Chinese medicine: When you do things to the extreme

Chapter 253: Orderly (Subscription Request)

"Here, push it over here!~" After seeing the stretcher, Professor Yang Lingchong immediately pointed in a direction and positioned it accurately.

He Qingqing said to the nurse on duty: "Monitoring, oxygen inhalation, intravenous access, prepare for intubation, prepare for tracheotomy! ~"

Seeing that the patient was covered in blood, she gave up on listening to the stethoscope and stuffed the stethoscope into her white coat, but it fell. She didn't pick it up, but moved quickly towards the bed.

It was Dong Xiao who picked up He Qingqing's stethoscope, hung it around his neck, and started running again.

Yang Lingchong visually estimated the general location of the injury, and He Qingqing approached to check the vital signs, and said decisively: "There is a pulse in the carotid artery, and the breathing is shallow and rapid!"

After more than ten seconds, Yang Lingchong still hadn't spoken, so He Qingqing said, "Both sides have regular rhythms, and the radial artery pulse is weak."

At the same time, the nurse quickly started ECG monitoring and oxygen inhalation on the patient's chest.

Green clothes said at this time: "Injury from a car accident, expected to have hemothorax, uncertain."

"There were no open injuries to the chest and abdomen, but the lower limbs were severely injured and there was a hematoma on the scalp. When we arrived, the patient was already unconscious and unresponsive."

"This is a temporary photo taken in the car. Please bear with it and take a look."

"Our preliminary diagnosis is all here." The man in green clothes quickly handed over...

Yang Lingchong took the tablet and documents he handed over and said, "Thank you for your hard work. Leave it to us!"

The other party said it was so urgent, there must be another task.

The main purpose of 120 is to escort and rescue on the way, rather than first aid and rescue in the hospital.

There are eight flat sheets in total.

They are all small pieces, head, chest, upper abdomen, lower abdomen, lower limbs and upper limbs!
Zhou Yanqing was given four X-rays at once. However, Zhou Yanqing did not look at the films, but scanned the patient's lower limb injuries.

If nothing unexpected happens, with the current amount of bleeding, there is definitely arterial injury!
However, Zhou Yanqing needed Zheng Qi from the neurosurgery department to determine the situation inside the brain and whether it was appropriate to start stopping the bleeding on the spot.

The patient's current method of stopping bleeding is very violent. There must be an orthopedic doctor on the scene who used a pressure rope to tie the bleeding tightly, tightly binding the side of the thigh.

"The intracranial condition is okay, and no hematoma has been found so far. The bleeding may now be more in the lower limbs..." Zheng Qi said.

Zhou Yanqing handed a nurse his prepared cell phone number: "Call this doctor and ask him to come to the emergency operating room."

After saying that, Zhou Yanqing took two steps forward and asked, "Professor Yang?"

"Come on." Yang Lingchong knew that Zhou Yanqing was asking him for authority.

Zhou Yanqing lowered his head and began to unwrap the gauze wrapped around the scissors: "Open the debridement pack!~"

"Blood pressure is 101/65!" The results of the first round of blood pressure measurement came out, the nurse reported.

Hearing this, everyone breathed a sigh of relief.

This was a patient with a very simple bilateral lower limb injury. It took only twenty seconds for everyone to diagnose him.

He Qingqing tilted her head and said, "The patient is still in a coma!~"

"Pay attention to hidden blood loss, or the patient may have lost too much blood without prompt treatment at the scene."

After Zhou Yanqing cut open the gauze, he saw the injured end of the knee joint, with blood oozing out of the popliteal artery where the femoral artery was derived.

If it weren't for the rope tied higher up, the bleeding would be more rapid.

Of course, in Zhou Yanqing's view, the popliteal artery at this moment was like a dying loach, with no room for struggle at all.

Since there was arterial bleeding, Zhou Yanqing naturally couldn't waste time on disinfection slowly. He just picked up a pair of hemostatic forceps and went straight to the bleeding.

There is no such thing as carefully uncovering the wound.

Upon seeing this scene, Yang Ling instinctively cursed at Associate Professor and turned his head away, unable to bear to watch it.

I dare not look at it either.

The existence of some people is that God chases them and feeds them, making it impossible for ordinary people to compete with them.

After Zhou Yanqing quickly dealt with the popliteal artery on this side, he picked up the hemostatic forceps and tweezers and carefully searched, and then temporarily clamped the proximal and distal ends of the superficial, damaged great saphenous vein to stop the bleeding.

The active bleeding in one place has been dealt with.

After covering with gauze and cotton pad, Zhou Yanqing came to the other side!
The same trick was used again, but the wound on the opposite side was more limited than the left side. There was no arterial damage, only venous blood slowly oozing out.

By the time Zhou Yanqing opened the wound, only two or three milliliters had come out.

The rate of bleeding made Zhou Yanqing frown: "Is the patient in a coma?"

At the current bleeding rate, the patient shouldn't be on the verge of shock, right?

Du Guodong knew what Zhou Yanqing meant: "The shifting dullness is negative, so there should be no active bleeding in the abdominal cavity."

“No contusions or lacerations of solid organs were found on the abdominal X-ray.”

This is the first patient here, so this is when medical resources are most abundant.

"The chest situation is rather complicated, but it's okay. After taking a chest X-ray, push the patient into the operating room." said Dr. Tan Wei, attending physician of the Department of Thoracic Surgery.

After Zhou Yanqing covered the wound on the treated side, he had time to look at the film: "Left joint trauma, femoral fracture, and open fracture of the tibial plateau."

“The situation is not particularly serious.”

"There are no avulsion fractures or joint dislocations in both upper limbs." Zhou Yanqing reported to Yang Lingchong.

This is the significance of the trauma center, which is to gather all the specialists together for a preliminary diagnosis and treatment at the first possible moment.

Yang Lingchong nodded: "Then let's do a CT scan and push him to the emergency operating room."

"Tan Wei, please arrange for your thoracic surgery staff to perform closed chest drainage as soon as possible."

Tan Wei nodded in response.

The patient's bleeding volume was very limited, so the patient's condition was not that urgent, and his life was not at risk.

However, at this moment, Zhou Yanqing grabbed the upper abdominal X-ray from the gastrointestinal surgery department.

I just raised my head slightly, and my scalp immediately tightened:
"Professor Yang, retroperitoneal hematoma, active!"

"How is it possible?!" Yang Lingchong's eyes narrowed immediately.

Retroperitoneal hematoma can cause very heavy bleeding, and the patient's mortality rate is not low.

Generally speaking, plain radiographs alone are not sufficient to diagnose retroperitoneal hematoma.

"It's true, a retroperitoneal hematoma, and it's active. It shows on the X-ray!~" Zhou Yanqing's tone was very cautious.

"Let's go to the CT room, we're going to cut in line for the emergency department! Don't bother signing up for an application form!" Upon hearing this, Yang Lingchong made a prompt decision and pushed the patient out quickly.

At the same time, Yang Lingchong, who was beside Xiang Miao, had already started calling people.

Because Xiang Miao trusts Zhou Yanqing, they get along well with each other!

"It's okay to deal with our orthopedic situation later!" Zhou Yanqing explained from a distance.

The nurses here are all experienced, so they quickly pushed the monitor, removed the fixed oxygen inhalation equipment, replaced it with an oxygen pillow, kept up with the pace, and trotted away.

Zhu Gongjiao, the resident chief of thoracic surgery, also followed to send the patient to the emergency operating room and called for help!
At this moment, He Qingqing turned around and said something at the door.

"If there is no patient's family member, call the general duty phone number!~" He Qingqing is experienced.

Dong Xiao from the emergency department did as he was told immediately.

The others quickly got busy with their own things.

The people from the cardiac surgery and gastrointestinal surgery departments kept glancing at Zhou Yanqing, but Zhou Yanqing was mobilizing people, so they couldn't bother him. After Zhou Yanqing hung up the phone, Du Guodong from the gastrointestinal surgery department smoothed his slightly coquettish hair and said, "Doctor Zhou, can you see this active retroperitoneal hematoma with a plain film?"

"It's a bit sci-fi!~"

The reason why Du Guodong reacted so strongly was that he spent the longest time reading the abdominal film, but he had no reaction at all.

Zhou Yanqing just took it and looked at it for three seconds before confirming it.

This is either a guess, or Zhou Yanqing really has some skills.

The general principle adhered to by the emergency department is that it is better to believe it exists than to believe it does not exist.

If Zhou Yanqing had guessed, sooner or later he would have ruined his character and become the naughty child who cried wolf.

If Zhou Yanqing was not guessing, then they all had to examine Zhou Yanqing's level.

Film reading has nothing to do with operation and can be said to be the most versatile diagnostic skill in medicine!

You need to learn a thing or two about any major!
The level of film reading skills, to a certain extent, reflects the level of diagnosis.

"Doctor Du, the segment here is not the air cavity in the intestine, but the shadow of the overlapping air cavity and bleeding."

"This sand shadow must be something that reflects the X-rays, so they cannot be fully projected to the bottom of the film."

"It is lighter than the bone and darker than the solid organs, and it is uneven. All I can think of is a blood clot," Zhou Yanqing explained in detail.

Du Guodong asked doubtfully, "Really? Is it that obvious?"

Lan Zhuozhi from the Department of Cardiac Surgery also took the film, his eyes narrowed into slits...

But the technology of film reading is actually of an entry-level nature. Some things are no longer high-end once you understand the clues.

But before you understand it clearly, your skills are not good enough, so you just can’t see it.

"I can only guess!~" Plain films are not CT scans, and the development is not that detailed, so Zhou Yanqing could not point out to them exactly where it is.

At least Zhou Yanqing has not studied this aspect yet.

"If this can be seen and confirmed, then there must be something, Doctor Zhou?" Lan Zhuozhi blinked his eyelids quickly.

It's more of a disbelief, but it's not expressed so obviously.

In the reality of the medical environment, it is better to believe it exists than to believe it does not exist.

Of course, the main reason is that Zhou Yanqing has come to the trauma center to take charge, so everyone is willing to believe that there is no false reputation.

Zhou Yanqing didn't continue explaining because it wasn't that important.

Everyone dispersed first, some took a rest, some played with their phones.

The department had just been opened and there were no patients under observation, so this was the natural result.

……

Five or six minutes later, the chief resident of neurosurgery, Gong Zhenyu, called out, "Brother Qi, the CT scan results are out."

Zheng Qi immediately turned on the head CT scan and did not choose to eat melon first.

It is more important to eliminate risks first than to watch the show.

The trauma center is equipped with quite a few work computers. There is a computer in front of each bed for emergency use to issue medical orders and check examination results.

Therefore, other people also saw the CT imaging images.

Things that are difficult to see on X-rays are much clearer on CT, especially since the area of ​​the hematoma is quite large.

"It's true!~" Du Guodong took a breath and held the back of his head with both hands.

"The hematoma is not small, but after being covered with a membrane, it is obscured by the gas in the intestine from a spatial structure perspective."

"Doctor Zhou, you have something special!~"

"You were very confident before. You must have more than 90% chance of success to speak in such a tone."

Zhou Yanqing smiled and nodded, "Not that high, I just tend to doubt it."

Don't brag too much!

When the others heard Zhou Yanqing being so rude, they all looked over at him.

"Yanqing is great. With such good film reading skills, we will be more comfortable in our future work."

"This diagnostic ability seems to be born for emergency cases." Lan Zhuozhi's major is cardiovascular surgery. Although it is heart and large blood vessel surgery, he is very professional in reading blood films.

Zhou Yanqing can see the active hematoma in the retroperitoneum, so his sensitivity to arterial dissection will be higher.

Zhou Yanqing smiled casually.

No reply.

……

Yang Lingchong came back very quickly. He only sent the patient to the emergency operating room and did not perform too many operations himself.

Trauma center only saves lives, not treat diseases!

Although active retroperitoneal hematoma is dangerous, it is still a disease that can be solved by others.

Clinically proven, it can delay the condition for a while.

"Yanqing, you're awesome!" Yang Lingchong gave Zhou Yanqing a thumbs up as he walked in.

Lan Zhuozhi said, "Professor Yang, we made a bet with Zhou Yanqing. If Yanqing can come up with another diagnosis that we can't, we will each owe him a cup of coffee."

"If it doesn't come out, we can split the bill. Do you want to come?"

This is not a gamble, this is just a simple treat and a stake.

"Sure?" Yang Lingchong agreed without even thinking about it.

As he was talking, a man with a nail stuck in the sole of his foot came over...

He jumped over from the surgical clinic on one foot, and the nurse was ruthless and just gave him directions but didn't help him.

When Zhou Yanqing saw this scene, he immediately rushed to the door, carefully treated the patient and put him on the bed.

This is also a traumatic emergency, but we just need to wait for Tian Chao or Yu Yue to deal with it.

Therefore, Zhou Yanqing began the detailed medical consultation in an orderly manner.

With this wound, bleeding for two days will not be life-threatening.

"Doctor, this is the situation. Is my condition serious? Could it be tetanus? I looked up information on the way here and was scared to death." The patient was a man in his fifties.

"It's okay. Even if there are tetanus bacteria on the wound surface of the nail, it won't break out so quickly. I can just get a tetanus shot later."

"Your wound is not very serious, it's okay, don't worry too much." Zhou Yanqing tried to be meticulous.

"Think about it carefully. After stepping on the nail, is there any other place that needs to be touched?" Zhou Yanqing asked.

Major emergencies should be handled extensively, while minor emergencies should be handled meticulously. Asking more questions is also a way to hone your theory!

When other people looked at Zhou Yanqing's medical consultation, they felt that it was a bit like using a cannon to kill a mosquito, but also a bit funny.

But there's nothing we can do about it, this is medical care.

(End of this chapter)