Doctor’s Life Simulator

Dr. Liu looked at the simplified version of the puncture instrument that Qin Lang took out, and now he was outside the hospital. He really had no confidence at all, and when his old face turned red, he refused:

"Doctor Qin, you look too high.."

Before Dr. Liu finished speaking, he saw Qin Lang evacuated the crowd and let them out, and then began to position the patient.

"Could it be that he wants to go up on his own?"

Dr. Liu was immediately stunned, good guy, I didn't let myself do it.

While Dr. Liu breathed a sigh of relief, he was also a little disappointed, but, when did he learn to perform abdominal puncture?

In my impression, I explained paracentesis to him last time. Could it be that this kid listened to himself and then went back to review and watch the video, and then he came down?

This is impossible, Doctor Liu squatted down suspiciously and watched Qin Lang's operation.

After watching Qin Lang put the patient in a good position, he began to determine the puncture point.

Qin Lang chose the lateral border of the right rectus abdominis very accurately. The junction of the right anterior superior iliac spine and the umbilicus was routinely disinfected with iodophor, and then connected to a 9-gauge needle with a 20mL syringe.

Because it is outside the hospital, it is not as formal as the hospital, but in emergency care, it is flexible and changeable.

Under Qin Lang's sterile gloves, the left hand fixes the skin of the puncture site, and the right hand holds the needle and pierces the abdominal wall vertically through the anesthesia area.

Looking at Qin Lang's operation, Dr. Liu took a deep breath. This kid really knows it, and why does he feel more skilled than himself?

In the shock of Dr. Liu, Qin Lang not only performed routine puncture, but also used a more high-end technique. In order to reduce the continuous infiltration of ascites after the operation, mobile puncture was used!

"No!"

Looking at Qin Lang's high-level skills, Dr. Liu's head was a little dazed. He just watched Qin Lang's right hand holding the needle through the anesthesia and piercing the skin to the subcutaneous, then piercing the abdominal muscle 1cm at a 45° angle, and then Penetrate vertically into the abdominal cavity.

When the resistance of the needle tip disappeared, the needle tip had passed through the parietal peritoneum, and Qin Lang began to extract ascites.

Since it was a diagnostic puncture, a 20ml syringe was used directly, and soon dark red turbid ascites appeared in the syringe.

Qin Lang's complexion changed. The dark red and cloudy abdominal fluid represented a particularly dangerous situation. It was very likely to be strangulated intestinal obstruction, intestinal necrosis, or the most terrifying hemorrhagic necrotizing pancreatitis.

Qin Lang immediately kept a sample, which was convenient for sending it to the hospital for inspection as soon as possible. At the same time, he further identified these ascites.

Dr. Liu looked at Qin Lang's operation and asked anxiously, "What did you find?"

Qin Lang smelled the odor of the abdominal fluid again, and basically judged the patient's condition closely, and said to Dr. Liu very seriously:

"Immediately contact Director Pang, who is on duty on the second line, and ask him to notify Director Zhuang to go to the emergency room together. As soon as we arrive at the hospital, we will perform a CT examination on the patient. Now, we need to send the patient to the hospital immediately. Danger."

"CT scan?"

Dr. Liu's second monk was confused and wanted to ask, but seeing Qin Lang's serious and nervous face, he didn't dare to ask more, and immediately called Director Pang to report to him for help.

Qin Lang, after draining the patient, pulled out the puncture needle, covered it with sterile gauze, pressed it with his fingers for a few minutes, and then fixed it with tape.

Simultaneously, when Qin Lang finished the operation and Dr. Liu put down the phone, he immediately cooperated with Qin Lang to help the patient up and walked out of the house. The family members were waiting, and they were also anxious.

"Doctor, what's wrong with my daughter? How's it going?"

Regarding the patient's inquiry, Qin Lang said in a low tone:

"The situation is not optimistic. I have initially performed a diagnostic peritoneal puncture on the patient, and it is highly suspected that it is hemorrhagic necrotizing pancreatitis. Now, Dr. Liu and I immediately sent the patient to the emergency department of the city's first hospital, and arranged the operation as soon as possible."

"Everyone please let us go, we need to board the ship immediately!"

Seeing Qin Lang's urgent tone, everyone immediately cooperated to get out of the way, and the rest of the tourists on the island also spontaneously protected Qin Lang and others with the patient boarding the ship.

The boatman also paid attention to it for the first time. After Qin Lang and Dr. Liu brought the patient to the boat, they would start it immediately. Everyone hoped that the patient would be sent to the hospital for treatment as soon as possible.

Deng Guang Flint, Dr. Liu and Qin Lang are also always paying attention to the patient's condition.

Acute hemorrhagic necrotizing pancreatitis is a kind of acute pancreatitis, which is caused by the continuous development of acute edematous pancreatitis.

The etiology is also very complex, and may be caused by gallstones, alcohol, vascular factors, trauma, high-fat and other living environmental factors caused by pancreatic and systemic inflammatory disease.

This type of pancreatitis is serious, develops rapidly, has many complications, and has a high mortality rate. The clinical manifestations of patients with this type of pancreatitis are complex, mainly including abdominal distension, vomiting, nausea, fever, increased blood pancreatic enzymes, and hematuria. And easily confused with other acute abdomen.

Therefore, it is very important to diagnose the disease as soon as possible and choose the appropriate treatment method to improve the treatment efficacy and survival rate of patients.

Dr. Liu didn't recover a little until he and Qin Lang boarded the ambulance with the patient. Taking advantage of the gap, he said:

"Doctor Qin, can you tell me how you came up with the idea of ​​a temporary paracentesis and made this conclusion?"

Dr. Liu's whole person was made tense by Qin Lang, and he didn't know why, and even felt that Dr. Qin was unpredictable and unpredictable.

Qin Lang explained:

"The identification of diagnostic ascites is mainly based on its nature, color, clarity, smell, combined with medical history and physical symptoms. Although there are many auxiliary examination methods for the diagnosis of acute abdomen, paracentesis is still the preferred method. , which is simple, timely, reliable, and not limited by conditions and circumstances.”

Dr. Liu nodded in agreement.

Qin Lang continued to analyze:

"First of all, the appearance of peritoneal fluid can be very different. For example, blood in the abdomen, pure blood is a sign of internal bleeding. Combined with other physical examinations and medical history, it can be determined that the liver and spleen rupture and hemorrhage."

"Brown-yellow or dark-green turbid blood type abdominal fluid, especially the puncture fluid mixed with food sediment, mostly the abdominal fluid perforated by larger gastric or duodenal ulcer lesions."

"Light yellow transparent ascites is more common in simple intestinal obstruction."

"Dan-yellow or milky-yellow inflammatory ascites, or thin purulent ascites, are more common in small holes in duodenal ulcers or perforation on an empty stomach. It may also be acute suppurative appendicitis with gangrenous perforation, or acute suppurative mesenteric lymph node rupture. "

"A small amount of straw-yellow and slightly dark ascites is more common in interstitial acute pancreatitis."

"The khaki purulent fluid is mostly bacterial liver abscess rupture."

"Brown-yellow turbid inflammatory fluid is more common in gangrenous exudation of gangrenous cholecystitis or gangrenous cholangitis."

"If it is **** ascites, such as red and slightly turbid **** ascites, it is mostly the early stage of strangulated intestinal obstruction."

....

....

"And the patient's abdominal fluid is dark red and cloudy, it is considered strangulated intestinal obstruction and necrosis, or hemorrhagic necrotizing pancreatitis. And combined with the odor of the puncture fluid, it is not foul odor or **** odor, then Strangulated intestinal obstruction and necrosis are basically ruled out, so the last remaining possibility is the most dangerous hemorrhagic necrotizing pancreatitis!"

After listening to Qin Lang's eloquent and systematic and detailed diagnosis ideas, Dr. Liu really admired it.

This is usually how much time it takes to settle and memorize. After all, Qin Lang's age is there, not relying on years of experience, so he can only memorize and recite through private time.

Dr. Liu felt admiration and respect for Qin Lang in his heart.

"There is one more question, why do you recommend that patients have a CT examination as soon as they arrive at the hospital?"

Just as Qin Lang was about to start answering Dr. Liu's question, the ambulance had already arrived at the First City Hospital, and the two of them stopped talking and immediately pushed the flat car to send the patient to the emergency department.

After arriving at the emergency department, Qin Lang immediately sent the abdominal puncture fluid for examination, while Dr. Liu followed Qin Lang's instructions, although he didn't quite understand the reason, he divided the troops into two groups and arranged the patients. Go for a CT scan.

At the same time, the second-line deputy director Pang also arrived, and director Zhuang Tong also received a call and rushed to the emergency department at the first time. In order to be able to arrive at the first time every time a situation occurred in the department, director Zhuang It was in Dongfang Xinfeng, which is the area of ​​Qin Lang, where I bought a suite.

Several people were also worried. After Director Pang and Director Zhuang arrived, Dr. Liu arranged for the patient to undergo a CT examination, and he came to meet the two directors to report the situation.

When Dr. Liu saw the two directors, he directly stated Qin Lang's judgment:

"Director Zhuang, Director Pang, the patient's condition is urgent. After our judgment, it is highly suspected that it is acute hemorrhagic necrotizing pancreatitis!"

Hearing Dr. Liu's words, the expressions of the two directors changed greatly:

"Doctor Liu, you must be clear about the consequences of your judgment. Acute hemorrhagic necrotizing pancreatitis is one of the common clinical acute abdomens, and the mortality rate of severe acute pancreatitis is as high as 50%-70%!"

Director Zhuang is very experienced: "Everyone, we need to confirm the patient immediately. The deterioration of acute hemorrhagic necrotizing pancreatitis is very rapid. If the diagnosis is not timely and the treatment cannot keep up, it is very likely that the patient will die suddenly. ."

"Moreover, 120 dispatched an ambulance according to the patient's family's call for help. The time on the way, according to the patient's condition, left us running out of time."

"In this way, Director Pang, you go to prepare and perform abdominal puncture on the patient. I will immediately contact the director of general surgery and go to the operating room to diagnose and identify ascites. After completion, I will immediately perform an abdominal color Doppler ultrasound for testing! "

After Director Zhuang's order was given, Dr. Liu was taken aback for a moment, then his face changed greatly, and he blurted out:

"Director Zhuang, do you mean to do an abdominal ultrasound, not a CT test?"

Hearing Dr. Liu's words, Zhuang Tong was a little surprised. When did this kid become so enlightened, he explained helplessly:

"Indeed, for acute hemorrhagic necrotizing pancreatitis, CT examination is indeed the gold standard. When CT examination scans patients with acute hemorrhagic necrotizing pancreatitis, there will be flaky shadows and low-density dots on the picture. It can also be clearly displayed on the pictures, making it more intuitive to judge patients. It can improve the accuracy of clinical diagnosis, and have a sufficient understanding of the degree and scope of pancreatic lesions, but it takes too long.”

"Also, this is only your preliminary judgment. There are other possibilities, so we still can't rule out other possibilities. First of all, we still need to complete the diagnostic puncture of ascites. And this also takes time."

"So, we can only settle for the next best thing, using the shortest abdominal color Doppler ultrasound to make up for the lack of the method through the rich clinical experience of Director Lin and I."

For, Director Zhuang also has no choice. If he can perform abdominal puncture earlier, he can still do CT diagnosis calmly~www.readwn.com~ Just when Director Pang is about to prepare for abdominal puncture, Director Zhuang contacts Director Lin, Director of General Surgery .

Dr. Liu was overjoyed and said:

"Don't worry about the two directors. We have already sent the patient for a CT test as soon as possible, and the fluid from the abdominal puncture has already been sent by Dr. Qin for the test."

Hearing Dr. Liu's words, Director Pang and Director Zhuang couldn't believe it: "What you said is true!"

"How did you do it?"

"Doctor Liu, you have done a great job!"

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