but Li Jingsheng quickly persuaded him, "We can't increase it any more, otherwise it will be counterproductive. At this time, putting on a ventilator is the only way to save lives."

The concentration of oxygen inhalation is not as high as possible.

If it is too high, oxygen toxicity will occur.

Moreover, the concentration of oxygen inhalation is too high, but it will have the opposite effect of inhibiting breathing.It can also cause atelectasis of the lungs.

Now that the patient has already developed pulmonary edema and has difficulty breathing, giving high-concentration oxygen inhalation is equivalent to making up for it.

Send patients straight to the road.

Professor Wu must understand these medical common senses, but in the practice of clinical rescue, the oxygen concentration needs to be adjusted flexibly.He probably lacked practical experience in this area, and seeing that the patient might die soon, he frantically increased the oxygen concentration.

After being reminded by Li Jingsheng, Professor Wu's old face had a fever again.

"I didn't think carefully. Why hasn't Xiao Qin borrowed the ventilator? This is really terrible!"

Professor Wu stomped his feet anxiously.

If he had adopted Li Jingsheng's opinion from the beginning, he wouldn't be in a hurry now.

Fortunately, Doctor Qin is quite capable.

The ventilator was borrowed at a critical moment.

"The doctor in Hunei is very generous. He heard that we had a critically ill patient. He was worried that we rarely use the ventilator, so he came here to help adjust it."

Doctor Qin also brought back a male doctor.

But it was Li Jingsheng's acquaintance, Dr. Tang Weilin from the Department of Respiratory Medicine.

He is also an excellent young doctor under Director Mu.

"Doctor Li, I heard that you are now joining our Second Hospital, congratulations! Welcome to our internal medicine department!"

When Tang Weilin saw Li Jingsheng, he immediately greeted him with a smile.

"Thank you, thank you! The patient had convulsions just now, and the symptoms of hypoxia have worsened. Let's rescue the patient first!"

"it is good!"

Tang Weilin turned to look at the two chief physicians.

"Director Hua, Director Wu, then I'll do it directly. If I had known that Dr. Li was here, I wouldn't have come here. Dr. Li's level is very good."

He also praised Li Jingsheng by the way.

"Do it!"

Director Hua was already in a hurry.

Professor Wu regretted not listening to Li Jingsheng's advice, and now hopes that the patient can survive this test.

For Tang Weilin's praise of Li Jingsheng's level is very good, the two deeply agree.

Just now I saw Li Jingsheng's brilliance.

After the patient was put on a ventilator, the hypoxemia was significantly improved.

You know, bronchoscope and ventilator are the 'magic weapons' of respiratory medicine.

Each department has some 'magic weapons', which are different.

The Orthopedic Surgery Department doesn't even have a ventilator, and they have to borrow it, which also shows that the Second Hospital is "poorer" than imagined.

Because orthopedic surgery is a relatively profitable department.

Of course, it also depends on the hospital.Although some hospitals have a large scale, but the orthopedic surgery business is not well developed, the ability to generate income will naturally be much weaker.

"Director Hua, I can't help here anymore, I'll go back to work at the outpatient clinic first."

Li Jingsheng looked at the time and it was a little bit past, presumably the patients at the outpatient clinic were already waiting extremely anxiously.

"Go! It seems that the decision to recruit you is correct."

Director Hua looked at him with extremely soft eyes.

"Qing Lan, I'm leaving! I'll see you tomorrow at noon!"

Li Jingsheng still enjoyed Ou Qinglan's adoring gaze on him.

That is hero worship.

Heroes are saddened by Beauty Pass.

Beauty is easy to fall in front of heroes.

"Ok!"

Ou Qinglan watched him leave all the time, and then she looked away.

Director Hua saw this scene.

He couldn't help but whisper in his heart, Dr. Li is not only good at medical skills, but also good at dating.

When did you win the number one beauty doctor in orthopedic surgery?

……

When Li Jingsheng returned to the outpatient room, there was indeed a long queue of patients.

As long as manual therapy is available, many patients are willing to wait even if they wait in line for two or three days.

The cost is low, less suffering, and the recovery effect is more ideal than surgical treatment, these are the advantages.

The damage caused by steel nails and splints is not as simple as surgical incision.Its damage to bones is almost lifelong.

If there is no way to drill N holes in a good bone, the doctor will not let the patient undergo this kind of operation.

Some patients received steel nails. After the patients were cured, they can move freely and rarely experience discomfort.

But there are also some patients who recovered after the operation.

After one or two years, or even longer, then there will be inflammation and necrosis of the bones, infection and suppuration, and so on.

Therefore, compared with manual therapy, surgical treatment has great disadvantages.

Especially those requiring internal fixation.

In order to solve this problem, orthopedic surgeons have also thought of some ways.For example, after a patient has recovered from the operation, the patient will be notified to undergo a second operation in the past for about half a year.

What are you doing?
Remove the steel nails and steel plates driven into the body.

The patient's bone is then allowed to heal further.

The risk of foreign bodies remaining in the body is also eliminated.

It is not difficult to see from here that surgical treatment and manual treatment are actually the same in principle.

It's all about reconnecting the broken bones and letting them grow back.

It's just that the process of surgical treatment is more complicated, and it needs to be repeated several times to achieve the effect of manual treatment.

This is why traditional Chinese medicine has declined and is overwhelmed by Western medicine, but bone-setting techniques have always had a very good market in many places.

Very popular with patients.

"Why did you come here? It's time for the patient to complain to us later."

Doctor Xu asked him with a dark face.

"I went to help rescue an urgent and critical case. It's okay. At worst, I will work overtime to treat all the registered patients."

Li Jingsheng treated one more case at noon because of overtime work, and other patients felt that this was unfair, so they complained to him.

Now, he is again voluntarily asking for overtime.

"Still working overtime?"

Dr. Chen said with a bitter face beside him.

Li Jingsheng is not afraid of being complained, Dr. Xu is not afraid of being complained, but Dr. Chen is afraid.

This is the difference between having real skills and not having real skills.

Dr. Chen has no confidence to fight against the medical department.

He can't stand any punishment.

"It's not easy for patients to come here with a sick body. For me, what I sacrificed is just a little personal time. For them, it's a big problem to solve. So I will work overtime according to the situation. If the medical department is really unreasonable, then Let Director Hua solve it."

Li Jingsheng explained.

"What's the matter with working overtime? We should have the final say on our manual reset clinic. Don't worry, the incident at noon has been explained clearly. But you must pay attention to the method and method of doing things in the future."

Dr. Xu is very supportive of his apprentice's kindness as a doctor.

The master and apprentice were tougher than the other, and they didn't take the punishment from the medical department to heart.

"Well then, I will resolutely obey the decisions of the two superior doctors."

Dr. Chen put the position in the right place.

As soon as Li Jingsheng joined the job, he was automatically demoted below Li Jingsheng.

"Hurry up and treat the patient!"

Doctor Xu asked Li Li to call her number.

Li Jingsheng was about 10 minutes late. Depending on the situation, they should have treated a patient.

The patient came in on crutches.

It was none other than the couple who had a dispute with Li Jing at noon.

The husband's speech is quite polite, mainly because the patient's wife is a little unreasonable.

When the two saw Li Jingsheng, their expressions were a little unnatural.

"What's wrong?"

Li Jingsheng was generous, he didn't mean to make things difficult for these two people.

Of course, there must be a little panic in my heart.

"I broke my foot while riding an electric scooter, please see if it can be cured!" the patient replied carefully.

The patient's wife bowed her head and did not speak.

People are like this.

You must be guilty of doing something bad!How much will be a little embarrassing.

"Ouch, this injury is serious!"

Li Jingsheng frowned after watching the film.

When the patient and his wife heard this, they thought that Li Jingsheng did not treat them on purpose.

"That...can you please help me treat it!"

The patient's wife looked at the elderly Dr. Xu pleadingly.

"I've been sick for the past few days, and I'm not in good health. I have to be treated by Dr. Li." Dr. Xu refused straight away.

The patient's wife turned pale when she heard this.

Only at this moment did she realize how stupid her willful and impulsiveness was.If there is no cure here, they can only go for surgery.

"Doctor Li, I'm the one at noon, I'm sorry, I spoke too harshly, please forgive me."

In order for her husband to be treated here, she could only bow her head and admit her mistake to Li Jingsheng.

"It's acceptable to speak loudly, but I don't dare to treat you because of complaints every now and then."

Li Jingsheng replied her a little coldly.

(End of this chapter)