Gou is practicing medicine in the clinic

Yesterday, when he first saw the child, he suspected that it might be appendicitis.

It's just that when I pressed the child's abdomen today, the tenderness was not obvious.Especially the tenderness in the right lower abdomen was significantly reduced.

Could it be that the child has improved after treatment in the hospital yesterday?
I took the child's temperature today and found that although he still had a fever, it had dropped to 38.2 degrees.It means the fever has started to subside.

If the anti-infection and anti-inflammation are effective, the pain will indeed be relieved after the local lesions are controlled.

But the child's blood pressure is unchanged from yesterday.

He began to suspect that the child's high blood pressure was not directly related to the disease.

It would obviously be much easier to diagnose them separately.

The child's symptoms progressed, he thought, more consistent with acute appendicitis.

If it is really acute appendicitis, and the child is such a young child, the probability of perforation is extremely high.

If not treated promptly, it can lead to acute peritonitis, sepsis, etc., which are fatal.

He was going to investigate this case in depth.

After arriving at the hospital, he parked his bicycle and called Xiao Linlin directly.

"Sister Xiao, after consulting my clinic yesterday, a child came to your department for consultation again. The three-year-old boy has symptoms of high blood pressure, abdominal pain, vomiting, fever and other symptoms..."

He told Xiao Linlin about the child's condition.

"What's the child's name? I don't even know the child's condition. It should be treated and handled by other doctors."

"The child's name is Chen Huan. He should come to your gastroenterology department later. I suspect that the child has acute appendicitis, but when he came to my clinic for examination this morning, the abdominal pain was significantly relieved. If possible, I might do a rectal examination. Better."

Li Jingsheng explained the general situation.

"Okay, let me ask. I know how to treat the patients you greet personally, so don't worry."

It's so easy to talk to a mature and smart woman.

There are many things that Li Jingsheng doesn't even need to say explicitly.

……

At around [-] noon, Li Jingsheng was still busy treating patients, and Xiao Linlin took the initiative to call him.

"Dr. Li, would you like to come to the inpatient department of the Department of Gastroenterology after lunch? The child has been admitted to the hospital. A digital anal examination was performed. A mass was touched in the front right corner of the rectum, and the tenderness reaction was very obvious. Your The diagnosis is probably correct. The child may not have acute gastroenteritis, but acute appendicitis. Now the child's condition is progressing rapidly, and I am a little worried that something may go wrong.

The cause of the child's high blood pressure has never been found.

You are also involved in cardiovascular diagnosis, so you just come over to help take a look. "

Xiao Linlin felt a mass in the right front through a digital anal examination, and there was obvious tenderness. The disease had actually been detected.

Consistent with Li Jingsheng's initial diagnosis, it can be basically concluded that it was appendicitis.

The early symptoms and signs of appendicitis in children are similar to those of mesenteric lymphadenitis and acute gastroenteritis, and it is very easy to be misdiagnosed and mistreated.

"I'll come over and take a look later. Since I've felt a mass on the right front and the sick child's condition is getting worse, can we consider doing an abdominal puncture to check the situation?"

Li Jingsheng felt that Xiao Linlin should also be able to think of this.

Clinically, the rate of intestinal perforation in children under five years old with appendicitis is as high as 44.5%.

In fact, it is even higher than the clinical statistics of 38%-44%.

This child had severe tenderness when he was examined yesterday. However, when he was examined today, the tenderness was not obvious anymore.

It could also be because a perforation has occurred.

Abdominal pain is severe when the appendix is ​​swollen.After perforation develops, the pressure in the appendix cavity is relieved, and the abdominal pain will be temporarily relieved.

But in this case, the scope of abdominal pain will expand.

Li Jingsheng was unwilling to accept the child for treatment in the clinic because of this.

If the child really has a perforated appendix, it also means that peritonitis has developed.

At this time, the danger to life will become more and more urgent.

"That's why I asked you to come over! I'm convinced by the two family members. The nurse sister and the intern doctor said they have dried up their saliva, but they just don't agree to do this abdominal puncture. Seeing the child's condition progressing and deteriorating, I am anxious It’s terrible, the family members don’t know how to worry at all, I’m really angry to the point of having a stomachache.”

Xiao Linlin also expressed her bitterness when talking about the two family members.

If Li Jingsheng hadn't greeted him personally, she probably wouldn't have wanted to care about it.

"These two confused family members, I will come over in a minute. Sister Xiao is going to eat first. I estimate that this sick child will soon be transferred to a general surgery department for surgery. Don't make yourself angry."

Li Jingsheng really wanted to scold those two confused family members.

"You are so comforting!" she scolded with a smile.

After the two ended the call, Li Jingsheng continued to deal with outpatients.

Not bad, the last one was a sprained and displaced ankle with a minor navicular fracture.After repositioning, just leave it to the student to apply the plaster.

He hurried to the cafeteria to eat.

He was really happy, Ou Qinglan had already prepared food for him.

As long as she helped to prepare the food, she would grab the best meat dishes every time, euphemistically saying that she wanted to make Li Jingsheng fatter.She also said she likes boys with meat.

Li Jingsheng actually knew very well that she just cared about him in disguise.

I only have time to look at messages on my phone when I'm eating.

"Jingsheng, the son of Secretary Bei has turned a corner. Several directors of the Department of Intensive Care and Neurology said that the child is very likely to die, and the fatality rate of acute viral encephalitis is very high. This time it is a fungal cryptococcal infection, and it is difficult to detect it in time. Find out the real cause. If the cause is found out later, the child's prognosis is likely to be very poor."

Director Lian Tao of the People's Hospital sent him good news.

The mortality rate from acute encephalitis is very high.

Children suffering from this disease have a higher mortality rate.

Li Jingsheng made a great contribution in rescuing Secretary Bei's child.

I will probably thank him individually later.

"This is the good news I heard today." "Looking at your tone, you have encountered another difficult case?"

"That's right. There is a three-year-old boy. I diagnosed him with acute appendicitis. Now his appendix may have perforated, causing peritonitis. But the child's parents refused to do abdominal puncture. I had to rush over to do some thinking after dinner. Work."

"This is not a difficult matter. Some family members are ignorant and stubborn. If you just tell them it's serious, they will be honest."

Lian Tao gave him advice.

"Haha, then I will try to play the role of the King of Hell after dinner later. Isn't it strange that such a young child has high blood pressure, low pressure and high blood pressure? At first, I thought it was related to abdominal pain, fever and other symptoms, but now it has basically The diagnosis of acute appendicitis shows that the child's high blood pressure is not directly related to the current disease. Please help analyze it."

Li Jingsheng took the opportunity to ask him for advice.

"Let's check for congenital heart disease!"

"The physical examination records before the child was two years old showed that the blood pressure has always been normal. The possibility of congenital heart disease is very small."

"Then check your child's food. These days, many mothers like to learn parenting knowledge, which is originally a good thing. However, they accidentally joined some drug sales groups, were sold by scammers, and stupidly helped count the money. Some scammers Under the guise of supplementing children with calcium and vitamins, improving immunity, or improving children's intelligence, some medicines that are not suitable for children are sold to mothers.

After eating, it can easily cause various adverse reactions in children. "

Lian Tao has richer clinical experience and has seen more strange phenomena.

Li Jingsheng was provided with an investigation direction.

"Brother Tao, thank you! With your reminder, I think we are probably not far from finding the truth."

Li Jingsheng felt that the child's mother was most likely the one Lian Tao mentioned.

Because she mentioned that she learned a lot about parenting.

He also said that the child had never been to the hospital.

"Honey, we took 15 minutes to eat, but you only left 2 minutes for me. Can't you work less?"

Ou Qinglan complained.

"I will definitely pay attention next time. But there is nothing I can do about it. When a patient sends a message, I have to answer it. Even the director and others discuss and exchange medical issues with me, and I still have to answer it. By the way, I have some good news for you. I also have a paper that was included in a core medical journal, although I am only the second author, it is still a big breakthrough."

The paper Li Jingsheng mentioned was published by Luo Binggang and Wang Weiwei together with him.

He is the second author.

This is very satisfying.

After all, he hadn't reached that level yet, and it was Luo Binggang and Wang Weiwei who were taking him flying.

"Really! It's such a happy thing, I have to celebrate it tonight. I'll treat you to the hotel of your choice."

After hearing this, she felt very happy for her boyfriend.

"Are you ready to book a room?"

Li Jingsheng asked her with a smile.

"Believe it or not, I'm going to hit you? Your words are getting more and more rude."

Her bright eyes glared at him fiercely, which was a warning.

"You are wrong. We can also rent two rooms!" Li Jingsheng argued.Seeing her eyes becoming more and more fierce, he quickly changed the subject. "If you really want to celebrate, I will buy some midnight snacks and go back to the clinic later in the evening to treat you to a feast. Forget it, go to the hotel to eat. Let's save some money and leave more money."

Just after eleven o'clock in the morning, he received the text message notification he had been dreaming of.

Let him prepare to go over and handle the subscription procedures for that small courtyard next Wednesday.

The deposit paid was exactly what Dean Fu said, 100 million.

Other expenses were not mentioned, but Li Jingsheng knew very well that the 50 management fee and the taxes on buying a house were unavoidable.

He had already prepared this money.

I hope the balance can be paid later.

Give him another two or three months and he should be able to get it together.

"Coming on a bicycle?"

"Ride!"

"I will go to the clinic with you on your bicycle in the evening."

"No problem. Are you choosing to be the girl laughing on the bicycle?"

Li Jingsheng asked her with a smile.

"The enemy! Haha..."

After saying that, even she laughed.

She is really the negative example who would rather laugh on a bicycle than cry in a BMW.

"I have to rush to the gastroenterology department, how about you?"

"I will definitely go back to the orthopedic surgery office! There are still two disease courses to be completed, so I have to hurry up and finish them, otherwise I won't be able to get off work on time."

she replied.

For resident doctors, writing medical records and disease courses should be the most time-consuming and nerve-wracking thing.

Some people are lazy and will use templates to cope.

This is actually very bad.

Writing medical records and disease course is also a serious reflection and summary of a case, which can be regarded as an accumulation of clinical experience.

When Li Jingsheng rushed to the gastroenterology department, he happened to see the child's father.

Standing in front of the nurse's station and consulting something.

It's just that the nurse didn't pay much attention to him.

"Doctor Li, you are here!"

The child's father looked very excited and happy when he saw Li Jingsheng. (End of chapter)