Doctor’s Life Simulator

Zhou Hengzheng led a group of his lower-level doctors to make rounds in the ward. He was also a little surprised when he saw Qin Lang's call.

However, after the previous surgery video of Qin Lang, and Professor Shen Xi, Dean Hang cultivated it, and established a laboratory alone, Director Zhou no longer treats Qin Lang as an ordinary little doctor.

Moreover, just yesterday, Tong Jinshan, director of the Department of Thoracic Surgery of Zijingang First Hospital, asked himself to invite Qin Lang to participate in this weekend's academic activities.

There is no doubt that Qin Lang will be a star doctor and future star that the entire city's first hospital will focus on training, whether in terms of clinical talent, background resources, or personal image.

After connecting the phone, Director Zhou heard Qin Lang's report:

"Hey, Director Zhou, I'm Qin Lang. Dr. Liu and I saw a patient in the emergency department. The initial diagnosis was an early thoracic and abdominal aortic aneurysm. We need your side for further diagnosis and examination.

Hearing Qin Lang's narration, Zhou Heng's eyelids jumped. He was very aware of the severity of abdominal aortic aneurysm. However, Qin Lang only diagnosed the thoracic abdominal aortic aneurysm based on simple signs and inquiries. Too exaggerated?

Even him, at least through CT, color Doppler ultrasound or magnetic resonance imaging, can he dare to make it clear.

Abdominal aortic aneurysm, a disease commonly seen in people over the age of 50.

Under normal circumstances, changes in the structure of the arterial wall are accompanied by age. With the increase of age, the elastin fibers in the arterial wall are degraded, broken and calcified. The aging aortic wall cannot resist the effect of aneurysmal dilation factor. , The arterial medial structure is damaged, and the arterial wall cannot withstand the pressure of blood flow shock and form a local or extensive permanent expansion or bulge.

Risk factors such as smoking, inflammation, trauma, advanced age, and hypertension all contribute to the occurrence and development of abdominal aortic aneurysm. Once abdominal aortic aneurysm ruptures, the mortality rate is as high as 50%-80%.

However, the diagnosis of abdominal aortic aneurysm can only be confirmed when the diameter of abdominal aortic aneurysm exceeds 4cm. The early manifestations are only pain, and the location is different. Most of them are located around the umbilicus of the abdomen, and the two ribs are on the waist. The nature of the pain can be dull, distending, tingling or Knife-like pain.

The principle of pain is due to the increased tension of the tumor wall, causing traction on the adventitia and posterior membrane of the arteries, compressing the adjacent somatic nerves, or due to the acute expansion of the tumor and tearing the arterial wall.

According to Qin Lang's description of the patient's situation, Zhou Heng, even he would think about gastrointestinal diseases at the first time, and it is difficult to think of a thoracic and abdominal aortic aneurysm, but after careful analysis, the aorta cannot be ruled out possibility of tumor.

However, these symptoms are very subtle, well hidden, and easily overlooked.

Zhou Heng glanced around. It happened that today was the director's major rounds, and he was ready to let his lower-level doctors try to see if they could diagnose the patient's real cause based on the patient's basic situation.

It would be a shame if the thoracic and abdominal aortic aneurysm could be diagnosed by a physician in the emergency department with a simple consultation and physical examination, and if the professional thoracic surgeon under him could not be up to it.

After Zhou Heng put down the phone, he shouted at his little doctors:

"Just now, a patient was sent to the emergency department. The emergency doctor's initial diagnosis was a thoracic and abdominal aortic aneurysm. We need further examination and diagnosis by our thoracic surgery department. It happens that you are all here to try to diagnose the patient's condition."

Zhou Heng looked at the relatively senior attending physician Zhang Anyi among the group of doctors.

Zhang Anyi saw Zhou Heng's gaze, but he didn't understand. Director Zhou wanted him to make a sample and show the diagnosis skills to the residents, interns, and trainees around him.

However, without CT, color Doppler ultrasound, or magnetic resonance examination, it is possible to diagnose thoracoabdominal aortic aneurysm, a vascular disease with an insidious onset, just by relying on physical signs and inquiries, palpation, percussion, etc.

After all, a thoracoabdominal aortic aneurysm does not grow on the blood vessel wall, but tears in the inner and outer lining of the blood vessel wall to form a dissection. An aneurysm that results in dilation of the adventitia at the distal end of the rupture, let alone an early diagnosis.

The patient was soon transported from the emergency department to the thoracic surgery ward.

Zhang Anyi could only bite the bullet, and soon, he had a clear understanding of the patient's basic situation.

However, looking at the patient's symptoms, Zhang Anyi was completely stunned. How could he have been diagnosed with an early thoracic and abdominal aortic aneurysm?

Obviously, there was only a problem with the gastrointestinal tract. After physical examination, interrogation, percussion, auscultation, and palpation, Zhang Anyi judged that it should be an incomplete intestinal obstruction.

According to his thinking, it should be to give gastrointestinal decompression or soapy water enema.

However, Director Zhou on the side was staring at him, and Zhang Anyi could only continue to explore the basis for the diagnosis.

"Could it be the emergency department doctor, mistaken?"

In the hospital, misdiagnosis is not uncommon. However, the conclusion of the emergency department is that the thoracic and abdominal aortic aneurysm is somewhat beautiful. If it is really an aortic aneurysm, if the operation is not treated in time, there will be a beautiful life. Liu Yinghong does not dare to make a conclusion at will.

How to do?

Zhang Anyi is a senior attending physician after all, and he has very rich experience. Since he can't come to the conclusion of thoracoabdominal aortic aneurysm by following the inference, then he will make a reverse inference according to the symptoms of thoracoabdominal aortic aneurysm.

If the patient is really in the early stage of thoracoabdominal aortic aneurysm, how to explain his current symptoms?

Liu Yinghong quickly thought: The patient first experienced pain in the left toe, and the tip of the toe turned purple, which was caused by thrombosis.

If the real cause is a thoracoabdominal aortic aneurysm, it is indeed possible that the aneurysm forms a mural thrombus, and the shed emboli are plugged into the lower extremity arteries, so that there is a limb artery embolism and pain in the left toe. This possibility exists of

As for the patient's gastrointestinal problems, it is better to explain. The gastrointestinal tract is also the organ most often compressed by aortic aneurysms. Due to the low activity of the duodenum, the compression can cause early symptoms, such as abdominal discomfort, dryness, and appetite. In severe cases, nausea, vomiting, exhaustion and defecation stop, etc.

Of course, these symptoms were also the reason why Zhang Anyi judged that the patient had incomplete intestinal obstruction. After careful pushback, Zhang Anyi really agreed with the emergency physician's point of view that the patient might really be a thoracic and abdominal aortic aneurysm.

Zhang Anyi, in the expectation of Director Qin Gallery and various resident doctors and interns, re-organized himself according to the symptoms of thoracoabdominal aortic aneurysm and reversed the symptoms of the patients, and made some false inferences. .

"The patient's abdominal pain, gastrointestinal compression, and symptoms of arterial embolism in the limbs, as well as pulsatile tachycardia around the abdomen, and ischemic symptoms of chronic arterial embolism in the lower extremities, believe that abdominal aortic aneurysm. It is recommended that further color ultrasonography be performed, ct examination or MRI."

Zhang Anyi put forward his own conclusions, but he was a little admired in his heart. The doctor in the emergency department was too powerful. It was possible to infer a bear abdominal aortic aneurysm through such subtle symptoms and combinations.

Regarding Zhang Anyi's conclusion, Qin Lang also nodded slightly, which was not bad, but it was obviously a trick:

"It's just, if there is no reminder from the doctor in the emergency department, can you all find out the real cause of the patient in a short period of time without being affected by the previous hospital treatment plan and diagnosis?"

Hearing Director Zhou's words, including Zhang Anyi, all the lower-level doctors' faces changed slightly. It is very rare to be able to infer that it is an incomplete intestinal obstruction. It is too difficult to think of abdominal aortic aneurysm.

Inferring from the conclusion and actually deriving the symptoms from one's own observations are completely two kinds of difficulty.

"Director Zhou, can you invite the doctor from the emergency department and ask him how he came to the conclusion of thoracic and abdominal aortic aneurysm?"

Liu Yinghong was very impressed and wanted to know what the other party's skills and tricks were.

"Wait for the color Doppler ultrasound examination and CT examination results, if the diagnosis is confirmed. I will invite the doctor to ~www.readwn.com~ to perform surgery on the patient together. At that time, you will have the opportunity to ask questions.

In fact, Liu Ying was also very curious, how did Zhou Heng do it, to be able to point out the symptoms so directly, but it wasn't so complicated, there must be a solid basis for him.

After half a day, the patient's various physical examinations came out.

Liu Yinghong was very excited to report to Director Zhou: "Director, the results are out. It is confirmed that the patient is indeed a thoracic and abdominal aortic aneurysm, but it is still in the early stage. If it is not targeted by Meilai, even conventional CT and color Doppler ultrasound are very good. Hard to find!"

Moreover, due to the early detection, the success rate of surgical treatment is still very high. If the treatment of incomplete intestinal obstruction is really delayed for a period of time, causing the rupture of the aortic aneurysm, the patient is very likely to die.

Thinking of this, Zhang Anyi was also afraid for a while.

In my heart, I became more curious and admired for the emergency physician.

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