Gou is practicing medicine in the clinic

Chapter 177 Diagnosis of Lobular Pneumonia, Immediately Extinct

"Siying, think about this case carefully, it should be of great help to improve your clinical diagnosis thinking."

Li Jingsheng turned his head to look at Han Siying beside him.

"Uh-huh!"

She has already begun to think about dialectics.

Li Jingsheng began to do some necessary physical examinations for the child.

Body temperature 38.7 degrees, moderate heat.

The child does not have diarrhea, but has experienced vomiting due to severe coughing, which is retching.

Lift up the child's clothes, you can see the collapsed abdomen and clear ribs, this child is very thin.

"It's too thin, you need to feed your child more nutritious food!"

Li Jingsheng said to his family.

"Ok."

The middle-aged woman nodded in agreement, but she didn't mean what she said.

I can understand how hard it is for this family.

She just called this child the fourth child, indicating that her family probably has more than four children.

For families with good economic conditions, it is not easy to support four children.Her difficult family will only be more difficult.

It is not bad to let the children read and eat well.

How is it possible to drink milk for children every day, and there are big fish and meat every day?

Li Jingsheng auscultated the child's heart and lung sounds.

The crackle of blister rupture can be clearly heard.

After finding out this step, Li Jingsheng already had some doubts in his heart.

"Siying, come and listen to his lung sounds."

She took over the stethoscope, and she was very unfamiliar with the operation, and she looked 'clumsy' everywhere, feeling a little flustered.

Even because of being too nervous, the position of auscultation was wrong, and no lung sounds were heard, which made a joke.

Under Li Jingsheng's guidance, she mastered the basics.

"I heard it, a very rough voice."

She said.

"Listen carefully, are there any other sounds? Or remember the child's lung sounds. In addition, many patients have obvious differences between the left lung sound and the right lung sound. You have to distinguish carefully."

Li Jingsheng is not a good teacher.

But for this motivated and simple female medical student, he is willing to train her as much as possible.

A doctor's energy and time are limited, and he cannot treat several patients.

Only by training more doctors can the domestic demand for medical treatment be met.

The current medical situation in China is that people who suffer from drought die from drought, and those who suffer from floods die from waterlogging.

It is difficult to find a bed in small hospitals, and there are many queues in large hospitals all night, and it is difficult to find a bed in many large hospitals.

Even patients with very serious conditions meet the admission criteria, but there are no beds, so they can only wait.

With Han Siying's medical background and motivation, as well as her demonstrated learning ability, I believe that as long as she enters a big hospital in the future, she will definitely not be bad.

When she needed help and teaching the most, it was fate that Li Jingsheng helped her like this.

As long as she is not a white-eyed wolf, she will definitely remember this mentor-student relationship.

When Li Jingsheng needs help in the future, she will do her best to help.

"I seem to hear a strange sound, like the sound of friction, and it's like... the sound of bubbles bursting!"

Her talent is really very good.

So many things can be found so quickly.

"Remember that voice?"

"Ok!"

She nodded.

"The abnormal lung noise you hear is wet rales. Pay attention to distinguishing their subtle differences. Like this child's wet rales are relatively heavy, and they belong to the sound of large blisters bursting. The lighter ones are moderately moist Rales, there is also a milder one that needs to be heard carefully, which is a fine moist rale. There is also a sound similar to crepitus, which is also a wet rale.

Finally, you have to pay attention to distinguishing the parts and differences of sounds.Novices tend to confuse it with the cardiophrenic fricative..."

Li Jingsheng taught her these clinical techniques seriously.

It cannot be learned at all in textbooks, because theoretical knowledge is described in words.Only in this kind of real combat can you easily distinguish which sound is wet rale, which is dry rale, and which is dry and wet rale at the same time after listening to it a few times.

It can also be seen from here that Li Jingsheng's level is N times higher than hers.

After all, Li Jingsheng himself worked as a resident doctor in the compound for several years, and later relied on the attribute panel to upgrade the Hu Nei diagnosis to the Xiaocheng level.

Under normal circumstances, she may need more than ten years of clinical accumulation to reach Li Jingsheng's current level.

It's also because of her talent.

"I initially suspect that your child's lungs have a problem. I need to check a chest X-ray. The fee is [-] yuan, just for the inspection fee. Do you think it's okay?"

Li Jingsheng asked his family members.

"Yes! I'm sure I believe you when I come here. There will only be more checkups in big hospitals."

The woman with four children must have been to a big hospital.

She feels that the clinic is much more affordable than the hospital.

It took Li Jingsheng more than 20 minutes to make the film, and he wanted to smash that grandfather's phone.

Now that I have some spare money, and I have the status of a doctor in the Second Hospital, I have the opportunity to build a good relationship with the logistics department of the hospital, and maybe I will have the opportunity to buy an obsolete X-ray detection equipment.

Based on my feeling, the hardware facilities of the Second Hospital should be quite good.

The clarity of X-rays taken by patients in orthopedic surgery is really excellent.

This grandpa phone will be cheap to deal with at that time.

After taking the film for the child, he already had a relatively clear diagnosis in his mind.

In the cardiophrenic angle area and inner zone of both lungs, there are small patchy shadows with increased density, with blurred borders, darker density in the middle, and lighter edges.And the density is uneven.

The density is uneven and flaky, which is caused by the doping of inflated alveoli.

From the above X-ray findings, it can be judged that the patient is probably pneumonia.

The lung markings were obviously thickened and the edges were blurred.

This indicates that there is extensive alveolar inflammation covering some thickened lung markings.

Then through the film, it can be seen that there are two atelectasis of the lung.

Combined with the patient's multiple symptoms, Li Jingsheng's final diagnosis was lobular pneumonia.

At the beginning of the physical examination, I thought it might be lobar pneumonia, but now with the help of X-ray examination, the result is clearer.

It is undoubtedly lobular pneumonia.

Lobar pneumonia is often caused by bacteria invading from the airway and staying in the alveoli directly, with a single alveolar as the center, and then widely spread to adjacent alveoli through Kong's foramen, eventually forming lobar inflammation.

Lobular pneumonia is caused by bacteria invading the bronchi and trachea from the upper respiratory tract, causing inflammation, and then spreading to the alveoli.

To put it bluntly, it is bronchial pneumonia.

Li Jingsheng's treatment for patients is mainly anti-infection treatment, cooling and expectoration.

"Does the child have a history of penicillin allergy?"

Before prescribing the medicine, he asked the family members.

"I do not know!"

How could the family members know this?

There is no way but to do a skin test.

Lactam and macrolide antibiotics are the first choice for Li Jingsheng to prescribe.

Pathogens cannot be checked, so probability theory can only be used to test drugs.

In fact, even if the pathogen can be detected, large hospitals will also make adjustments and replace other drugs if they find that the effect of the drug is not good.

"Temporarily prescribe medicine for three days for the child, preferably in the morning every day for infusion. It is recommended to get some nutritious food for the child after returning home."

After Li Jingsheng prescribed the medicine, he once again mentioned strengthening nutrition for the child.

……

When it was past eleven o'clock, two staff members from the Drug Administration came.

After entering, with a sullen face, he began to check the over-the-counter medicines in the clinic, but found no problems, and then asked for the procedures for taking medicines.

Li Jingsheng has no loopholes at all now, so he is not afraid to investigate.

"Damn it, it must be the owners of the seven pharmacies who reported me."

I don't know if the seven people reported together, or a certain family reported separately?
The two staff members of the Drug Administration checked very carefully, obviously wanting to find out something wrong.

Li Jingsheng was very calm.

There is a real problem, that is, the magic city Youyao came out to clean up the mess.

Such a big company must have good strength, and there should be strict quality control in terms of quality and evolution channels.

Watching two staff members of the Food and Drug Administration check this and that at the counter greatly affects the customer's perception.

Customers and patients didn't know about it, and thought there was something wrong with the clinic.

At this time, Li Jingsheng's cell phone rang.

It was Director Hua calling.

"Doctor Li, is it convenient to answer the phone now?"

"Convenient and convenient! Please tell me!"

What Li Jingsheng was most worried about was that something happened at the clinic, and something happened at the hospital.

"It's like this. You have made a great contribution to the successful rescue of yesterday's rescue case and the department's avoidance of a catastrophe. The department is in great need of an outstanding doctor like you who is brave, knowledgeable and capable. Our department at noon There is an important difficult case consultation, is it convenient for you to come and participate? It should be of great help to improve your orthopedic clinical diagnosis ability and study treatment plan."

Director Hua is here to show his kindness.

Li Jingsheng made a great contribution yesterday, so he couldn't help but show it!

Taking Li Jingsheng as a key talent training department, this is the best reward.

For the department, it is also a win-win situation.

It not only cultivates excellent talents, but also improves the strength of the department.

"I'm afraid I can't get away now! Two staff members from the Food and Drug Administration have come to check in my clinic for more than 40 minutes. I have to stay in the clinic to deal with it."

Li Jingsheng told the truth.

He is very happy to have this opportunity to participate in the consultation of difficult cases.

But I can't go away!
"People from the Food and Drug Administration inspected your clinic? Is it a routine inspection or only for your family?"

After hearing this, Director Hua expressed concern in his tone.

There is also a hint of anger.

"It seems that it is not a routine inspection. The car is parked at the door, and I will check it directly when I come in. Maybe my clinic has sold more health medicines than usual these days, which caused dissatisfaction among colleagues and reported me."

Those with pinkeye, that's really annoying.

"Let me settle this matter for you. You are a doctor in our Second Hospital now, and you have to see the owner when you beat a dog. Your clinic doesn't sell expired or banned drugs, right?"

Director Hua directly stated that he wanted to help him settle the situation.

And the tone is quite firm.

The head of the department is amazing!

Li Jingsheng couldn't help thinking of the weirdness of this area in the south of the city again.

Only the Second Hospital and a third-level hospital exist. Lao Zhao warned Li Jingsheng not to try to make it bigger.

Analyzing from another angle, the influence of the Second Hospital in the area of ​​medical care and medicine seems to be beyond imagination.It should also have extraordinary influence in the administration.

Li Jingsheng doesn't understand these matters of the upper class.

Just be a little fish silently.

"I promise to operate legally, and I haven't done any of those illegal things."

Li Jingsheng secretly rejoiced, fortunately, after the first newspaper, he noticed a potential crisis, self-examined and corrected, and had filled up some loopholes.

"Just wait!"

Director Hua hung up the phone immediately after speaking.

Less than ten minutes later, two staff members of the Food and Drug Administration seemed to have been notified and left in a hurry.

After searching for a long time, I did not find any problems.

Li Jingsheng ordered a box lunch and ate with three employees.

While we were eating, the stationmaster Joe came driving a BMW.He stopped at the door without fear of violating regulations and fines, so he hurried in.

It can be seen that the stationmaster Qiao has a serious face and is very unhappy.

"Hey, Joe Station Master, you are here! Please take a seat!"

Li Jingsheng wondered in his heart, could it be that he didn't listen to the call from the stationmaster Qiao, and sold health medicines intermittently, which annoyed the stationmaster Qiao?
As soon as the people from the drug supervision department left, the station master Qiao immediately came over with a sullen face. This is why Li Jingsheng was not found out, very upset?

"Did the people from the Drug Administration come to check on you just now?"

Joe, the station master, was not polite, with a dark face.

"Correct!"

Li Jingsheng was also not sure what the stationmaster Qiao meant?
"These bastards clearly want to give me eye drops. Don't worry, I will give you an explanation for this matter. Also, I didn't know about this matter beforehand. Give me some time, and I will find out. Who If it's not good for you, it means you can't get along with me, Qiao, and I'll smash his job."

After Qiao stationmaster finished speaking, he drove away in the car.

It's very different from the calm and majestic Joe stationmaster in the usual days!
Today's Qiao stationmaster, more like a distraught, angry image.

After pondering for a while, Li Jingsheng understood a little bit.

It is very likely that Director Hua found someone to deal with this matter, and then the Second Hospital blamed Stationmaster Qiao on his head.

Maybe the stationmaster Qiao really didn't know, but it's useless to say it, so he staged this image of "anxious Zhang Fei".

Less than an hour later, the stationmaster Joe called.

"It has been found out that it was Boss Cheng of Huimin Pharmacy who reported you. But don't worry, this matter will give you a satisfactory explanation immediately. The pharmacy dared to take care of the affairs of our medical institution. It's really disgusting." killed them."

Stationmaster Qiao was obviously still angry.

"Thank you!"

Li Jingsheng really didn't know what to say.

Boss Cheng of Huimin Pharmacy reported him, which was not a surprise.

After all, that idiot was a little bit desperate at the Sunshine Clinic yesterday.

Around four o'clock, Boss Zhao came in person.

Today's Lao Zhao is different from usual. He is sweating profusely, the front and back of his collared T-shirt are soaked with sweat, and his face is a little red.

It seems that this is a long way!

"Brother Li, come out to see something."

Standing outside, he waved at Li Jingsheng, looking at Li Jingsheng with a rare look of fear.

It is the kind of trembling that comes from the depths of the soul.

"Look at what?"

Li Jingsheng had no patients on hand at the moment, so he went out to stare at Boss Zhao.

"Did you see the Huimin Pharmacy? Three cars from the City Supervision Bureau surrounded it, and the surname Cheng is over."

Li Jingsheng subconsciously looked at the location of Huimin Pharmacy, which was more than 150 meters away, so he couldn't see it clearly.

A few city supervisor's cars could be vaguely seen parked in front of the door.

What a quick move.

Li Jingsheng couldn't help but tremble, it's better to hang out in the old street in the south of the city!
It turns out that it is so easy to wipe out a pharmacy or clinic.

This is not something that power alone can do.

It is an invisible, intangible, but real powerful force.

When Li Jingsheng joined the Second Hospital, he became a member of this interest camp.

In other words, the entire medical and pharmaceutical industry in the south of the city is in the same interest camp.

Anyone who dares to break the rules will be killed.

"The person surnamed Cheng went through many twists and turns, wrote a report letter, made a report call, saying that your clinic sold illegal and expired drugs, and said that someone took it a while ago and had an accident. The city supervisor will not listen to him. What nonsense, I didn’t expect the drug supervisor to be tricked by him for some reason. Hmph, thanks to the fact that he has opened a pharmacy here for nearly four years, he doesn’t even know who is in charge.”

A sharp light flashed in Boss Zhao's eyes.

"There is one more thing. I was also entrusted by others. I can say a few words. Boss Liu, who is opposite me, came to your pharmacy yesterday and had a little conflict with you. She asked me to tell you. She can swear to God that she She absolutely did not participate in the reporting of the Sunshine Clinic. After a while, she is going to treat you to a meal and make amends in person.”

Boss Zhao is a person who can't move when he sees a beautiful woman.

Now I'm helping that Boss Liu with a message, as a peacemaker, if I say that I didn't get any benefits, I wouldn't believe it.

"You old Zhao opened up about this matter, I believe it. Please tell the stationmaster Qiao, I am very satisfied with the result, thank him for upholding justice."

Li Jingsheng had seen the strength of the Second Hospital.

With the status of a doctor in the Second Hospital, it turns out that he can be so "horrific".

Of course, he is not an ordinary doctor of the Second Hospital, but a special talent who has been appreciated by Director Hua and specially hired by the Second Hospital.

It cannot be argued with common sense.

After seeing off Lao Zhao, Li Jingsheng sent a message to Director Hua.

"Thank you, the matter has been satisfactorily resolved."

"If you're polite, I'll see you. Remember to come to work in the hospital tomorrow."

Director Hua looked quite young, but he replied to text messages faster than young people.

"haha ok!"

When Li Jingsheng replied to the message, a knowing smile appeared on the corner of his mouth.

It's so cool to eat on your own.

Patients came to seek treatment one after another, and Li Jingsheng kept busy until around 40:[-] in the evening, and finally finished his work.

Today's income from diagnosis and treatment is not bad. I received one bone setting, one trauma suture, and several other cases.

Zero and zero total, close to a gross income of [-] yuan.

This is because Li Jingsheng is too kind, prescribing less medicine if he can.

According to the set of the Kuaikang clinic, the gross income in a single day may reach 8000 yuan.

Selling a piece of health care medicine is still going up, selling more than 4000 yuan.This was due to the investigation by two staff members of the Food and Drug Administration for nearly an hour, which had some impact.

Otherwise, it should have sold a little more.

Some customers saw the staff of the Drug Administration inspecting the drug, and they were afraid of problems, so they postponed the purchase of drugs or simply went to other pharmacies and clinics to buy them.

As long as no problems are found, the impact is minimal.

"Clean up and get off work! Siying, the clinical knowledge I learned today must be carefully summarized when I go back. Every mature doctor accumulates and grows step by step in this way."

Li Jingsheng will go to work in the Second Hospital tomorrow.

Although he has already prescribed medicines for several follow-up patients, he is still worried about changes in the patient's condition.

If the condition changes, the prescription must be adjusted.

I still have to find a way to recruit a certified doctor in order to be freed.

The glass door was pushed open, and Fatty Zhang from the People's Pharmacy personally led the two of them and brought in four cardboard boxes.

It says high-end imported fruit.

Fatty Zhang smiled all over his face, "Boss Li, I was a little impatient when I came to negotiate with you yesterday about selling medicine. Please bear with me if there is anything wrong. These are a few boxes of durians. Please don't dislike them. They are my little things." Mind."

　Thank you readers 1674597666915164160 for rewarding and supporting, thank you very much.

　　
　
(End of this chapter)