Gou is practicing medicine in the clinic

Chapter 176 Treatment of Pericarditis

Obviously he was the one who took the lead to put pressure, but now he is the first to run away.

A shameless person is invincible.

"I, I seem to drink a little too much water!" Boss Liu of Fredo Pharmacy followed closely behind, clutching his stomach.

This woman was very strong when she came, but now she is retreating for fear of falling behind.

What Li Jingsheng felt was that this woman seemed to have a split personality.

When he scolded her for needing more brains, his eyes and expression wanted to rush up and strangle Li Jingsheng to death.

But the drums died down behind.

Under normal circumstances, women are very impulsive when they are angry, and it is impossible to be so rational.

Judging from her overall performance, she doesn't look like a very resourceful woman.

It felt like an invisible red thread was holding her down.

"Oh, I'm in a hurry to come out. I forgot to lock the door of the store. I have to go back and have a look."

Another weird reason.

Three of the seven pharmacy owners left at once.

The rest were already stragglers, and no one dared to confront Li Jingsheng head-on.

Even Boss Cheng from Huimin Pharmacy just gave Li Jingsheng a vicious look, then left with a heavy groan.

No wonder Huimin Pharmacy is the worst business among the seven pharmacies.

Boss Cheng, a 37-year-old man, is so impulsive in doing things, he is far behind Fatty Zhang.

In this kind of place where fish and dragons are mixed, those who can really do well must learn from Boss Zhao of Kuaikang Clinic and Fatty Zhang of Minmin Pharmacy.

To die is to face and suffer.

Boss Cheng knew that he had become the youngest of the seven and had become cannon fodder, so he didn't seize the last chance to repair the relationship before leaving, but for the sake of bullshit and worthless face, he treated Li Jingsheng badly.

This behavior is really stupid.

Seeing the seven pharmacy bosses approaching aggressively, leaving in disgrace after two rounds of fighting, Li Jingsheng remained calm.

In the confrontation just now, he could feel that he seemed to have really grown a lot and became a lot stronger.

When faced with the attacks and coercion of these people, not to mention that he was able to handle it with ease, at least he was calm and calm.

If it was a few months ago, so many bosses came to put pressure on him, he must have been terrified.

"It's okay, let's go home from get off work!"

Li Jingsheng didn't say any polite words of gratitude or thank you, but he looked at the three employees with extremely gentle eyes.

Love is an extremely precious thing.

Li Jingsheng will develop even better in the future, and he will never forget the friendship between the three of them.

"The boss was so handsome just now!"

Han Siying couldn't help smiling when she saw the dark clouds dissipate.When he looked at Li Jingsheng, his eyes shone with starlight, which was the light of worship.

"It's not handsome, it's mighty!"

The child Xiao Gao's adjectives are also not good enough.

"I think it's more appropriate to call it Weiyi! When the boss confronted them just now, he was really like the emperor in the TV series, full of momentum and unfathomable power."

After Tang Ping finished speaking, she covered her mouth and smiled again.

"Or there's nothing wrong with being masculine!"

"Are you all praising me or hurting me? Hurry up and get off work!"

Li Jingsheng was really dumbfounded when they praised him indiscriminately.

Through this 'battle', his image in the minds of the three employees has become taller and mightier, which is true.

……

The next day, Li Jingsheng opened for business as usual.

Those who buy medicine and see a doctor flock in like a morning market.

"Don't worry, everyone line up. Those who see a doctor line up in front of the consultation desk over there, and those who buy medicine line up at the counter."

Li Jingsheng sighed in his heart, looking at the situation, he might not be able to eat breakfast again today.

However, as soon as the door opened, so many customers and patients entered, he was very happy, and it was another busy and fulfilling day.

Gone are the days of seeing less than one patient a day.

"Boss, I feel a pain in my chest, and it's very hard to breathe."

A man in his 40s took the first place on the consultation table.

He seems to know Li Jingsheng.

In fact, after going through a few 'big incidents', Li Jingsheng has become a little famous in the south of the city.

Being on TV made many people in Lijiang know Dr. Li from the Sunshine Clinic.

"Sit down, please. I'll issue them a number plate first."

Li Jingsheng took out the number box from under the consultation table and issued number plates to eight patients, and then sat back at the consultation table and began to diagnose patients.

This box was made by Han Siying using the medicine box.

Divided into 12 grids, each grid puts 10 number plates.

There are numbers written on the partition of each grid, 1-10, 11-20...

The girl's delicacy and ingenuity are reflected in this simple cardboard box.

She even drew a red cross on the front of the box, with the number plate of the Sunshine Clinic written in silk embroidered characters.

"Where does the chest hurt?"

Li Jingsheng asked the male patient No.1.

"This is the piece!"

The man was referring to the left chest position.

Both the left lung and the heart are on the left side of the chest cavity.

Li Jingsheng's face became much more serious.

"I'll take your temperature first!"

The ear temperature was 38.5 degrees and the forehead temperature was 38.4 degrees.

There are obvious fever symptoms.

"When did you start feeling unwell?"

"Yesterday at noon! I felt a little uncomfortable when I was eating lunch. Later, I fell asleep after eating and felt a little fever and tightness in my chest. I took a pack of Wujisan at night. After getting up this morning, I felt very labored to breathe. It's like being covered by someone's nose. My wife scolded me to find a doctor, I think it might be a cold, and it's not a big problem."

The man described the course of his illness.

Wujisan is a relatively common traditional Chinese medicine prescription, which has the effects of relieving the exterior and warming the interior, dispelling cold and dampness, regulating qi and promoting blood circulation, and reducing phlegm and stagnation.

Many older people choose to take it to treat cold diseases after catching a cold.

The effect is not bad.

In addition, it is a traditional Chinese medicine prescription, with few side effects, and it is not very picky about physique.

"Come on, let me listen to your heart and lung sounds. Try to relax and breathe normally."

Li Jingsheng motioned for the man to unbutton his shirt, exposing his chest, and then pressed the probe of the stethoscope on it.

The lung sounds were clear, but a little heavy, and no dry or wet rales were heard.

But a pericardial rub was heard.

Listening carefully, the pericardial fricative is a scratchy rough sound, which is a triphasic fricative.

The area... seems to be in the precordium.

At this time, the patient started to cough and instinctively leaned forward.

Li Jingsheng heard it more clearly this time.

After the patient finished coughing, Li Jingsheng tried to palpate the patient's heart, but he heard a dull sound.

And increase to both sides.

The proficient diagnosis of cardiovascular medicine immediately made him realize that the patient did not have a cold, but a problem with the pericardium.

When percussing the heart, he always felt that his auscultation level and diagnostic ability were not good enough, and some of them missed the key details.

"If it's not a cold, what disease is it?"

Li Jingsheng felt that it was necessary to use that grandfather-level X-ray detection equipment to assist in the diagnosis.

Now it is basically certain that the patient's lesion is in the pericardium.

He dared not treat most serious heart diseases.

Some with a small risk factor should be able to try.

After all, now they have a small level of drug efficacy and pharmacokinetics, and a proficient level of cardiovascular internal medicine diagnosis, so they must be applied to their effectiveness.

The more you use the medical skills, the more familiar you become, and the more you use them, the more refined you become.

After a brief communication, the patient agreed to do an X-ray examination.

To tell the truth, it was not an ordinary effort to check the heart with that grandfather-level X-ray detection equipment.It is best to have high-quality X-ray detection equipment for the pericardium and lungs.

Naturally, he didn't want to lose a business easily.

After a lot of hard work, I finally found out some tricks.

Chest X-ray showed that the shadow of the heart increased to both sides, and the apical beat was obviously weakened.

After checking this step, he was basically sure that the patient had pericarditis.

"Do you have symptoms of chills?"

"Does it mean that you are afraid of the cold?" The patient asked puzzled.

"Correct."

"It doesn't seem to be there. I just have a fever all over my body, my head is a little dizzy, and I don't have much energy in my body."

"Your disease is likely to be pericardial inflammation. Judging from the time of onset, it should be acute pericarditis. I suggest you go to a big hospital to see it, which is safer."

After Li Jingsheng found out that the patient had pericarditis, he could not confirm the type of pericarditis because of limited conditions.

If conditions permit, an echocardiogram, electrocardiogram, routine blood test, or even a pericardial biopsy can be performed to accurately determine the type of pericarditis.

Then prescribe the right medicine.

"Can you cure it here? I know our medical skills here are very good. If you can cure it, give me a cure. I trust you."

A 40-year-old man is really not afraid of death.

In order to save some medical expenses, I chose to be treated in a small clinic.

Of course, this is also related to the good reputation of Sunshine Clinic.

"Well... well, I'll give you some medicine to try. If the effect is not obvious after taking it today, you don't need to come again, and go to the hospital for treatment."

After pondering for a moment, Li Jingsheng actually agreed.

Dare to promise, because there is a certain degree of certainty.

There are many types of pericarditis, with idiopathic pericarditis being the most common.

Tuberculous pericarditis usually results from direct spread of tuberculosis in the mediastinal lymph nodes, lungs, or pleura.

Clinically, there will be a systemic reaction to tuberculosis and pericardial effusion.

The disease generally does not have precordial pain and pericardial friction rub.

Therefore, tuberculous pericarditis can be directly ruled out.

For the remaining neoplastic pericarditis, the disease generally progresses slowly, and the fever symptom is often characterized by long-term low-grade fever, which can also be ruled out.

There is also suppurative pericarditis, which is most common in pneumonia, empyema, and sepsis. The pericardial effusion is mostly purulent, and the course of the disease is long, and the onset is rarely so urgent.

Finally, there is a syndrome caused by heart injury.

This kind of patients who often occur in high-fall injuries, post-operation, and acute myocardial infarction can be directly ruled out.

The last thing left is viral pericarditis.

Caused by a viral or bacterial infection.

The onset is more acute and the progress is rapid.

It is highly consistent with many symptoms of this patient.

The patient is now only having difficulty breathing, and his heart rate and pulse are not bad.It should belong to the early stage or mild disease, and Li Jingsheng is sure to cure the disease.

So that's why I agreed.

The patient was prescribed ibuprofen extended-release capsules.

Fenbid is mainly used to relieve pain, reduce inflammation and reduce fever.

I was planning to prescribe ribavirin, which has a good effect on the early treatment of viral pericarditis.

Ganciclovir also has the same therapeutic effect.

After comprehensive consideration, Li Jingsheng chose the most commonly used ibuprofen sustained-release capsules.

"Is it enough to just prescribe one medicine?"

The patient asked in disbelief.

"The medicine is three-point poisonous, and there are not too many medicines. Now you take the medicine home, take it according to the amount, and then take a good rest. I believe there will be a good therapeutic effect."

Li Jingsheng said confidently.

Medicines are expensive but not many.

Really smart doctors choose to use less medicine and use better medicine.

This good medicine does not refer to expensive medicine, but accurate and symptomatic.

"Well, I'll go home and try it. Don't say anything else, your way of selling more medicines here is much different than other clinics and pharmacies. If the treatment effect is good, I will definitely help you to death in the future. You do publicity. We need really good doctors with high standards and medical ethics here."

Satisfied, the man bought the medicine and left.

A total of 30 yuan.

Plus the filming money, 130 yuan.

If you go to a big hospital, at least one thousand and five go up, and the time in line is estimated to be less than half a day.

After the electrocardiogram is checked, an echocardiogram will be checked, and a pericardiocentesis is likely to be performed, and then the specimen will be sent for examination.The laboratory will conduct bacteriological, biochemical, cell classification and other inspections on the extracted fluid.

After all the inspections, it is likely that the results will not be available until the next day.

Then the outpatient department of the hospital, for patients with pericarditis, most of them are admitted to the hospital.

Therefore, if a patient goes to a large hospital for treatment of this disease, [-] yuan is not much more than [-] yuan.

And it will cost a lot of time.

For a mildly ill patient like him, resting well and less queuing and tossing are more effective than any good medicine.

From this point of view, a good clinic brings great benefits to the people.

Diagnosing and treating this patient, the harvest of the attribute panel is also considerable.

Doctor level experience +5, cardiovascular medicine diagnosis +10, drug efficacy and pharmacokinetics +5, life value +11.

After receiving a big job at the beginning, the next five patients were all common diseases.

He asked doctors and prescribed prescriptions one by one.

When the third patient was diagnosed, Han Siying finished her work at the counter and stood behind him to study.

Under normal circumstances, if you work in a large hospital, the resident physician will have the opportunity to study in the outpatient clinic after three years.And there is often only one day of learning opportunities in a week.

Then after being promoted to an attending doctor, excellent doctors will have the opportunity to be qualified for outpatient consultation.

Han Siying has just graduated and has only one year of hospital practice experience.

Being able to study with Li Jingsheng in the outpatient clinic is of great help to her.

"Doctor Li, my child has a fever, cough, and rumbling breathing. Can you please see if he can be treated here?"

A middle-aged woman with tanned red and tanned skin was leading a six or seven-year-old boy.

Looking at the clothes of these two women, it can be basically seen that they are migrant workers, and their economic conditions should not be very good.

The middle-aged woman is about 33 and four years old, and her actual age may be a little younger.

The hair was tied up at the back of the head casually, and a lot of loose hair was exposed on the temples.

Wearing a pair of black trousers and a cheap floral shirt, his skin was so dark that he woke up.

And her hands are very rough, and even some small cracks can be seen.

The bones of the body look rather thick.

The child is wearing a school uniform, and the shoes on his feet are cheap sports shoes, and the corners are very worn.

Parents nowadays regard their children as baby bumps. Even if the economic conditions are not good, they still choose good ones for their children to eat and clothes for their children.

Both the middle-aged mother and the child looked a bit malnourished.

It is basically certain that her family's economic situation is relatively poor.

She was able to call out Li Jingsheng's surname, obviously she knew Li Jingsheng.

"How long has the child been sick?"

Li Jingsheng signaled the child to sit down.

Unexpectedly, the child was quite sensible, looked at the mother beside him, and said something in dialect.

It should mean let mom sit down.

"It's okay, there's still a chair, Siying, you can bring another one here."

When Li Jingsheng saw this scene, he didn't say anything, but in his heart he felt that this child was very sensible.

The children of poor families are in charge early.

They see the embarrassment of their parents struggling to make a living, so they are more sympathetic to their parents' difficulties.

The child was sick and unwell, but wanted to let his mother sit.

Really heartwarming.

"I'll just hold him! Don't bother you!"

The child's mother quickly stopped Han Siying, and sat on a chair with her son in her arms.

"My fourth child caught a cold last Monday. I bought some medicine at the pharmacy and got better after taking it. But he kept coughing, and now he started to have a fever. Since last night, his breathing has been a bit heavy. This morning He didn’t feel better when he got up, and his breathing became heavier, so I asked the construction site for leave and brought him to see a doctor.”

There are several large construction sites around, and it is estimated that this middle-aged woman works there.

The child has had a cold for more than a week, and is still coughing, and has started to have a fever, and the breathing is aggravated because of difficulty breathing.

It shows that the condition is getting worse.

"Doctor Li, do you think that the medicine my son took was left behind by the pharmacy, and that's why his condition recurred?"

The woman didn't shy away from it at all, and asked directly.

"The possibility of this should be very small. The current medicines are all packaged medicines. The manufacturers leave the factory and package them. After strict multi-channel inspection procedures, they are released for sale. Generally, there is no problem with safety."

Li Jingsheng often hears patients mentioning the term "doctors intentionally leave hand tails".

It is not ruled out, but it is generally impossible to happen in regular hospitals.

The doctor is eager to cure the patient's disease in one go, and there is no need for the patient to rush to the hospital every three days.

The case of "return visit" is called follow-up visit in a good way, but it is actually different from normal follow-up visit.

The term "return to factory" should have been heard.

Unqualified products are sent back to the manufacturer for repair or replacement.

The number of times a product has been returned to the factory indicates that the quality of that product is poor.

In the same way, if a patient goes to a doctor to see a doctor and comes back for follow-up visits every now and then, it shows that the doctor's technical fistula.

If there are too many follow-up patients, the doctor will be reviewed by the quality control department and the medical department of the hospital, and if it is determined that the medical skills are not up to standard, he will immediately withdraw from the post of outpatient work.marginalized.

So no doctor in a regular hospital dares to joke about his future.

Moreover, follow-up visits bring very little benefit to doctors, so there is no need for this at all.

As for the large number of patients in small clinics and the high rate of return, this is generally not a waste of time.

At most, the dosage is deliberately reduced to achieve a certain therapeutic effect, but it cannot be cured at one time.The goal is to give the patient multiple infusions.

For example, the amount of medicine that can be infused in one time is deliberately divided into two or even three times.

This happens in clinics.

Anyway, Li Jingsheng never did it.

(End of this chapter)