Gou is practicing medicine in the clinic

Chapter 405 Mature doctors think more comprehensively, is rat poison a strong poison?
The surgery hasn't even been done yet, but Ou Qinglan is directly said to be the hero.

This shows that there is a lot of reliance on Li Jingsheng in this operation.

"Dr. Li, this patient has an osteoma on his vertebrae, and has osteoporosis and compression fractures. We are currently planning to perform percutaneous vertebroplasty on the patient after osteoma removal."

Professor Wu introduced the basic situation of the patient.

No wonder Professor Wu attaches great importance to this operation and has high hopes for it.For the second group with poor performance, such a patient is definitely a rare opportunity.

Bone cement is not widely used.

It is generally the elderly who choose this medical technology.

Just imagine, putting cement into the body, no matter how safe doctors say it is, there are still very few people willing to try it.

Li Jingsheng took a look at the patient's surgical site.

With his knowledge of the human skeleton, he could almost tell at a glance that the patient's vertebrae had been fractured.

As for tumors, they can only be diagnosed after feeling the bones.

This operation is extremely difficult to perform, and Professor Wu's team cannot cure it even if they work together.

Li Jingsheng's surgical skills have been continuously improved, and he is now capable of taking on important tasks.He was able to perform the most difficult tasks of incision, separation, and resection in this operation.

There are also fracture repairs. With his help, the safety will be greatly improved.

The quality of fracture repair is even more guaranteed.

……

Li Jingsheng helped Professor Wu complete the operation and hurried back to the outpatient clinic for consultation.

Already more than ten minutes late.

Fortunately, the doctors under my command are very capable and can comfort the patients.

Li Jingsheng rarely encounters problems with reset techniques.

If even he can't reset it, it means the patient's problem is very serious.Other doctors will most likely be unable to reset it as well.

And his bone-setting medical skills are still improving.

But after reaching proficiency, it is already very difficult to advance.

We can only accumulate over time and slowly upgrade.

Besides, his current bone-setting skills are completely sufficient for the time being.

The saved health points need to be used to upgrade other medical skills.

After Li Jingsheng returned to the clinic, he quickly got into work.Handle various patients one after another.

Not every patient has a fracture.

Some are bone diseases, while others are just soft tissue injuries.

Basically he can cure it.

Every time a patient is cured, Li Jingsheng's heart will be filled with a sense of accomplishment and very happy.

Just like a person suffering from obsessive-compulsive disorder, he hopes that every patient who comes to him for treatment can be cured and left.

"Doctor, please help my husband see if his lumbar disc can be cured?"

A woman in her 30s pushed her husband into the outpatient clinic in a wheelchair.

Li Jingsheng touched the bones with his hands.

"His lumbar disc has prolapsed!"

The third and fourth intervertebral discs of the lumbar spine are prolapsed.

If his hand is not injured, it can be cured.

There is no cure now.

Because this requires both hands to perform the technique at the same time, and there are very high requirements for the force point, strength, angle, and the coordination of both hands applying force at the same time.

"Can it be treated? We came here from far away."

the woman asked hopefully.

"I'm sorry. Not only does he have a prolapsed lumbar disc, but he also has scoliosis of the knee. It's too difficult to restore it manually. I can't cure it at the moment."

Li Jingsheng did not ask the patient to wait for half a month before coming back.

Because doctors must be responsible for their own words and deeds.

If the patient listens to him, he can go home and wait.If you die during this waiting process, or your lower body is completely paralyzed, who is responsible for this?

He is already a mature doctor.

He would not say anything that would be risky or misleading to patients or their families.

After hearing this, the woman's face turned a little pale.

The male patient is sitting in a wheelchair with a slightly numb expression.

Maybe this wasn't the first time he heard a doctor say there was no cure, but he had heard it so many times that he was already used to it.

"I heard that you have excellent medical skills. We came all the way here. Can you try to treat my husband? Even if he can't be cured, I won't blame you."

"Sorry, if the problem is in the limbs or a lower-risk part, I might be able to try it. The problem now is the lumbar spine, and the risk is too high. I really can't try this."

Li Jingsheng refused again.

"OK, thank you!"

The woman looked sad and pushed her husband away.

After the patient left, Jin Yanyu asked with some confusion, "Teacher, weren't you able to treat this kind of patients before? Is it because you can't treat them now because of the arm injury?"

"Yes. It takes a lot of effort to treat this kind of intervertebral disc prolapse. Especially when the patient also has scoliosis, the risk is very high. In the future, if you encounter patients who are too high-risk and beyond your own capabilities, you must not be careless. Try. It’s easy to go terribly wrong.”

Li Jingsheng looked at several students and warned them.

To create a famous doctor, it takes ten years or even a lifetime.But it only takes one mistake to destroy a doctor.

"Why didn't you tell your family just now that you could wait for your hand to heal and then notify them to come over?"

"First of all, I'm not sure when my hand will heal. Secondly, if I tell patients they can wait at home, they will lose a lot of choices. If they can't get a cure after asking here, they can ask and try elsewhere.

It would be better to wait until my hand is healed before calling the patient to ask if he has been cured. "

Li Jingsheng's attitude towards Jin Yanyu has obviously improved a lot now.

In the past, if this kid had dared to ask questions like this, he would never have been able to explain so patiently.

He might even scold Jin Yanyu for being troublesome.

"I learned something again today."

Jin Yanyu nodded.

Others also had the same thoughtful expressions.

A good teacher can bring out batches of good students through words and deeds.

He went on to treat other patients, not to mention.

……

After finally getting off work, he was still thinking about the patient with blood in his stool.

People come from far away to seek medical treatment at his clinic. If he can diagnose, he will do his best to help patients diagnose the cause.

After get off work, sitting in a taxi, he looked through the patient's information.

ALT and AST, the two data are 42u/L and 31U/L respectively.

The normal values ​​of alanine aminotransferase and aspartate aminotransferase are between 0 and 40U/L.

The value for women is a little lower, about 35 or less is normal.

This patient's alanine aminotransferase exceeded 40U/L, which is an abnormal data.

But it doesn't exceed the standard value by much.

Even if the patient's liver function is somewhat abnormal, it is only slightly abnormal.

Logically speaking, it should not cause coagulation abnormalities in patients.

"Unfortunately, my clinic does not have a laboratory, otherwise we could try to use normal plasma to correct the prolonged coagulation problem."

His eyes flashed, and his mind was thinking of every possible way to diagnose the cause.

If prolonged coagulation can be corrected with normal plasma, it indicates the presence of pathological anticoagulant substances in the patient's body.

Although there was no way to do this experiment, the patient had an abdominal ultrasound at the county hospital.

The possibility of cirrhosis and acute liver failure is basically ruled out.

Abnormal coagulation function is often caused by abnormal coagulation factors.

Based on some of the patient's examination data and various symptoms, Li Jingsheng concluded that he was still worried about the liver.

When he returned to the clinic, the patient with bloody stool was still waiting for him.

"Dr. Li, I finally meet you!"

A young man and a 27-year-old woman saw him walking into the reception hall and stood up almost at the same time.

The young man recognized Li Jingsheng himself at a glance, indicating that he must have seen him somewhere.

The other party is from out of town, and the only way to know Li Jingsheng is to watch his Douyin videos or see his work photos on the Internet.After all, he is a figure who has appeared in newspapers and TV news. It is not difficult for patients or family members to see his photos.

"Hello, hello! I happen to be having a consultation at the Second Hospital today, so I'm not at the clinic. I'm really sorry."

Li Jingsheng shook hands with the young man and woman.

The patient was an older man and clearly not the two.

"It's okay, we didn't make an appointment with you before we came. I saw news about you on the Internet. You helped the paralyzed female patient find the cause of the disease that had not been found for 11 years. I just wanted to bring you My father came over to try his luck.

It would be best if we could find out the problem, but if we really can't, we have left our contact information at Qiaobang Hospital. When beds become available, I will send my father there for treatment. "

The young man looked only 24 or [-] years old, but he seemed quite mature and very eloquent.

"My brother really believed in your clinic. I couldn't convince him, so I brought my dad here."

The woman interjected at the right time.

"Thank you for your trust, I will try my best. This is your father, right?"

Li Jingsheng looked at an old man being supported by a woman.

Sitting in the chair, things looked bad.

"Yes, this is my dad. He had blood in his stool for a while, but he didn't tell us. Later I found out that he had bought medicine outside, but it had no effect. After discussing it with my brother, I quickly took him to the county seat Hospital treatment.

I just treated it there for a while, but it still didn't feel better.

Later, the doctor there talked to us and asked us to be transferred to a provincial hospital. "

The family members briefly introduced the situation.

Their father is now 57 years old, barely considered an elderly person.

The vast majority of the elderly are similar and do not want to go to the hospital for treatment when they are sick.I just buy some medicine myself and take it to deal with it.

For them, as long as it doesn't hurt, they can endure it.

Until one day I couldn't hold on any longer, collapsed, and was taken to the hospital by my family.

Often, some elderly people suddenly faint at home and are rushed to the hospital.In fact, many elderly people have been ill for a long time before they fainted.

It's just that they hide it from their children and refuse to talk about it.

Li Jingsheng put on his mask and squatted down to check on the old man.

He found the old man sitting on a chair and his body was shaking.The hands, in particular, were shaking quite badly.

"Did your dad's body tremble like this before he got sick?"

"No. I have never seen him like this before. Even though he is 57 years old, a person can cultivate more than ten acres of land, and he can throw a bag of eighty or ninety kilograms of rice onto his shoulder and carry it away. .”

When the young man talked about his father, he admired him very much.

As children, the people you admire most when you are young are your parents.Because their parents gave them a warm home and sheltered them from wind and rain.

Children will naturally think that their parents are the most capable people in the world.

Before the patient was ill, there was no body tremor.

I'm shaking so much now. Is it because I haven't eaten, is my body shaking due to hunger, or is it because I'm sick?

If it is caused by illness, could it be caused by damage to the brain nerves?

For example, if you are infected by viruses, some encephalitis, and meningitis, you may have symptoms of abnormal body shaking.

When Li Jingsheng examined the patient's body, he found that there were large subcutaneous ecchymoses on the patient's inner thigh.

Is this extensive subcutaneous bleeding?

"lupus!"

A disease suddenly appeared in Li Jingsheng's mind.

Lupus manifests itself in many forms, and it can also cause blood clotting abnormalities.

It was only after examination that he finally ruled out lupus.

There was no rash on the patient's body, and no obvious blisters, damage or other abnormalities were found on the mucosa in the mouth.

Diagnosis is in trouble again.

"Have you done any blood tests at Qiaobang Hospital?"

Li Jingsheng asked his family members.

"After checking, the results were similar to those of the county hospital. Later, the doctor also screened the blood and urine for poisons and said they were negative."

The woman logged into the Qiaobang Hospital APP and showed Li Jingsheng the test results.

"Does your dad usually stay home alone?"

"Yes! My brother and I have both bought a house in the city and settled down. We want to take him to live in the city, but he always says he is not used to it. We have no choice but to let him. Usually he is alone. At home, he cultivated more than ten acres of land, raised several pigs, two cows, chickens, and raw eggs. He was never willing to eat them himself. He always left them for me and my brother..."

As she spoke, the woman's eyes became red.

He took out a tissue and wiped his tears.

The love between relatives is indeed hard to let go.

Especially when facing life and death, family love is even more precious.

"Uncle, can you talk to me?"

Li Jingsheng looked at the patient and saw that the old man's eyes were slightly dull, but he should be able to think.

The mind should be clear.

"Yes!" The patient nodded.

It just seemed like it was a little laborious when speaking.

"Do you usually have chronic diarrhea?"

"what?"

The patient doesn't understand very well.

The woman repeated it to the old man in dialect, and then the old man understood.

"No."

The old man's head was shaking and shaking as he spoke.

Li Jingsheng looked at the woman, "When you went to Qiaobang Hospital for treatment, did you tell the doctor about your father's specific symptoms?"

"I must have said it!"

"Show me all the test results over there. My small clinic has limited conditions and cannot do many tests."

Li Jingsheng explained.

Qiaobang Hospital will most likely conduct the experiment using normal plasma to correct the disease.

Sure enough, he soon saw the inspection.

The results are out.

There are abnormalities in a number of coagulation factors. The patient is deficient in FII, FVII, and FIX, and some coagulation factors are completely normal.

After reading this result, Li Jingsheng was slightly shocked.

It shows that the patient is deficient in vitamin K-dependent coagulation factors.

How can a normal person, who is doing well, suddenly become deficient in vitamin K?

The function of vitamin K is to carboxylate the glutamic acid in the activation site of proteins dependent on it, including FII, FVII, VIX and FX, as well as the protein S and protein C structures, into Y-carboxyglutamine through carboxylase. acid.

It then binds to calcium ions and becomes activated.

It has now been basically determined that vitamin K deficiency causes abnormal coagulation factors.

This should be the culprit that causes patients to have blood in their stools and urine.

Clinically, when it comes to vitamin K deficiency, I believe any doctor with a little experience will think of a drug.

Its name is Shuduqiang.

This poison was developed by humans to deal with rats.

After rats eat it, it will cause abnormal blood coagulation and eventually die.

It is also toxic to humans, poultry, and livestock.

Could the patient accidentally ingest rat poison?

However, the blood and urine poison screening tests were all negative.

This once again put Li Jingsheng's diagnosis in trouble.

Vitamin K, which can be provided by some foods, is a fat-soluble vitamin.

In addition to being provided by food, there is also a part synthesized by intestinal cells and then absorbed by the small intestine.

If the patient was not poisoned by accidental ingestion of rat poison, could there be a problem with intestinal absorption?
The small intestine cannot absorb vitamin K synthesized by intestinal cells?

There is such a possibility.

"Does your dad have diarrhea now?"

Li Jingsheng faced the disease and remained indomitable.He constantly tried his best to investigate all possible possible causes.

(End of this chapter)