Gou is practicing medicine in the clinic

Chapter 258 The disease that stumped Dr. Shao, Keshan disease
Wound healing has a lot to do with the doctor's technique.

The incisions are neat, the debridement is good, the suturing is excellent, and then the infection is controlled, and the healing will be fast.

Otherwise, even if it takes fifteen days, let alone five days, initial healing may not be possible.

If the skin graft becomes necrotic, a second surgery will definitely be required.

Because the wound of this operation is in the mouth, the environment is humid, and there will be food residues after eating, these are unfavorable factors that affect wound healing.

Therefore, the quality of iodoform gauze packaging also determines the success or failure of the operation to a certain extent.

For Li Jingsheng, this operation has added a lot of surgical experience and is also a major improvement in his personal surgical ability.

For an operation, technical skills alone are not enough; details must be done well.

A big job had just been completed here, and Li Jingsheng was about to sit down and take a rest when he heard Dr. Shao greeting him.

"Dr. Li, there is a patient here with a strange condition. I'm not sure. Please take a look for yourself."

Dr. Shao now speaks to him with great respect.

"What's wrong with him?"

Li Jingsheng got up and walked over to have a consultation with Dr. Shao, which is also a respect for the elders.

Dr. Shao is much older than him, so he must be treated with enough respect.

This is also a courtesy to talents.

"Nothing wrong with me, just dizziness and vomiting."

The patient took up the conversation himself.

This is a 46-year-old male patient who looks pale and listless.

His speaking voice was also weak.

"Dr. Shao, what is your initial diagnosis?"

"The patient reported that he started to get sick last night. At first he thought he had caught a cold, but then he felt more and more uncomfortable. He went to the pharmacy to buy cold medicine and took it, but it didn't get better. He started vomiting again this morning and took two more cold capsules. By noon, he was still sick. It didn’t go well, so I came to our clinic for treatment. I thought it was a viral cold at first, but after listening to his explanation and combined with his symptoms, I felt that it didn’t look like a cold.”

There is no doubt about Dr. Shaobing’s strength.

There are relatively few diseases that Dr. Shao finds difficult to diagnose.

Some diseases have a sudden onset and the initial symptoms are highly similar to those of a cold, but they are not a cold.

Cold treatment will be ineffective if followed.

It may even lead to irreversible tragedy.

"Have you taken his blood pressure?"

"No! I just took the temperature, low fever, 37.2 degrees."

Dr. Shao replied.

After hearing this, Li Jingsheng decided to take over the patient himself.

"Come over there! Let me take your blood pressure first."

Calling the patient over, Han Siying happened to be in the operating room to help with the tidying up.

"Master, are you encountering a difficult case?"

"Dr. Shao suspects that this patient's illness is not a cold. I'll check it out on him. You're here just in time to measure the patient's blood pressure."

She measured the patient's blood pressure. The high pressure was 89mmhg and the low pressure was 70mmhg.

Normal blood pressure for adults, systolic blood pressure is between 90 and 139.

This patient's systolic blood pressure was only 1mmhg lower than the normal value, and logically, it can be considered normal.

After all, in clinical diagnosis, doctors with a little experience will not be dogmatic.

Like this, it's completely flexible.

Li Jingsheng frowned slightly.

His current doctor level has reached the deputy chief physician, and his cardiovascular internal medicine diagnosis has reached a small achievement. He has a high sensitivity and accurate judgment on various cardiovascular diseases.

Judging from the big brother's stout figure, he is obviously not a desk person.

Most of what I usually do is physical work.

It stands to reason that such a strong man cannot have such low blood pressure.

Their systolic blood pressure can often reach over 110.

Because in the process of doing physical work, their hearts and blood vessels have been well exercised.

"Have you ever had a physical examination?"

Li Jingsheng asked.

He wanted to compare the patient's previous physical examination data.

"No."

The patient shakes his head.

Heavy manual laborers earn hard-earned money. Their working environment is poor and their health is not guaranteed.

Many people are satisfied as long as they can get a salary.

As for buying social security, medical insurance, and arranging for a physical examination every year, they simply don't dare to expect it.

Perhaps shaking his head aggravated the patient's dizziness, so he covered his mouth and quickly got up to look for a trash can.

It can be seen that this is a very honest and honest big brother.

I felt extremely uncomfortable. I was vomiting and wanted to throw it into the trash can so as not to stain the floor.

Li Jingsheng quickly took the small garbage basket beside him and placed it next to the patient.

"Just spit it out, it'll be fine."

As soon as he finished speaking, the patient covered his chest hard and began to vomit.

Frightened, other patients and family members frowned and distanced themselves.

Who knows if this is an infectious disease?
Li Jingsheng saw the patient retching for a long time and only vomited some yellow water.

Some people describe severe vomiting and always say, "I vomited all my bile out."

The sour and bitter liquid is not necessarily bile.

It could also be acid in the stomach.

But if the vomiting is severe, the bile can indeed be vomited out.

"Here is paper, wipe your mouth!"

Li Jingsheng handed over the tissue.

"Thank you! I'm sorry!"

The eldest brother vomited a bit violently and his voice was a bit hoarse.

"It's okay, it's okay. You're sick. It's the same for everyone. Did you vomit this kind of yellow water the last few times you vomited?"

"It wasn't the first time. Everything after that seemed to be yellow water."

"Besides dizziness, nausea, and vomiting, are you feeling uncomfortable anywhere else?"

"It seems like my breathing is a little stuffy, but it's not bad."

"Did it start suddenly last night?"

"Probably! I felt a little uncomfortable before I even had dinner. I thought I was working shirtless, so I scrubbed my body with cold water and then caught a cold."

At this point in the consultation, Li Jingsheng began to think deeply.

It's not a big problem if you take cold medicine and it doesn't work.

If you have a severe cold or take the wrong medicine, or if you buy fake cold medicine or generic medicine produced by a small factory, you may have poor efficacy.

He synthesizes the patient's symptoms, medical history and other information.

Symptoms include low blood pressure, vomiting, nausea, dizziness, mild chest tightness, and vomiting yellow water.

Low blood pressure became the focus.

Patients may have symptoms of hypotension before onset,
It is also possible that the blood pressure dropped sharply after the attack last night.

Li Jingsheng launched a diagnosis of two hypotheses.

A rare disease that once roamed the country and gradually disappeared came into his mind.

It is quite useful to read more books at ordinary times.

It can prevent him from running out of food when encountering such difficult cases.

In the future, he will definitely continue to stick to the good habit of reading, work hard, and accumulate richer medical insights and knowledge.

"I'll give you an X-ray to see what's going on inside the chest. Can you take a look? I initially suspect that your disease may be related to the heart or cardiovascular system." Li Jingsheng asked the patient for his opinion.

"can."

The patient readily agreed.

"Examinations at our clinic are all charged separately. X-rays or B-ultrasounds cost 100 yuan each time. Please scan the QR code to pay."

Han Siying is becoming more and more qualified now.

I know that I persuade patients to pay the examination fee.

For boss Li Jingsheng to bring up this kind of thing, it seems a bit low-priced.

It is proposed by the nurse or medical assistant so that the patient will not have a bad impression of Li Jingsheng.

Some patients are more sensitive and the doctor asks for a fee for the examination before they have finished the treatment. This will make them think the doctor's appearance is ugly.Just thinking about making money.

This can significantly reduce mutual trust between patients and doctors.

“I don’t know how to scan the QR code, can I pay in cash?”

"Yes!"

Han Siying took one hundred yuan from the patient and handed it to the cashier.

Tang Ping is now mainly responsible for the cash register.

In fact, there is very little cash accepted, and most of them just scan the QR code to pay.In order to save the salary of a cashier, Li Jingsheng never hired a separate cashier.

Each clinic employee is available to handle cashiers when necessary.

But the person who reassured Li Jingsheng the most was Tang Ping.

Even Xiao Gao and Li Jingsheng were on guard.

Money and silk move people's hearts, and this has been the case since ancient times.

Rather than waiting for them to make a mistake and then firing them or even sending them to a bureau, it is better to take precautions in advance and not give them the opportunity to make mistakes.

Small clinics are no better than big hospitals, and it is not easy to recruit every employee.

Each of them is a rare talent in Li Jingsheng's heart.

So he cherishes it very much.

After taking the patient for a chest X-ray, Li Jingsheng found that the patient's whole heart was enlarged to a certain extent, and there was local stiffness at the edge of the shadow of the heart, and the heartbeat was weakened.

After making these discoveries, he became more certain that the patient suffered from what is commonly known as "vomiting yellow water disease".

Also known as Keshan disease.

This is a rare cardiovascular disease that can cause heart failure and even blood clots. If not treated in time, death will occur quickly.

Many of the patient's symptoms were basically consistent with Keshan disease, and now the chest X-ray showed that the whole heart was enlarged.

There is also stiffness at the edges of the heart shadow.It can be preliminarily concluded that it is undoubtedly the disease.

There is currently no conclusion on the cause of this disease.

Medically, it is believed to be closely related to selenium deficiency.

However, the etiology is unknown in many patients.

And the disease is divided into at least four types, including acute, subacute, chronic and latent.

This patient should have acute Keshan disease.

Fortunately, taking cold medicine was ineffective, so I rushed to the clinic for treatment in time.

Fortunately, I met Li Jingsheng, a brilliant doctor who is good at diagnosing cardiovascular diseases. Otherwise, the consequences would be disastrous.

But if he meets Dr. Shao, an old doctor like Boss Zhao, he probably won't be in any danger.

They were all extremely vigilant.

The patient will definitely be sent to a large hospital for further examination. It is impossible to treat the patient rashly just to earn 200 yuan.

"I initially suspect that your disease is acute Keshan disease, because this disease can easily lead to death if not treated in time. I can try to give you medication. If the effect is still not good, then you must go to a large hospital for further treatment. do you think it's OK?"

Li Jingsheng asked patients for their opinions.

"What is Keshan disease?"

"It is what is commonly known as yellow water vomiting disease among the people. It is a cardiovascular disease. I just took a X-ray and you can see that your whole heart is significantly enlarged. If the treatment here is effective, your symptoms will soon improve after taking the medicine. .”

"Okay, please give me some medicine to try. Is it expensive?"

This is the first time the patient has asked about the price.

"It's not expensive now, but if you have a shock or even a severe case and you need to be sent to the hospital for emergency treatment, the cost will be very expensive. You may even be admitted to the ICU. Spending money is a trivial matter, and the key is to save your life."

Li Jingsheng said.

"Then give me treatment! If I don't have enough money with me, I'll call someone to deliver it. I have a wife and children at home, and an old mother to take care of. I can't die."

The eldest brother is a very down-to-earth person.

Put the entire family responsibility on your shoulders.

"Well, I will try my best to treat you, and there is no need to put any psychological pressure on you. Now I have rich experience in treating various Keshan diseases. Generally, as long as you receive timely treatment and intervention, the chance of it becoming severe will be low."

Li Jingsheng asked the patient to wait in the infusion room.

The patient was quickly prescribed medication.

Treatment is mainly given in several aspects.

First, be quiet. The patient's body must be quiet, which will help reduce the burden on the heart.

After careful consideration, he did not use diazepam as a sedative, but instead used chloral hydrate.

Second, use drugs that enhance cell metabolism, such as coenzyme-A and cytochrome C.

Third, maintain the patient's body temperature. He does not need to remind him of this. The patient has already put on a coat.Moreover, the clinic is now equipped with air conditioning, and the temperatures in the reception hall, infusion room, and medicine purchasing area are all very suitable.

Fourth, treating patients with heart failure.

Li Jingsheng was extremely cautious in using this medication because the patient had heart failure and had a low tolerance for drugs such as digitalis.

After careful consideration, he chose a very small dose and decided to observe the effect before further medication.

Fifth, take a large amount of vitamin C supplements.

This measure is often used for the treatment of acute Keshan disease, especially rescue.

After Li Jingsheng thought about it for a while, he decided to add 25% glucose solution intravenously to the patient's first dose.

I don’t dare to use too much, and I don’t dare to use too little. Take about 35ml.

After writing out the prescription, I asked Tang Ping to check it out.

After she saw it, she smiled and said, "The boss's current prescription level is much better than mine, and he asked me to check it. This is a disguised reminder to me. He wants me to read and study more after get off work, so as to improve the prescription level!"

"Haha, it's good that you have this awareness. People should live to learn. Our clinic now has two nurses. Meng Luo is good at surgery, and you are good at treatment. The important task of administering medicine to patients basically depends on you. "

Li Jingsheng had no objection.

Tang Ping is his old employee and subordinate, and now her salary is higher and more stable.

But we can’t forget the hard days of the past.

Let her progress along with the clinic and become the top level in the nursing field.

"Follow the order! Hehe..."

She covered her mouth with a chuckle and walked away.

Whether it’s a woman or a man, income is the best nourishment.

Tang Ping now looks more confident than before, her personality is more cheerful, and her temperament has become more outstanding.The appearance seems to have become more beautiful.

Still so young and with a child, it would be better if she found another man.

It's so hard for a woman.

Based on her conditions, it is absolutely possible to find a man with good financial conditions.

Li Jingsheng couldn't open his mouth about this kind of thing.

I can only wait until there is a suitable opportunity to mention it in the future.

She must have been hurt and scared by her ex. She has become extremely distrustful of men and is afraid to find a new man.

After giving the medicine to the patient, Li Jingsheng felt a little uneasy and asked Tang Ping to watch the patient closely.

If something is wrong, you must immediately send it to the hospital for emergency treatment, or take other measures.

Until Li Jingsheng got off work, close to [-]:[-] in the evening, the patient did not feel any discomfort after taking the medicine.

Instead, his complexion improved little by little.

When it came, it was pale and bloodless, which was very scary.

Now a trace of blood has returned.

The blood pressure was measured again, and the systolic blood pressure had risen to 102mmhg.

not bad.

"Brother, how do you feel now?"

Li Jingsheng asked the patient.

"The medicine here is very effective, much more effective than the cold medicine I take. Now I don't feel dizzy, I don't feel nauseous, and my chest doesn't seem to be so tight. It's just..."

The patient hesitated.

Li Jingsheng, Tang Ping and others felt their hearts tightening after hearing this. Could there be new symptoms?

"It's just that I haven't eaten all day and I feel very hungry. I have been staying in the clinic for observation for so long. Can I leave now?"

The patient's words amused everyone.

This big brother is really a real person!
"Yes, absolutely. If you feel any discomfort at night, remember to go to the hospital or call me. If you eat food, try not to eat spicy food." Li Jingsheng warned with a smile.

The patients were sent away and everyone got off work.

Li Jingsheng was leaving for three days, so he made a special statement to several employees.

Especially Tang Ping.

During his absence, Tang Ping had to take his place as the boss.

Fortunately, the Sunshine Clinic is now very stable, and it has become a close friend of its colleagues in the old streets in the south of the city. No one dares to bully it.

Nothing should happen.

"Master, I feel so happy for you! Someone has brought you food."

Han Siying reminded in a low voice.

Li Jingsheng looked up at the door and saw Ou Qinglan standing at the door carrying packed meals.

"It's from the hospital cafeteria, so I know you haven't eaten yet!"

"Master Wife, I haven't eaten either!"

Han Siying is getting more and more naughty.

He even joked with Ou Qinglan.

"Find your boyfriend to solve the problem!" Ou Qinglan now looks much more generous than before.

She no longer blushes easily when the clinic staff makes fun of her.

"Forget it, I'll find a way to solve it myself! Goodbye, master and wife!"

Han Siying waved her hand and walked away carrying her white canvas bag.

Although her monthly income is not low anymore, she still carries her rucksack every day, and she has never changed her clothes.This little girl is very frugal. She is many times better than those vain girls who borrow money to buy designer bags and iPhones.

Li Jingsheng knew that she had great ideals and ambitions.

I want to save money, work as a trained doctor in the People's Hospital, and take the Ph.D. exam in the future.

Such a good and motivated girl with a high level of understanding made Li Jingsheng, Tang Ping and others very fond of her.

……

Li Jingsheng was going to represent the Second Hospital in the city's skills competition tomorrow, so he warmed up to Ou Qinglan for a while and then sent her home.

He went to bed an hour earlier than usual.

Sufficient sleep must be ensured, so that you can have the energy to beat your opponent tomorrow.

Not long after falling asleep, he was awakened by a sudden ringing of the phone.

Thinking that the patient with Keshan disease had something wrong, he suddenly woke up more than half of the sleepiness, and quickly connected.

"Hello!"

"Uuuu...Master, I seem to be in big trouble."

Han Siying's crying came from the other end of the phone.

"Don't worry, don't worry, what happened? Are you okay now?"

Li Jingsheng knew that she was a girl and lived far away.

If you get off work later, it will take more than an hour to commute, which will make it even later.

She is so frugal that she is never willing to take a taxi.

Buses are crowded every day.

"Woo... When I was going home just now, the same man suddenly pulled me from behind. After I broke free, he chased me again. I ran away upstairs to the dormitory, but he was still chasing after me. Then I sprayed him with the anti-wolf spray you gave me. As a result, he covered his face and eyes, screamed and fell off the balcony."

Han Siying's voice was vibrating.

This should be a very scary moment.

"First call the police, call 120, and I will rush over right away. When the police come, you can directly say that the man wanted to do something wrong to you, and you only resisted out of fear and sprayed him with pepper spray."

After all, Li Jingsheng had experienced a lot of things. After hearing this, the first thing he thought about was not caring about that man's life or death.

Instead, help her find ways to avoid liability.

The victim cannot be allowed to pay for the perpetrator's illegal behavior.

He has seen many such things in the news and in reality.

These days, many anti-homicide cases involve the victim paying money to the perpetrator.Because the perpetrator is dead or disabled.It's certainly not fair.

(End of this chapter)