Gou is practicing medicine in the clinic

Chapter 39

Diagnosis: Proficiency in general surgery 10.1/100.

Cool!
As long as the 'money' is in place, it really is what you want.

This diagnostic medical skill was instantly promoted from entry-level to proficient level.

He was pleasantly surprised to find that the vision of diagnosis of general surgery diseases was opened up at once.In fact, every medical student learns the same clinical theoretical knowledge. Why are there strong and weak?
In the diagnosis process, experience accumulation is one aspect, and diagnostic thinking is equally important.

With the diagnosis experience of various similar diseases, combined with the patient's symptoms, examination results, medical history, age, etc., comprehensive analysis and syndrome differentiation are carried out.

In the end, the correct diagnosis can be obtained by removing the false and seeking the truth.

It can greatly reduce the probability of misdiagnosis and missed diagnosis.

The improvement of diagnostic thinking requires accumulation and diligent thinking.

Opening your horizons is equivalent to improving your diagnostic thinking.

It gave him the feeling that after the diagnosis of general surgery has been promoted to the proficient level, the diagnosis of diseases in this field seems to have reached a new high point.

Standing at the foot of the mountain to look at the scenery before, I could only see a small part.

Now that I have climbed halfway up the mountain, the height of the station is different, and the field of vision has opened up, and I can already see more things.

Doubts, diagnostic clues, and details that were easily overlooked before can be fully seen at this moment.

There are a variety of causes of pustules on the back.

The common ones are folliculitis, diabetic patients, local injury and infection, long-term bed rest and pressure on the back and lack of hygiene...

The old man had a sudden onset. More than a month ago, he suddenly felt back pain. After a while, a large red and swollen lump appeared, and then began to suppurate.

Folliculitis, local injury and infection can basically be ruled out.

The old man's clothes are decent and clean, and he doesn't look like a person who doesn't pay attention to hygiene.

Li Jingsheng carefully searched for clues, trying to find out the real cause of the disease.

He observed the pustules on the old man's back again, and now he could see pink liquefaction flowing from the wound.There is a wisp of yellow-white liquid in the middle, which is easy to ignore if it is not extraordinarily detailed.

If he was still just an entry-level general surgery diagnostic skill, even if he saw the yellow-white liquid mixed in the pink liquid, he wouldn't care at all.

At this moment, he has proficient diagnostic skills in general surgery, which immediately attracted his attention.

"I just finished debridement at the community service station yesterday, and used anti-inflammatory and antibacterial drugs in the abscess cavity. How could it suppurate so quickly?"

Because according to Li Jingsheng's common medical knowledge, it takes at least three days for a pustule to mature and liquefy, that is, suppurate.

He immediately found a cotton swab and picked up a little yellow-white liquid.

Those pink liquids are blood and body fluids, very faint.

However, the yellow-white liquid he stirred up seemed quite viscous.

Like purulent snot, it can be drawn.

But not as viscous as purulent nasal mucus.

It can basically be concluded that this is mature pus.

What exactly is going on?

Could it be that the debridement in the abscess cavity is not in place, and there are still infected lesions remaining?

After Li Jingsheng found a thread, he seemed very excited.

As long as this old man is cured, his small clinic will become famous in the field of general surgery.In the future, it will attract a steady stream of patients with surgical diseases to seek medical treatment.

This is the type of patient he most desires.

It's not just because he has spent a lot of life and time to learn and improve many surgical skills.And not just because surgery is lucrative.

Also because surgery is easy to learn and difficult to master, not to mention in clinics, but in most primary medical institutions, even community health service centers, the operation of surgery is basically in a barren state.

Because the training of surgeons is too difficult.

The cycle is long, the threshold is high, the risk is high, and the investment is also large.

The point is, after being trained with great difficulty, they directly jumped to a bigger hospital.

Water flows to low places, but people go to high places!

Who doesn't want to have a good time?

If you have a better ability and can enter a bigger hospital, you will naturally choose to develop in a big hospital.Not only will there be more room for development, but the working environment and learning environment will be better.

Income will also be higher.

At the same time, social status and medical status will follow.

There are very few surgical patients in primary hospitals, which is one of the reasons why good doctors cannot be retained.

After all, small hospitals can only treat minor ailments such as colds and fevers, which have been deeply rooted in the hearts of the people.

"Old man, I want to open your wound and look inside. It will hurt a little. Do you need some anesthetic?"

Li Jingsheng asked the old man.

"It's okay, this pain is nothing, I can bear it."

In front of his wife, the old man showed his iron will.

"You just have to be brave! Don't scream when you're going to be in pain!"

The old lady taunted her husband by the side.

In fact, it is also a disguised concern.She definitely still wanted her husband to take anesthesia, just in front of outsiders, and she didn't want to damage her husband's dignity.

That's why I reminded you so cynically.

"Who are you underestimating? Dr. Li, it's okay, you can check it out! I promise I won't complain of pain."

The old man spoke forcefully, but closed his eyes, and then clenched his back molars, his cheeks protruding.

Li Jingsheng held back his smile and led the old man into the treatment room inside.

"Do you need a cork for your mouth?"

"What do you want that thing for, get it quickly."

The old man said impatiently.

Li Jingsheng was mainly worried that he had crushed his teeth.

The old man turned his head and saw that the door of the treatment room was closed, but his wife did not come in, his expression relaxed a lot.

He took a deep breath, closed his eyes again, and gritted his teeth.

Li Jingsheng used a sterile cotton swab to poke the incision, and the pus cavity was quite deep.

He shone a flashlight inside, looking for the source of the wisp of yellow-white pus.

The old man's body was trembling slightly, obviously in extreme pain.

The cold sweat on the forehead also kept coming out.

But Leng didn't say a word.

The main reason is that he is afraid of being heard and laughed at by his wife outside.

After a lot of hard work, Li Jingsheng found the source of the pus outflow at a superficial position about 2cm to the left of the abscess cavity.

"Strange, how did the pus flow out from here?"

He was very excited about this discovery.

At the same time, I also wondered that this position is an easy-to-operate position for surgical debridement, and the possibility of it not being cleaned up is very small.

Moreover, it had been debrided three times, and the second time was even performed by Ding Wangshou, a senior surgeon.

How could it be possible to leave a small piece of infected and suppurated tissue left untreated?

If something goes wrong, there must be something strange.

Li Jingsheng changed a long cotton swab and tried to scratch the source of the pus.

"Well!"

The old man snorted.

Teeth were clenched.

It can be seen that the tissue in that piece is slightly white, and the pus does not continue to flow out.

"It hurts a bit, bear with it a little bit! As long as you find the cause, there is a great hope that your abscess will be cured."

Li Jingsheng observed the location of the source of the pus that he locked just now.

After a while, the light yellow pus flowed out again.

Very little.

Only as thin as a hair.

If he hadn't made a diagnosis in advance and deliberately searched for the source of the pus, he probably wouldn't have found this discovery at all.

He simply checked the entire abscess cavity carefully several times.

Make sure only that spot is continuously draining pus.

"Is this a hidden sinus path?"

A flash of light flashed in Li Jingsheng's mind, and he knew that a major breakthrough had been made in diagnosis.

The real cause may well have been found.

Doctors at health service stations will definitely use alcohol or normal saline to cleanse patients when they debride wounds.

This causes the source of the pus to temporarily disappear.

Because whether it is alcohol or saline, there are strong irritants.

When cleaning the abscess cavity, the muscles will automatically contract because of the pain.

The sinus tract was forced to be temporarily closed, and no more pus would flow out.

When the patient went to see a doctor after a few days of onset, the abscess cavity was already seriously infected and pus was everywhere, and it was even more difficult to find this tiny sinus tract.

This also led to the failure of all surgeons at the health service station to discover this hidden sinus tract.

Intractable pustules arising from sinus tracts are uncommon but can be encountered clinically.

However, under normal circumstances, the sinus tract will be relatively large, and the pus drainage opening will be formed directly on the body surface.An experienced doctor can diagnose it at a glance.

The old man's sinuses were in his back, and it took a long time to seek medical treatment. The medical skills of the health service station and the examination equipment were limited, so the real cause of the disease could not be found out.

After treatment again and again, the disease just doesn't get better.

Repeatedly.

Now that Dou Dao has been discovered, this is a good thing.

But it's not too early to be happy.

If the sinus path is too deep, Li Jingsheng will definitely not be able to handle it.

In addition, his small clinic has no other examination equipment except for an outdated X-ray machine and a B-ultrasound machine.

Fortunately, high-precision instruments such as color Doppler ultrasound, CT, and nuclear magnetic resonance are not required for sinus inspection.

Combined with B-ultrasound and X-rays, it can be detected completely.

In the case of large hospitals, it is more rigorous, and often combined with laboratory data for inspection.

If it is deep in the body, such as the chest cavity, abdominal cavity and other parts, in order to find out the sinus tract at this time, sinusography may even be done.

Li Jingsheng suppressed the excitement and joy in his heart.

The opportunity to make a name for yourself is at hand.

But be sure to hold on.

You must keep calm, otherwise, if the disease is not cured, and the person is disabled or killed, then it will really become joy and sorrow.

"Grandpa, there has been a major breakthrough in the diagnosis of your cause. I found out that there is likely to be a sinus tract. Next, I need to do an ultrasound examination and X-ray examination for you. The cost of these two examinations is 200 yuan."

The old man doesn't look like someone who is short of money.

He should be able to afford the cost of these two inspections.

Li Jingsheng's inspection equipment is always a bit old, but it must be pointed out that it is not.

"Great. Sure enough, I came to the right place. As long as you cure me, it will not be a problem to give you an extra 1000 yuan in red envelopes. No... [-] yuan is still a little less. I will give you an extra [-] yuan." red envelope."

The old man is very rich.

Bang bang bang!
When the old lady heard that her husband was spending money again, she knocked on the door frantically.

"Old man, let's get the disease cured first. People's hospitals don't allow doctors to accept red envelopes now, so don't hurt their doctors."

The old lady is also somewhat quick-witted.

This excuse is high-sounding, it will not make Li Jingsheng unhappy, and it will prevent her husband from giving Li Jingsheng an extra red envelope of 2000 yuan.

Men are generous and women are stingy, this is almost innate.

　The promised additions were delivered two days ago, and I would like to thank all readers for their great support.Brother Jiang added a new chapter to show his heart.

　　
　
(End of this chapter)