Gou is practicing medicine in the clinic

Because no obvious lesions were found in the large intestine, Director He applied procaine sealing and hot compress to the root of the mesentery.

However, the range of small intestinal lesions is very large, and it is very difficult to formulate a surgical plan.

It’s impossible to cut out all these small intestines, right?
Director He must have thought deeply before putting the intestinal tube back into the abdominal cavity, and asked his doctors to sew the patient's skin to close the abdominal cavity.

In other words, cutting open the patient's stomach does not actually involve any substantial surgery.

Doing this is somewhat irresponsible.

In other words, fear of taking responsibility.

It’s really hard to evaluate.

In fact, similar situations like this patient’s occur from time to time.After the doctor opened the cranial cavity or abdominal cavity, he found that it could not be treated or the operation risk was too great, so he sewed it back up.

First of all, whether it is an abdominal or thoracotomy, as long as the incision is made, the harm to the patient will be very great.

The purpose of abdominal dissection is to resolve the disease.

Almost no real effective solutions were taken, and the abdominal cavity was closed. The patients and their families were afraid that they wanted to die.

I was already sick and my body was in a bad state.

Is it a joke to open up the abdominal cavity and not treat the disease?
The key is that after the patient was returned to the ward, less than four hours later, three to four hundred milliliters of dark red liquid was discharged from the anus.

The patient's blood pressure immediately dropped, his consciousness became blurred, and he vomited a large amount of brown liquid.

Urine output was also significantly reduced.

This series of symptoms taken together is a very bad sign.

Because the patient's condition has reached this stage, it is possible that the condition will continue to deteriorate at any time and then die.

Li Jingsheng finally understood why Director Bi would choose to call him overnight and lower his head for help.

I believe Director Bi must have sensed the danger.

"Did you check your urination routine?"

After reading the patient's basic condition, Li Jingsheng looked up at Director He.

The whole process of reading the information is not long, only about 3 minutes.

He knew very well that He Qingzhi was probably extremely anxious right now.

"Which urination routine are you referring to? Admission or post-operative?"

"It must be after surgery!"

Li Jingsheng could tell that Director He was in chaos and had no master.

Otherwise it would be impossible to ask such a mentally retarded question.

"Here, here!"

He Qingzhi asked Li Jingsheng to check on the computer.

If you want to print a patient's examination report, you generally need to go to the self-service machine in the outpatient clinic to print it.This requires entering the patient's card number or swiping the ID card, which is more troublesome.

The family members must be in a particularly bad mood right now, so it's best to bother them less.

Li Jingsheng pulled the examination report to see that the patient's urea nitrogen was 33.8mmol/l, creatinine was 249umol/l/, serum potassium was 3mmol/l, sodium was 144mmol/l, and chlorine was 96mmol/l.

When Li Jingsheng saw this result, the first thing he thought of was acute renal failure.

"This seems to be kidney failure! Is there any medicine to treat it?"

Li Jingsheng asked.

Furosemide is generally used.

"Yes, I gave the patient a large dose of furosemide and other drugs on the spot, hoping to help the patient resume urination."

After all, He Qingzhi is a chief physician, so his skills are certainly not bad.

Is it possible that I don’t know how to perform some basic rescue operations?
"How is the effect? ​​Is urination normal now?"

"Oh, it would be nice if it was normal. After taking the medicine, it still has no effect, and I even have anuria."

He Qingzhi shook his head and sighed.

He picked up the thermos cup, opened the lid, raised his head and took two big gulps of tea.

I don't know if I want to use tea to calm my irritable heart, or if I instinctively want to drink more water and urinate.

It’s just that no matter how much water he drinks, he can only urinate on his own!

The patient still cannot urinate.

"How long has it been since the patient stopped urinating?"

"Almost over eleven hours."

"Then his condition is very dangerous. Why not consider a second laparotomy and perform surgery? There is obvious intestinal obstruction, and there are multiple small intestinal segment obstructions, and the scope is so wide.

If left untreated, no urine is normal. "

When Li Jingsheng asked this question, he really didn't feel pain in his back while standing and talking.

But with a problem-solving attitude.

"I have thought about cutting his intestines. It's just such a wide range of small intestinal lesions. Which section do you cut? Do you cut all of them?"

He Xianzhi asked rhetorically.

"At least find a way to unblock the patient's intestines so that the patient can be rescued. You definitely don't need to cut it. You can't do it unless it's absolutely necessary."

The human intestine is very long and the small intestine is thin.

But the small intestine plays the absolute main role in nutrient absorption.

Cutting out a small section of the small intestine may have little impact on the patient's postoperative life.

But cutting out most of the small intestine, or even an entire section of the small intestine, would be a joke.

The patient's subsequent nutrient absorption will basically be impaired.

Even after the operation, how will the patient survive in the future?

Does taking nutritional injections every day cost you your life?
He Qingzhi did not dare to cut randomly, which was both irresponsible and responsible.

This is not a contradiction.

To say that he is irresponsible is to put the intestines back in without doing any substantive treatment.

If you feel it is difficult to handle during the operation and are unsure of the surgical plan, you can just seek consultation with someone!

Li Jingsheng didn't know much about the department of general surgery.According to his experience in the First Hospital, the larger the department, the more severe the involution.

It’s not office politics, it’s competition.

Because there are only so many places for further education in a department, including directors, deputy directors, advanced individuals, etc.

If you want to achieve something, or even grab your favorite spot, you must defeat a lot of competitors.

At this point, unity basically disappears.

After He Xianzhi had a laparotomy, if he encountered problems, he should have invited other chief doctors to consult and discuss them together.It's very possible that you can't just ask others to do so.

You can easily dismiss him by saying, "I really can't leave now."

Li Jingsheng can imagine this kind of thing.

"What's the patient's current temperature? Doesn't he have a high fever?"

"Here, this is the latest data from the patient's physical examination."

Director He Qingzhi showed a handwritten piece of paper to Li Jingsheng for review.

The body temperature is 37.2 degrees, which is low fever.

Heart rate 104 beats/min.Breathe 24 times/min.Blood pressure is a key point, with systolic blood pressure of 151 and diastolic blood pressure of 79.

Isn’t it said that the blood pressure has decreased?
It seems it has gone up now.

Judging from the patient's blood pressure, there should be no risk of death for the time being.

"His blood pressure rose so high because he completely stopped urinating, right?"

Li Jingsheng thought of a possibility.

"Correct."

He Qingzhi didn't dare to be too sure, and seemed a little unsure when answering.

Li Jingsheng carefully recalled what he had just seen in the ward. The patient had a painful expression.

"Is the patient conscious now?"

"There is no problem with his sanity. Ask him questions and his answers will be normal."

Generally, as long as the orientation is normal, it can be judged as clear mind.

Li Jingsheng began to think about the patient's current condition.

Acute renal failure is the first consideration.There is also the possibility of intestinal segment necrosis after mesenteric vascular obstruction.

The temperature in the abdominal cavity is actually quite high.

In patients with low-grade fever, the duration of intestinal segment necrosis tends to be shorter.

It has been more than ten hours since the patient's surgery, and the possibility of necrosis has also increased significantly.

In addition, the problem of toxic hepatitis in patients must be considered.

The patient is anuric, which causes large amounts of toxins in the intestine to be absorbed into the bloodstream, which can worsen acute renal failure.

"Dr. Li, do you have any diagnostic suggestions?"

He Qingzhi was so anxious that he stamped his feet.

Taking the initiative to ask is also a sign of being impatient.

But he was really anxious.

"I have three tentative diagnostic opinions: acute renal failure, intestinal necrosis, and toxic hepatitis. If I want to make suggestions, I must find a way to confirm whether there is indeed intestinal necrosis.

In terms of rescue, the patient's severely diseased intestinal segments or even necrotic intestinal segments are removed.

This should be necessary. "

Li Jingsheng gave a suggestion, but he found that Director He obviously didn't want to do it.

Had to come up with an alternative plan.

"You can also consider intestinal decompression and drainage surgery."

"That's okay. I need to perform intestinal decompression and drainage and have another laparotomy. I'm a little worried that the patient and family members will curse if I keep doing it."

When He Qingzhi said this, his face turned slightly red.

As a chief physician, he is very old. When treating patients, he messes up his sense of proportion and is scolded by patients and their families. He must be a little reluctant.

Instinctively want to avoid this situation.

"We have come to this point and have been scolded by the family. If the problem can be solved, I think it is worth it. If you wait until the patient dies, the family will apply for a medical malpractice appraisal, then go to court and go to the competent authorities. Your Whether my career can be saved is a question mark."

Li Jingsheng explained the interests to him.

I really don’t know what Director He is thinking. At this point, why are you so desperate to save face?

If you do something wrong or fail to do it well, you must stand upright when you are beaten.

The more you are afraid of being scolded and dare not act, the more trouble you will end up in.

"Okay, I'll make arrangements immediately! Although the time I chatted with you just now was very short, I can see that you are a young doctor with real abilities. Director Bi asked you to help me. Can you help me to the end and stay? Do consultations and surgeries together?”

He Qingzhi looked at Li Jingsheng cautiously like a child.

Ask for his advice.

"Don't worry. Since I'm here, I will help you solve the problem even if I sleep in the hospital tonight. This patient's condition is very dangerous. I suggest that if the conditions are met, it is best to have a second laparotomy immediately. . Before that, you can also make a good surgical plan. But I think it will be more accurate to wait until after the laparotomy and check the patient's abdominal cavity before formulating the main surgical plan."

Li Jingsheng suggested that he perform laparotomy on the patient immediately.

Entering the palace for the second time is a bit embarrassing.

No doctor wants it, but I have to go to the palace when I need to.

"Thank you Dr. Li! One thing I can assure you is that even if the patient does have an accident, you, the doctor who helped, will not be responsible for all the responsibilities. I will take the responsibility and will never burden you."

He Qingzhi was quite moved after hearing this.

It also provided a guarantee to Li Jingsheng.

"Hurry up and make arrangements! I will check the patient's information again and sort it out."

"Okay! You can pour the water yourself. If you are hungry, there is food here."

He Qingzhi took out some meat floss cakes, put them on the table, and left in a hurry. (End of chapter)