This doctor has a system

Chapter 384 449. Even a slap in the face can make him cry for a long time
Afraid of water or wind? This is not AIDS, this is clearly a frightening disease with a 100% mortality rate: rabies!

The two looked at each other, both realizing the seriousness of the problem.

"Think carefully, have you been bitten by a dog recently?" Gao Feng asked.

"Two months ago, I was bitten when I was playing with a stray dog ​​downstairs in the community." Xiao Li's answer made Gao Feng fall into despair. This was the last result they wanted to hear. In fact, even if it was AIDS.

"Have you had any rabies vaccinations?"

The answer was no, just rinse it with water.

"There was no bleeding at that time," Xiao Li said.

Rabies is mainly divided into four stages, namely the incubation period, the prodromal stage, the excitement stage and the paralysis stage. Without life-support treatment, most patients will die within 4-7 days of first clinical symptoms.

Obviously, these symptoms of Xiao Li now indicate that he has entered the excitement stage. Although the outcome was already determined, at this time he could only choose to give it another try, and he was sent to the infectious disease hospital that morning.

Four days later, news came from the infectious disease hospital that the patient died at 9 a.m. that day.

The director had seven or eight people working for him, and the questions he asked were unprofessional, too simple, and very embarrassing.

What I fear most is the sudden silence in the air.

The director always asks some questions when making rounds. If you are not professional enough or are not familiar with the patient's condition, you will be scolded at any time.

Grand rounds are a devil in the eyes of some doctors. At this time, Fan Yulong was memorizing the test results and treatment plans of several patients with more complex conditions.

At this time, the interns in the department were the most relaxed ones. They were at the bottom of the ward round group and could only stand on the outermost periphery to build momentum.

In Zhang Zhengye's eyes, death is not a big deal. Moreover, the patient had rabies, a disease that is horrifying, and it should have ended like this.

Gao Feng felt a little uncomfortable. This patient had just graduated from college and started working, and his life had ended just as it began.

The five-shot lightning whip is no joke. As long as it is a respiratory disease, no matter how unconventional it is, I can always tell you everything.

"Yes, the patient is not sure whether it is bullae or pneumothorax, so I just want to be on the safe side."

In fact, positioning is not the focus of ward rounds. Doctors at each level have their own pressures and responsibilities to bear during ward rounds.

"Xiao Zhang, you are really 6." The director "praised" him when the shift was handed over.

"You hurt me that night." The nurse who worked with him couldn't help but sing this song when she saw him during that time.

There are regular trainees standing in front of us, so even if the director asks questions, they can't get their turn.

Of course, don’t think that it will be easy if you become a director, and you will only be responsible for asking questions.

Everyone came to the ward early that day and quickly reviewed the patients under their care. Some medical orders needed to be issued in advance.

Sometimes, if neither the trainees nor the resident doctors can answer the questions asked by the director, then the attending physician will have to answer. If there is no answer, that would be terrible.

Director Ma Baoguo is naturally able to control the situation.

"Closed chest drainage under CT guidance?" Director Ma felt a little strange.

The director also needs to check some of the treatment suggestions made by the attending doctor, and point out any errors or omissions in a timely manner. Without practical experience, it is impossible to control the situation.

"What do you mean you don't speak?"

"Well, you did a good job." Director Ma smiled and nodded. Everyone was very happy. Today was a good start.

"The patient is a 64-year-old male, diagnosed with pulmonary CA," the tube doctor quickly reported the case. "He developed difficulty breathing during treatment at the local hospital. After coming to our hospital, he was treated under CT guidance."

"Are you only capable of omnipotence?"

If the director asks you a question later and you are unable to answer on the spot, it will be a big loss.

Clinically, doctors have long been accustomed to positioning issues. All in all, high-level doctors usually stand on the right side of the patient's upper body, which makes it easier to communicate with the patient.

"Is it like this?" Li Youliang asked puzzledly. Their boss also made weekly ward rounds at the provincial hospital, and he had never seen his subordinates so nervous.

And it’s not just based on one’s own experience, but also includes new medical advances and some cutting-edge medical content.

Speaking of this grand ward round, the station is also very particular. A layman may not understand, why do we need to divide the station if we just check the ward?
To put it simply, it can improve work efficiency. Only by having rules in everything can you get twice the result with half the effort. Otherwise, when it comes to ward rounds, the director, deputy directors, attendings, residents, and graduate students all get together, and there is no "convention", so it won't be a mess.

He would only feel sorry for those patients who had a hope of survival but died due to one or other problems.
-
Today is the day of grand rounds.

"What's the condition of this patient?" Director Ma said, pointing to a patient with a chest bottle.

The standard here at Xiehe is indeed very high, but the higher the level of hospitals, the more people die.

When he was working on the front line, he was on duty at night and sent away three patients in one night, and pushed three patients to severe cases.

But someone will always get scolded, that's for sure.

"Director Ma likes to curse people most on this day." Fan Yulong said, "I don't want to be the lucky one."

Zhang Zhengye didn't feel too sad. He had been working for a long time and was a little numb to death.

"Are you a respiratory doctor who doesn't know how to use antibiotics?"

Soon a resident doctor surnamed Zhou was hit hard by Director Ma. He could not even say a word if he was directly fucked by a set of five lightning whips.

It's like when the teacher calls on someone to ask questions in class, there are always thousands of voices in my heart, hoping not to call me.

The doctor who is mainly responsible for reporting stands on the right side of the patient's lower body, and other doctors stand from the inside to the outside according to their seniority.

"If I were you, I'd kill you with a piece of tofu after get off work!"

When you are a resident (doctor), you must be familiar with each patient's condition and memorize the test results.

"Director, I was wrong." Dr. Zhou said tremblingly, "In fact, this plan was decided by Director Liu and others."

"How dare you make excuses!" Director Liu on the side shouted, "This little Zhou has learned nothing from following me! It's really unreasonable!"

"Are you worthy of Director Ma's sincere teachings like this?"

"so stupid!"

Everyone
Then some people were praised, but others were scolded so hard that they couldn't hold their heads up.

No wonder everyone doesn't like this grand round, Gao Feng thought to himself. Director Ma usually smiles, but today he acted like a troll, killing whomever he caught. "No, will I do this during the ward rounds in the future?"

Soon the last patient arrived.

"The patient, a 22-year-old female, was admitted to the hospital with the main complaints of fever and cough for three days." The bedside doctor reported, "The chest CT showed lung abscess."

"The white blood cell count when I came to the hospital was 13,000, and when I was reexamined yesterday, it was 19,000."

The patient still has repeated fevers and coughs up a lot of yellow sputum. The bedside doctor believes that the anti-infection strength is not enough and plans to upgrade the antibiotics today. It just so happened that I had a ward round today, so I thought I would let everyone take a look.

Director Ma picked up the patient's chest CT scan, looked at it, and then handed it to the troops behind.

"Everyone, please express your opinion." Director Ma spoke as everyone watched the chest CT.

"It's best to do a bronchoscope and lavage this area. Not only can it have a therapeutic effect, but it can also collect specimens for examination." A director suggested.

"Antibiotics can increase. Her inflammation indicators are still rising, which means that the anti-infective treatment is not good." Someone said, "It can be combined with moxifloxacin."

"Professor Gao Feng, what do you think?" Director Ma suddenly turned his attention to Gao Feng.

Gao Feng really has some opinions. Even if Director Ma doesn't mention him, he will say it later.

"I think the diagnosis may have been wrong," he said.

"Huh?" Someone couldn't help shouting, but then felt inappropriate and quickly closed his mouth.

Wrong diagnosis?

Everyone is very curious. The patient's symptoms are very consistent with the symptoms of lung abscess, and the chest CT also reported the same.

Both clinical symptoms and chest CT point to the same disease. Generally speaking, the probability of diagnostic error in this case is relatively small.

"Professor Gao, have you discovered anything?" the doctor in charge asked respectfully.

Gao Feng has been here for many days, and almost all the doctors in the department know him. He is also nicknamed "the ruthless reading machine" in private.

Excellent people will shine wherever they go. Gao Feng is like a sparkling firefly in the dark night, attracting the attention of others wherever he goes.

What kind of pretentious and slap-in-the-face plot? nonexistent.

"I think the patient should have pulmonary sequestration accompanied by infection." Gao Feng said, "The density of this area is uneven, and you can see scattered gas shadows and spotty calcifications in some places. Also"

"So, in summary, it is very consistent with the symptoms of pulmonary sequestration."

The bed doctor's eyes widened. Are there so many signs? Why did not I see?
"If not, let's do a contrast-enhanced CT scan to take a look." Director Ma said, "I don't feel like it's a lung abscess. This area seems to have a blood supply."

Pulmonary sequestration is a congenital developmental abnormality of the lungs. Pathologically, the lung tissue of a certain lung segment is isolated from the normal lung tissue and receives blood supply from the systemic circulation. The isolated lung tissue does not have normal gas exchange function.

Depending on whether the isolated lung tissue and adjacent normal lung tissue are wrapped by the same visceral pleura, it can be divided into two types: intralobar type and extralobar type.

People with pulmonary sequestration may not have any clinical symptoms, but most patients develop cough, sputum, fever and other symptoms due to concurrent infection of the isolated lung, and some patients may be accompanied by hemoptysis.

CT manifestations: solid mass in the lower lobe of the lung, irregular shape, uneven density, uneven enhancement on enhanced scan, and air-liquid leveling when combined with infection. The diagnosis can be confirmed by seeing that the lesion is supplied by the aorta.

"Then let's do an enhanced CT scan tomorrow." The doctor in charge told the patient on the spot, "Don't eat or drink after 12 o'clock tonight."

"Can I do it today?" the patient asked, "I haven't eaten yet today." She lost her appetite when she had a fever and didn't eat breakfast.

The doctor in charge then contacted the imaging department. They were not very willing, but after his persuasion, they agreed to let it go.

After more than 20 minutes, the patient finished the examination, and everyone gathered in front of the computer to watch the film.

On enhanced CT, it was clearly seen that there was systemic arterial blood supply in the lesion, and the diagnosis of pulmonary sequestration was undoubtedly very correct.

"Professor Gao, you have a sharp eye." Director Ma smiled, "The people in the imaging department are not as good as you."

"It's just my luck. After all, I'm in the respiratory field, and I'm quite proficient in lung imaging examinations." Gao Feng said modestly.

Who here is not a respiratory expert? Director Ma thought to himself, how can this young Gao Feng watch movies so well?
He was confused. Even if he started learning from his mother's womb, this level would be a bit exaggerated, right?
But that's not unacceptable. There are always some geniuses in the world.

Director Ma feels that he is a semi-genius. He was at the top of his studies when he was a child. He was still at the top when he went to university, he was still at the top when he studied for graduate school, and he stayed in the hospital directly after getting his doctorate. After working for more than 10 years, I directly became the department director.

Thinking about it this way, he felt a little sympathetic to Gao Feng.

"Director, we want you to take another look at our 26th bed." A doctor came over and said, "The patient still complains of chest pain."

This doctor's surname is Ye, and he is a junior doctor who follows Director Ma.

"It's been three days, and it still hurts?" Director Ma obviously knew this patient very well, and he frowned.

"The pain is getting worse and worse," Dr. Ye reported. "I used regular painkillers, but the effect was not good."

The patient was 66 years old and was admitted to the hospital due to chest pain that had been intermittent for half a year and worsened for 3 days.

During the chest pain attack 3 nights before admission, the electrocardiogram in the emergency department showed no obvious abnormalities and no dynamic changes. Myocardial enzyme and troponin tests were all normal.

Chest CT showed a little inflammation of the lungs and thickening of the left pleura.

pleurisy?
After comprehensive consideration, the doctor in the emergency department admitted the patient to the respiratory medicine department.

The patient's chest pain recurred that night after admission, and the burning pain further worsened. The electrocardiogram still showed no obvious dynamic changes compared with before.

Doctors from the cardiology department also came for consultation. Because the electrocardiogram and cardiac enzymes were normal, they said it didn't look like a disease in their department. Even if it was caused by the heart, it shouldn't be a big problem.

But the patient still kept complaining of chest pain, and burst into tears when the pain arose.

"He is just hypocritical." The patient's wife told everyone, "When we had a quarrel in the past, I would slap him in the face and he would cry for a long time."

"Shut up!" the patient said angrily, "I cried at that time because I was sad and my heart hurt! But this time it's really heartache!"

"Aren't they all the same?" the wife muttered.

In her eyes, the old man in her family is fragile. When she was young, other people's husbands were strong-looking, but her husband has always been a thin dog.

He was still sick and hospitalized at every turn, and she served him like an old lady all her life.

The nurse then took another electrocardiogram from the patient, and the result showed: normal electrocardiogram.

(End of this chapter)