Doctor Peerless

Chapter 629 The Eloquent Condition Analysis

Dr. Lin asked tentatively, "Excuse me, are you Zhou Sheng?"

Zhou Sheng was stunned for a moment, and asked strangely, "Do we know each other?"

He really is Zhou Sheng.

Dr. Lin smiled, "It's the first time we met, but I heard people talking about you. I saw you today, and you are indeed young and promising."

Facing Dr. Lin's praise, Zhou Sheng was a little confused.

He thought for a while, he was outside his chest, as if he had no acquaintances.

I don't know where Dr. Lin heard of himself.

There is a serious illness in front of him that needs to be consulted, and Zhou Yisheng has no time to delve into this matter.

Zhou Sheng could only smile, and stopped answering the question.

There isn't much time for small talk in a consultation.

The following will soon officially enter the consultation time.

First of all, of course, Zhou Sheng introduced the patient's situation.

At the same time, Bai Mingming put the patient's chest X-ray on the reading light.

In the consultation room, the eyes of several people from outside the chest were immediately attracted.

Zhou Sheng began to analyze the chest X-ray while introducing the patient's condition.

Typical mediastinal emphysema.

Dr. Lin understood it at a glance.

He paid more attention to how Zhou Sheng discovered the patient's condition.

Zhou Sheng briefly explained the diagnosis process.

While listening, Dr. Lin nodded frequently in agreement.

At the same time, he was also slightly surprised.

From Zhou Sheng's description, it only took two hours for the patient to be diagnosed with spontaneous esophageal rupture from admission to hospital.

This is a very rare disease judgment.It can be said to be extremely fast.

Dr. Lin vaguely recalled a consultation on a ruptured esophagus that he participated in three or four years ago.

The Emergency Center was still the Emergency Department.

It took more than ten hours for the emergency department to confirm the condition.

Dr. Lin sighed in his heart, these young people in the emergency department are not easy!

Wait for Zhou Sheng to briefly explain the situation.

The next step is to study and judge the patient's current condition.

The premise of research and judgment is, of course, to have an inspection report on the esophagus.

Dr. Lin asked, "Have you taken a photo of the patient's esophagus?"

Zhou Sheng said: "It's been prepared a long time ago. Mr. Bai, the radiography film."

Bai Mingming immediately stepped forward to change the film on the film reader.

Dr. Lin secretly praised again in his heart, Zhou Yisheng is quite well prepared this week.There is no consultation yet, and the esophageal radiography has been done.

It seems that they are quite confident in their judgment of the condition!

The esophagus photo was hung up.

Zhou Sheng used this photo to continue to analyze his condition.

"Contrast medium leaked out, contrast medium appeared in the thorax, mediastinal emphysema, and there is no septic shock at present. The location of the esophageal breach is in the lower segment, and the length is about 3 cm from the imaging observation. This situation is typical. For esophagothoracic fistula..."

According to the type of esophageal rupture, it can be divided into esophagothoracic fistula and esophagomediastinal fistula.

Fistula, pronunciation leakage.In the interpretation in Chinese, it refers to the pipeline formed by the outward rupture of the lesion in the body, from which the secretions in the lesion flow out.

This word is used to express the image of ruptured esophagus.

As for thoracic fistula and mediastinal fistula, it can be seen literally that a fistula affecting the thoracic cavity is a thoracic fistula.A mediastinal fistula affects the mediastinum.

It can be clearly seen that the area of ​​pleural fistula is larger than that of mediastinal fistula, and the scope and organs affected are wider.

Zhou Sheng finished expressing his condition.

Logically speaking, as an expert in this field, Dr. Lin, who is an extra-thoracic doctor, should give supplementary and treatment advice next.

But Zhou Yisheng's newborn calf is not afraid of tigers.

In other words, he hadn't been in the hospital for a long time, and he hadn't caught up with the atmosphere in the workplace.

Unknowingly, Zhou Sheng also brought the wolfishness on the operating table to the consultation.

Zhou Sheng couldn't stop at the moment: "In this case, fasting, gastrointestinal decompression, anti-infection, blood volume and albumin supplementation, water electrolyte acid-base balance correction, and nutritional support should be given at the same time..."

Zhou Sheng talked eloquently, and several interns, including Cao Xin, had their brains running at high speed, trying to memorize. This is a rare clinical learning opportunity.

Even Bai Mingming and the two thoracic resident doctors listened carefully.Secretly write down the response given by Life next week.

Dr. Lin was not angry because Zhou Sheng took his lines.

On the contrary, he listened quietly, and the treatment measures given by Zhou Sheng were all very pertinent.

The esophagus is ruptured, so fasting is definitely required.Fasting requires nutritional supplements.

Food and bacteria in the esophagus enter the chest cavity, poisoning and infection must be considered.Anti-infection, replenishing blood volume and albumin, and correcting the acid-base balance of water and electrolyte are also necessary operations.

Up to now, Dr. Lin didn't think there was anything outstanding about Zhou Sheng's treatment.It is just satisfactory, and it is the basic clinical treatment method to deal with esophageal rupture.

But it never occurred to him that Zhou Sheng hadn't finished talking yet.

He continued: "The patient's wound is not particularly large, and it was discovered in a timely manner. However, considering that food, digestive juices, and bacteria have entered the chest cavity, closed chest drainage and a retractable stent under the gastroscope should be placed as soon as possible to seal the fistula. mouth."

Hearing this, Dr. Lin was a little surprised.

In the past, treatment of such esophageal ruptures, regardless of the size of the wound, generally required standard surgical procedures.Esophageal repair, drainage, or even esophagectomy.

However, with the continuous development of endoscopic technology, more thoracic surgery uses esophageal covered stent implantation to close small gaps.

But these are cutting-edge technologies.

And there are not many patients with esophageal rupture.

This kind of operation may not be performed once a year.

Therefore, not many people know about advanced endoscopic surgery.

This week, Zhou Sheng is still young, and he is still in the emergency department. He is a little surprised that he knows about endoscopic treatment.

Zhou Sheng said this in one breath.

There is a feeling of vomit.

There is something in the stomach, not to mention that it will cause internal injuries.

But after speaking it out completely.

Zhou Sheng also felt that he had talked too much.

"Doctor Lin, I'm done talking, please express your professional opinion."

Dr. Lin smiled, this should be more or less said, what else can he say.

I can only add one point, let the few "students" I brought continue to increase their clinical experience in this disease.

"Dr. Zhou's analysis is very good, especially in terms of treatment, he has given a general direction. I agree that the patient's onset time has not exceeded 24 hours, and the photo shows that the wound is about 3 cm, which is suitable for endoscopic treatment. It is not appropriate. Late, this case is admitted to our department, and surgery will be arranged this morning."

The consultation ends here.

People outside the chest left one after another.

The rest of the department transfer was arranged by Bai Mingming.

Zhou Sheng and Cao Xin returned to the lounge and changed their clothes.

The two left the emergency room one step ahead of Bai Mingming.

The two walked side by side.

Zhou Sheng asked: "How do you feel about the first day of emergency work? You worked overtime on the first day, do you feel particularly tired?"

Cao Xin smiled, "It's not bad. It's very fulfilling."

"Can you hold on? Do you want to leave?"

"Impossible, unless you don't want me, Team Leader Zhou."

"It's impossible to not want you. Dean Cheng introduced you. How could I drive you away? I will follow Su Quan from tomorrow. If you have any questions, you can come to me at any time."

"Roger that!"

The two walked and chatted until they separated near the hospital parking lot.

……

(End of this chapter)