White armor

Chapter 154 Xiehe’s cleaning aunt can diagnose

"..." Luo Hao looked back at Meng Liangren.

Meng Liangren realized that he seemed to have said the wrong thing.

Bah, bah, bah, how can you say such a slap in the face?

"Don't worry about him pretending to be poor." Chen Yong said scornfully, "I went out for surgery a few days ago and earned several hundred. Anyone else would have bought a BBA. If it were me, I would definitely buy U8."

"Trams in the Northeast are not suitable because of the serious power feed." Luo Hao said, "When the blade battery technology is improved in a few years, I will change this car to a gasoline-electric hybrid."

"There is a garage downstairs in our dormitory, and there is also a garage in the hospital. Where can we feed the electricity? Luo Hao, you should be prepared to drive it for the rest of your life."

"I'm used to it, why can't I drive it for the rest of my life?"

Luo Hao turned the key and the 307 started.

Meng Liangren felt something was wrong, but he couldn't say anything.

"to be honest."

Luo Hao saw the diagnostic assistant AI give a diagnosis, which was similar to his own judgment - bladder rupture.

"Oh, don't worry, I'll take a look." Luo Hao smiled easily.

I ate too much today at noon, and when I turned over, I suddenly felt severe pain in my upper abdomen, accompanied by nausea and vomiting.

"I haven't seen the disease yet..."

The patient underwent cesarean section under combined spinal and epidural anesthesia 6 days ago, and the operation went smoothly.

"Ronald, are you off work?"

As for other diagnoses, they are all secondary to bladder rupture, so it doesn't matter.

"Are you busy? Come to the emergency room? The daughter-in-law of a friend of mine had a stomachache after being discharged from the hospital after giving birth."

"With a large amount of ascites within one week after giving birth, and acute renal failure, the first consideration is bladder rupture."

"Director Feng, please admit him to the hospital for cystography." Luo Hao said to Feng Zixuan firmly.

"Hello Feng." Luo Hao answered the phone.

Abdominal B-ultrasound showed: (1) The right renal sinus area was slightly separated. (2) A large amount of ascites. The standing abdominal radiograph showed no intestinal dilation and free air. Abdominal puncture was performed to remove light bloody ascites.

She was discharged from the hospital on the 5th day after the operation. At the time of discharge, her body temperature was normal, her blood count was normal, her abdominal wound healed well, and her bowel movements were normal.

For Xiehe, I am tired of seeing it. Aunts who clean the house all know that a large amount of abdominal fluid and changes in kidney function within 1-2 weeks after giving birth are caused by bladder rupture.

"Huh? So heavy? Didn't you just give birth to a baby?"

"Yes, I had a caesarean section 6 days ago. I took a look when I was discharged from the hospital a day ago. Nothing happened. I went home for a day, and then I was delivered to her lying down." Feng Zixuan scratched his head.

After taking a look, it was Feng Zixuan calling.

Luo Hao first understood the condition.

It would be fine if the bladder ruptured, at least all malignant diseases could be ruled out.

Now Feng Zixuan and he don't see each other at all, and he calls directly when something happens, just like a summoner.

Feng Zixuan was speechless.

General examination: Acute painful disease appearance, whole-abdominal tenderness, rebound tenderness, positive shifting dullness, unsatisfactory palpation of liver and spleen, and no palpable mass.

"What?!" Feng Zixuan was stunned, "Okay, why is the bladder ruptured? Besides, urination was normal before discharge."

"I just got in the car and haven't moved yet."

"Ronald, my nephew-in-law's condition is quite serious. She suddenly suffered from a large amount of ascites and acute renal failure." Feng Zixuan stood in the corridor with a serious look on his face.

A urinary catheter was left in place for 24 hours after the operation, and the urine output was 2 mL. The urine was light yellow in color. The patient urinates on his own 100 hours after the catheter is removed, and thereafter urinates 3 to 4 times a day.

Feng Zixuan has never encountered this before.

[People say that a man will be a boy until he dies, but how can there be a boy...]

For "ordinary" hospitals, this is an incurable disease.

Luo Hao's cell phone rang.

"Ronald, what are your initial considerations?" Feng Zixuan asked.

He also hoped that this was the case, and it was said by Luo Hao. This was the best news Feng Zixuan had ever heard.

"Director Feng, you don't believe me when I tell you, take a look at the patient first." Luo Hao smiled.

"Okay, we'll be here soon." Luo Hao readily agreed.

When I arrived at the emergency room, the B-ultrasound doctor was still there, packing up things.

A young female patient developed a large amount of ascites and acute renal failure within 1 day...

Seeing Luo Hao's smile, Feng Zixuan felt as if a stone had dropped in his heart. He was no longer so agitated and felt confident.

Luo Hao had seen many cases of similar patients when he was a trainee in school. They were all transferred to Xiehe from the emergency department of hospitals in other places.

Luo Hao didn't care. He turned off the engine, got out of the car, and rushed to the emergency room.

Feng Zixuan hesitated slightly.

Luo Hao didn't urge him. He looked at Feng Zixuan and didn't explain directly to Feng Zixuan. He just waited for him to make his own decision.

Feng Zixuan was silent for less than 3 seconds, then picked up the phone and called the urology department.

After exchanging a few words, Feng Zixuan hung up the phone.

Soon, residents from the urology department were rushed in.

After learning about the condition, he was a little angry, but when facing Feng Zixuan, he still tried to suppress his anger.

"Director Feng, the patient had normal defecation and defecation before discharge. He ate too much when he was discharged home, so why did his bladder rupture." The resident manager explained helplessly, "It's really not our surgery's business. It's up to the nephrology department. ”

"Huh?" Feng Zixuan snorted, making the resident tremble with fright.

"Where is your director?" Feng Zixuan asked calmly, not wanting to be familiar with the hospital manager.

"I'm going home from get off work, and I'll turn around and come back halfway. I guess I'll be there soon."

"Okay, let's wait until Director Pei arrives." Seeing that the patient's vital signs were stable, Feng Zixuan was not in a hurry, so he went to comfort the patient's family.

15 minutes later, Director Pei of the Department of Urology rushed over.

"Director Pei, I think it's a ruptured bladder. I'll send it to your department for an angiogram." Feng Zixuan said.

"Director Feng, it's okay to admit the patient." Director Pei said after seeing the patient, "But I firmly deny the bladder rupture. Who made the diagnosis? We are the first hospital of a medical university and are the ceiling of medical care in the province. We are the leader. Damn, who gave you such a ridiculous diagnosis?"

Feng Zixuan listened to Director Pei's long speech and was led to the First Hospital of the Medical University itself. He took a deep look at Director Pei and then looked at Luo Hao.

Their eyes crossed and Director Pei was in a daze, but Luo Hao understood.

If you see through it, don't tell it off. If you tell it off, you won't have any friends. There are many things that just need to be done, there is no need to say anything.

Luo Hao and Feng Zixuan have this tacit understanding.

"Hello Director Pei, my diagnosis." Luo Hao smiled and came to Feng Zixuan and Director Pei.

"Doctor Luo." Director Pei frowned and looked at this young man who had been in the limelight recently.

Then, a disdainful smile emerged. Why was he everywhere? It was annoying to see him.

It’s true that Chen Yan takes care of him, but he may not be spoiled by him! It just so happened that he bumped into his own muzzle without knowing what to do, so he taught him how to be a subordinate... No, he was a team leader.

"Ronald, I'm not trying to show my seniority, do you have any basis for diagnosis?"

"Yes, the diagnosis is based on..."

"Forget it, there is no need to argue. I still say the same thing - Director Feng wants me to accept it, so I will accept it, but the patient's diagnosis is wrong and the treatment is delayed. Who is responsible?" Director Pei asked.

That is to say, there is no table in front of him. If there was a table, Director Pei would definitely snap at the table and question him sternly.

Feng Zixuan looked at Luo Hao without saying a word and with firm eyes.

"Well, since the Department of Urology does not recognize the diagnosis of bladder rupture, I will accept the patient." Luo Hao smiled, "I will write all these in the medical record. Director Pei, don't you object."

"Objection? Why should I object?" Director Pei's mouth had already turned to his ears, and he didn't care about Luo Hao's words at all.

"Chen Yong, admit the patient and prepare for emergency cystography."

Arranged by Luo Hao.

Chen Yong didn't care about any conflicts and went to the emergency medicine doctor. After chatting happily for 30 seconds, he issued a hospitalization order and the emergency medicine doctor sent Chen Yong out.

Meng Liang was dumbfounded.

What is going on in this situation?

An old doctor like him has seen similar situations countless times. He knows that it is difficult to get immediate results in this kind of thing, and people always listen to whoever talks loudly.

This is friction within the hospital. As for the result of the friction...it's hard to say.

Professor Luo seemed to be looking for death when he admitted a patient with unexplained sudden massive abdominal effusion to the hospital.

The key is that the patient also suffered from acute renal failure and was not admitted to the relevant department but to the interventional department.

What's this?
And after that?
How to write this medical record? !

Meng Liangren's head hurt from time to time.

The key is that Professor Luo also mentioned seeing things in medical records, which is a clarion call for battle between doctors.

If the medical office holds a case seminar, whoever loses will be unable to hold his head high for the rest of his life.

But in Meng Liangren's opinion, Professor Luo Haolo is more likely to lose.

When he saw Luo Hao talking to Director Feng Zixuan, he tiptoed to find Chen Yong.

"Teacher Chen……"

"No, just call me Xiao Chen." Chen Yong quickly stopped, "Lao Meng, what's wrong with you? If nothing happens, send the patient back to the ward and prepare for cystography."

Meng Liangren tugged on Chen Yong's cuffs, but before he could reach his hand, Chen Yong dodged him.

"Speak if you have anything to say." Chen Yong looked wary.

Meng Liangren let out a sigh of helplessness. This medical team seemed to be in a mess, and they couldn't even transfer the blame at the most basic level.

It is probably because Professor Luo is too young and has little clinical experience.

"Chen...Xiao Chen, why don't you go and persuade Professor Luo? He is not a patient in our interventional department, so there is no need to admit him."

"Lao Meng, Luo Hao has the final say in the medical team. There can only be one voice." Chen Yong said seriously.

Fuck! ! !

Meng Liangren was educated by the young Chen Yong.

There can only be one voice in the medical team!
This kind of principled issue is very important, but it is just a principle. In actual practice, it is completely different.

Meng Liangren felt awe-inspiring, stopped talking nonsense, and began to help Chen Yong push the patient to the hospital to prepare for cystography.

The emergency examination results showed that there were no contraindications for surgery, and the patient was pushed to the DSA room after an indwelling urinary catheter was placed.

Because the Department of Urology had a negative opinion, Luo Hao did not use their imaging room, but chose his own operating room.

"Emergency?"

As soon as he entered the operating room, Yuan Xiaoli came up to him.

"What disease?"

"Director Yuan, consider it to be a ruptured bladder. Let's do an angiogram. It's not considered an emergency. It's not considered an emergency." Luo Hao explained.

Yuan Xiaoli stared as wide as a ping pong ball.

……

"Director Feng, it's not that I don't want to accept him. The patient has nothing to do with our Department of Urology. It's not like blaming the blame. If you ask me, send the patient to the ICU. Our hospital's critical care force is very strong." Pei The director did not leave, but chatted with Feng Zixuan.

Feng Zixuan had a weird smile on his face and looked at Director Pei unabashedly, making him panic.

"Director Feng, how many years have we been together? Let me just tell you, what kind of person am I, Pei?" Director Pei could only try to be emotional, "Admit the patient. The contrast agent will increase the burden on the kidneys. If there is really no urine, "Whose responsibility do you think it is?"

"Haha, I believe in Ronaldinho." Feng Zixuan expressed his stance. Director Pei was speechless for a moment.

The fewer words, the greater the amount of information.

Director Feng Zixuan said he believed Luo Hao, but what next? He didn't believe a word of what he said. This was the subtext.

Have you offended Feng Zixuan and Director Feng recently? Director Pei is doing self-examination.

The larger the tertiary hospital, the greater the energy of the director, and the higher the possibility of saying "no" to the head of the department.

But Feng Zixuan is an exception.

Over the years, no matter which clinical director played tricks on him, they all ended up in a very tragic end.

Director Pei shuddered as he thought deeply.

"Feng Chu, tell me, is there any basis for the diagnosis?" Director Pei asked bravely.

You have become you unknowingly.

"What Ronaldinho was about to say just now was interrupted by you. I don't know if there is any basis for diagnosis." Feng Zixuan replied calmly.

Gan!
Director Pei was startled.

You didn't say anything when I interrupted you? What were you doing at that time? This is to beat himself up, Director Pei understands in his heart.

He had begun to regret that he had just admitted the patients regardless of whether they were there or not. As for future matters, Director Feng would definitely be responsible.

"Let's go and take a look." Feng Zixuan didn't say much else and called Director Pei to the interventional catheterization laboratory.

Director Pei felt uneasy, but he still couldn't help but admit defeat now.

I just got off work and was eating hot pot and singing songs. Who would have thought that I was about to be beaten by Director Feng!
Fly to disaster.

But Director Pei was still confident in the diagnosis and felt that as long as he didn't make any mistakes, Feng Zixuan would have to be more cautious even if he wanted to beat himself up.

"Director Feng, if you say a word, I, Pei, will have nothing to say. But Ronaldinho is too young, and his diagnosis is so unreasonable. I really don't understand." Director Pei was thinking about it while chatting with Feng Zixuan.

Feng Zixuan said nothing else and walked slowly to the interventional catheterization laboratory with his hands behind his back.

I put on shoe covers and a sterile surgical gown and entered the operating room.

Without a technician, cystography cannot be called a surgery, it is just an "operation".

In the operating room, Luo Hao had already injected the contrast agent along the catheter.

Several hundred milliliters of liquid were poured back.

"The contrast agent also needs to be metabolized by the liver and kidneys. The patient has acute renal insufficiency, and I am also responsible for the patient." Director Pei explained calmly.

But Feng Zixuan did not comment, and sat directly in the position of technician No. 66 and watched quietly.

The line is being stepped on inside.

On the screen, the retrogradely infused liquid with contrast agent slowly rippled in the bladder.

Although Director Pei didn't agree, he clenched his hands into fists unconsciously.

He began to be afraid for no reason.

Even if he was discharged from the hospital just one day after delivery, no matter how absurd and impossible the diagnosis of bladder rupture was, he would still be afraid.

What if.

No, absolutely not, Director Pei comforted himself.

The bladder is so flexible that it wants to rupture, except under certain circumstances.

The patient had given birth to her children and was discharged from the hospital smoothly. She had smooth defecation and defecation before discharge. This was all provided in the past history.

Unless someone deliberately hides it.

But in the hospital, this can be ruled out.

It's not like a giant white tower. If there is a conflict between doctors and directors, they would rather talk with their fists and use old punches on each other than make a fuss about the patients.

Just as he was thinking about it, Director Pei suddenly saw a trace of contrast agent "floating" out of his bladder.

I am!

impossible! !

Absolutely impossible! ! !
My eyes are dazzled, my eyes must be dazzled.

Director Pei moved closer to the computer screen, and a trace of contrast agent appeared clearly on the screen.

It's not that the eyes are dazzled, it's that the contrast agent injected along the urinary tube does overflow the bladder along the bladder leakage point, forming an image before the eyes.

how can that be!

Director Pei moved closer.

"Director Pei, you are blocking my view." Feng Zixuan said lightly.

He was not surprised or surprised, he just said with a slight hint of teasing.

"what?"

"If you get closer, you'll get stuck in the screen."

"..." Director Pei was stunned and took half a step back.

"Director Pei, I don't understand very well. I want to ask you for advice." Feng Zixuan stretched out his hand and placed his delicate fingers on the screen. "This is the contrast agent."

Director Pei nodded in a daze.

"This should be the bladder."

Director Pei continued to nod.

"Is the patient's bladder deformed? How could I remember that the bladder doesn't look like this?" Feng Zixuan asked sarcastically.

Director Pei's face turned red and he didn't know how to answer.

Luo Hao kicked open the airtight lead door, and with a "stab" sound, the lead skirt tore open and was thrown to the ground.

Meng Liangren was startled for a moment, remembering the scene of Technician No. 66 following Luo Hao to pack his things during the afternoon surgery.

He had just been shocked, but how he had a ruptured bladder after childbirth was not as important as packing his things.

Meng Liang is a self-taught person.

The old attending doctor has accumulated rich clinical experience and... clinical experience over the years.

The ability to observe words and emotions is second to none, as long as he wants to.

Now Meng Liangren must be thinking!

Following Luo Hao, Meng Liangren picked up the lead skirt.

"Director Feng, the diagnosis is clear - bladder rupture." Luo Hao smiled.

"Stab~"

Luo Hao tore open the lead coat and threw it to the ground. Meng Liangren then picked it up and hung it back to its original position.

"Haha, Ronaldinho, it's really true, how did it come about?" Feng Zixuan asked with a smile.

“Special reasons such as drunkenness, pregnancy and childbirth can cause it.

During pregnancy, the enlarged uterus compresses the urethra, causing difficulty in urination, causing overfilling of the bladder and thinning of the bladder wall. Bladder rupture can occur during delivery due to prolonged labor and increased abdominal pressure. Postpartum bladder muscle tone decreases, which affects intravesical pressure. Sensitivity is reduced and acute or chronic urinary retention is easy to form.

If not detected and treated in time, spontaneous bladder rupture may occur. "

"What about acute renal failure?" Director Pei asked in a harsh voice.

"Due to the reabsorption of urinary ascites in the abdominal cavity, blood BUN and Cr abnormally increase, resulting in pseudo-renal failure, which is an important indicator for diagnosing intraperitoneal bladder rupture." Luo Hao explained plainly, "If it is pseudo, don't worry about it. ”

“In the auxiliary diagnosis of internal and external bladder rupture, cystography is the most intuitive, important and reliable examination method for diagnosing bladder rupture.

Bladder water injection test is also commonly used to diagnose bladder rupture, but there are often certain false negatives and false positives. Generally, 200 to 300 mL of water is required. "

"As for the treatment, leave the urinary catheter in place and keep it open. If you do a cystogram tomorrow night or the next morning, the fistula will no longer be visible."

"!!!"

"!!!"

"Spontaneous bladder rupture has a very poor prognosis if treatment is delayed, and the associated mortality rate is as high as 24% if delayed for 25 hours or longer."

"But if it is discovered in time, the patient can recover on his own as long as he has an indwelling catheter."

"Why haven't I heard of it?" Director Pei asked in a low voice.

"The patient has a large amount of ascites and is accompanied by renal failure. As long as he is hospitalized, an indwelling catheter is inevitable, so the vast majority of patients improve 'inexplicably' and are discharged."

"..." Director Pei was startled after hearing Luo Hao's explanation.

He has extremely rich clinical experience and instantly thought of several cases of patients who had improved inexplicably.

!!!

So that’s it!
"Director Feng, please tell the patient's family that he will be discharged after three days of observation. Also, I have to live in the corridor with an extra bed. The conditions are not good. Please move it to a higher ward."

"Okay, it's not urgent." Feng Zixuan smiled slightly, "Xiao Luo, please write down the medical records carefully. Tomorrow morning... Director Pei, how much did you perform the surgery?"

"More." Director Pei said quickly.

"Then we will organize a study session for relevant departments at 3 o'clock tomorrow afternoon, and I will preside over it." Feng Zixuan finalized the matter.

As he spoke, the corners of his mouth raised and he looked at Director Pei.

Director Pei felt a bitter taste in his mouth.

"Director Feng, I'll get busy first."

"Go ahead. The patient will step down and go directly to a senior official. I'll contact you. There's no need to worry about the medical records. Isn't there nothing to deal with?"

"Well, just leave an indwelling catheter. It's not recommended to give antibiotics. We'll have to look at the situation first. If the blood count doesn't clear up tomorrow morning, it's still too late to give it."

"Go and do your work, it's hard work." Feng Zixuan said.

Luo Hao smiled and was not polite to Feng Zixuan.

With the "combat friendship" in India, the barrier between Luo Hao and Feng Zixuan has almost disappeared.

Feng Zixuan and Luo Hao looked at each other, their eyes intertwined, and Luo Hao nodded.

After the patient was sent away, Feng Zixuan was still sitting on the technician's chair, swaying slightly, looking leisurely and at ease.

He was not in a hurry to explain the situation to the patient's family, but just made a phone call.

Director Pei didn't dare to leave, and stood quietly aside, waiting for Feng Zixuan's next words.

"Director Pei, please check the information." Feng Zixuan said with a smile, "Don't be unable to say a word during the discussion of the medical records tomorrow. It will appear that the technical level of the urology department in our hospital is too low to be on the table."

"Crack~"

This sentence was like a slap on Director Pei's face, making his face turn red.

After Feng Zixuan finished speaking, he stood up and left.

An hour and a half later, Feng Zixuan finished his work and picked up his phone.

"Director Pei, where are you?"

"Director Feng, I went home, searched for relevant information, and asked friends from other hospitals in the group, and I learned a lot." Director Pei replied.

Director Feng smiled and shook his head.

It has been quiet for too long, and Director Pei has lost his most basic vigilance.

What's the most important thing about this?
Did it come from postpartum bladder rupture? A real misdiagnosis is here, and I am afraid it will be difficult to forget it in the future.

This is not the point, the point is Luo Hao’s medical record!
Feng Zixuan read Luo Hao's medical records.

Luo Hao's medical records were so well written that even Director Chen Yan and Chen came to ask for help.

Medical records are like a knife, and Feng Zixuan believed that Luo Hao would spend several hours polishing and sharpening the knife.

(End of this chapter)