Chinese medicine: When you do things to the extreme

Chapter 256: Little fun in the emergency department!
As soon as Yang Lingchong left, a stretcher carrying a patient came straight from the entrance of the emergency department.

The sharp-eyed nurse in the blue hat opened the door of the trauma center wide open, allowing the people in white coats and green clothes to rush in quickly, pushing the patients.

Zhou Yanqing and others stood up and moved towards the door to prepare for the consultation.

However, most people stopped what they were doing after hearing a shout from afar.

"Pneumothorax!" a middle-aged man in a white coat shouted very experiencedly.

Hearing the sound, Zhou Yanqing and others began to disperse to give more space to Tan Wei and Zhu Gong from the Department of Thoracic Surgery.

As the patient approaches, even from a distance, one can see that the patient's lips are dark blue, his mouth is slightly open, and he is trying to breathe in big gulps, but because the negative pressure between the visceral wall and pleura of the chest disappears, breathing becomes extremely difficult.

"Put the bed over here and give him oxygen!" He Qingqing from the emergency department ordered people to push the bed into position while giving medical instructions to the nurse.

On the other side, two experienced nurses have already started opening the puncture kits!
The patient had no open chest wound, so it should be classified as a tension pneumothorax.

Difficulty breathing is a particularly important step in the lifeline and its treatment priority is extremely high.

Zhou Yanqing and others did not get close, but watched Tan Wei and Zhu Gong operate quickly.

Tan Wei just glanced at Zhu Gongjiao, and Zhu Gongjiao immediately understood and started to disinfect quickly.

"Get out of the way!" Zhu Gongjiao shouted, and then quickly inserted the puncture needle into the right second intercostal space at the midclavicular line.

At the same time, Dong Xiao from the emergency department took over the position of pressing by the man in green clothes, allowing the man in green clothes to make room to complete the handover with He Qingqing.

"The patient was injured in a car accident. Initial considerations include a closed fracture of the right lower limb, closed abdominal injury, and positive mobile dullness." The patient had no open injuries, and the doctor in green clothes could only make a diagnosis through his own physical examination at the scene.

Upon hearing this, Xiang Miao from the Vascular Surgery Department, Huang Yaqin from the Hepatobiliary Surgery Department, and Du Guodong from the Gastrointestinal Surgery Department immediately stepped forward and began to examine the patient.

At the same time, Tan Wei quickly completed the puncture and exhaust, and began to connect the chest closed drainage tube...

As the air pressure in the pleural cavity is released, the patient's breathing begins to become gradually stable and the feeling of suffocation slowly disappears.

"The blood oxygen level is 89%, and the high pressure is 95!~" the nurse replied after connecting the blood pressure and blood oxygen instruments.

Huang Yaqin roughly palpated the abdomen, then raised her head and said, "After the closed chest drainage is completed, send it directly to the photo room!~"

It is a non-open injury and the amount of fluid accumulated in the abdominal cavity is not much, which proves that even if there is active bleeding, the amount will not be large.

A quick examination and pushing the patient into the operating room for laparotomy is necessary!

"The intravenous access has been established!~" At the same time, a nurse next to He Qingqing quickly applied adhesive tape to the patient.

"The patient's blood pressure is fine, let's replenish the colloid at a uniform rate first!" He Qingqing said.

The systolic blood pressure of 95 is not high, but it is not particularly low either!
"Okay!~" The nurse immediately slowed down the infusion speed.

"..."

After the patient's suffocation was relieved, he began to breathe heavily, and then opened and closed his dry lips, weakly: "Thank you!~"

"You need to go to the X-ray room right now. We need an accurate diagnosis."

"After the examination, the next diagnosis and treatment plan will be determined based on the results."

"You don't have any family members, so just press your fingerprints directly, okay?" He Qingqing quickly signaled to the nurse and Dong Xiao who was following her to press their fingerprints.

The patient nodded! ~
He said two more words: "Thank you."

"Don't worry, when you get to the hospital, cooperate with us. We will contact your family members after your test results come out."

The man in green clothes just arrived at the entrance of the trauma center at this time. He turned around and said, "I have contacted the family members at the scene. It will take some time for them to rush over from Hexi."

……

After the patient was quickly pushed in for examination, He Qingqing tilted her head and said, "Doctor Zhou, you are responsible for reading the film!"

"Just now the nurse quickly drew blood when establishing the intravenous access. Dong Xiao, you are responsible for tracking the test results."

Zhou Yanqing nodded and said, "Okay, Mr. He, the fracture in our orthopedics department should be treated in the second stage. Our trauma surgery department has sent someone to apply plaster."

"While the patient was admitted to other departments, he was probably treated with traction first."

For non-open fractures and inactive hematomas, the orthopedic treatment principle is to reduce swelling first and then perform surgery.

"Okay, thank you for your hard work, Dr. Zhou!" He Qingqing added cautiously.

According to the division of labor in the trauma center, Zhou Yanqing can leave the patient alone after doing all this.

However, it seems that Zhou Yanqing still has to take the lead in film reviewing now.

And this was originally her, He Qingqing's responsibility!
However, some things that happened in the morning made He Qingqing feel rather mysterious!

Yang Lingchong came back soon, and He Qingqing quickly completed the report on the medical treatment with Yang Lingchong.

Yang Lingchong heard this and said, "Did you call the emergency operating room? We must prepare the emergency operating room as soon as possible."

"This patient will most likely need a laparotomy!"

"I've called. The head nurse of the emergency operating room will reply within ten minutes." He Qingqing replied.

"The patient's abdominal and chest X-rays are out." Zhou Yanqing interrupted.

"What's the situation?" After hearing Zhou Yanqing's voice, everyone turned around and moved away, wondering which specialist should take action.

If it is an open wound, then treat it on the spot.

For this kind of closed trauma, it would be more appropriate for the specialist resident to send the patient to the emergency operating room for treatment, and even an associate professor may be required to step in.

Zhou Yanqing was suddenly surrounded by seven or eight heads, which made him feel a little uncomfortable, but he quickly suppressed his discomfort: "The spleen is bruised and lacerated, and part of the essence is injured!"

Zhou Yanqing couldn't remember the degree of spleen rupture, which is a professional subject in hepatobiliary, spleen and pancreatic surgery, so he just reported what he saw truthfully.

Huang Yaqin tilted her head: "Second degree injury, Liao Huatong, call back, we need to do a partial removal and repair, hospitalization is not enough! ~"

If a full-thickness rupture requires total splenectomy, it can always be done during hospitalization, but partial resection is more difficult than total resection and cannot always be done during hospitalization.

"There is pancreatic damage!" Zhou Yanqing suddenly looked up and said cautiously to Huang Yaqin.

Zhou Yanqing is not a general surgeon, but he is also familiar with surgery!

The most iconic one is this: the incidence of pancreatic injury is very low, accounting for only 1% to 2% of abdominal injuries, but it often occurs in the neck and body of the pancreas, and pancreatic leakage is prone to occur after injury.

The mortality rate is as high as 20%!

Huang Yaqin frowned when she heard this and changed her words: "Call the second-line team."

Hospitalization is not a solution, and the associate professor must come.

"Where is the liver?" Huang Yaqin asked.

The probability of liver injury is higher than that of pancreas injury. Generally, 90% of violent pancreatic injuries will also cause liver injury.

"I didn't see anything special from the X-ray!~" After reading the film, Zhou Yanqing gave his seat to Huang Yaqin.

In closed injuries, the incidence of gastroduodenal injuries is relatively small!
Zhou Yanqing couldn't tell what the damage was.

"Sister Qin, we can only further confirm it after the CT scan results come out!~" Zhou Yanqing explained to Huang Yaqin who was frowning.

Obviously, Huang Yaqin is still looking for the damage points very carefully.

Little by little, I found all the injuries I mentioned.

Huang Yaqin has the ability to read films, but her proficiency is slightly lower than my own, so she may be a little slower.

Based on this, she directly chose to trust her own diagnosis after the first glance at the plain film. After Huang Yaqin finished gesturing with her fingers, she immediately picked up Liao Huatong's phone and said, "Teacher Teng, this is Yaqin?"

"Yes, there is a patient here with a rare closed pancreatic body injury. I don't think Chang Hao can handle it."

"Hey, thank you for your hard work, Teacher Teng!~"

"Okay." Huang Yaqin was very lively and cheerful. She politely hung up the phone after a few words.

Du Guodong from the gastrointestinal surgery department asked, "Yanqing, usually pancreatic injury is accompanied by duodenum and small intestine injury? This patient really doesn't have any?"

Zhou Yanqing shook his head.

Cautiously said: "Maybe I didn't notice it."

Huang Yaqin explained: "What you are talking about is that pancreatic damage is difficult to diagnose immediately, and the digestive fluid secreted by the pancreas has already caused erosion of the intestines!"

"Or it may have already caused diffuse peritonitis, which was discovered during the exploration."

“It’s still early days!~”

Du Guodong looked at Huang Yaqin with some fear, but more of respect, as if he was suppressed by Huang Yaqin's bloodline.

……

The patient has not returned yet, but the basic diagnosis and surgical direction have been determined.

All that remains is to wait for the patient to go to the operating room and then have the specialist come over to perform the surgery.

That’s what a trauma center is all about!
The patient was pushed back after the CT scan.

Therefore, everyone can see the patient's imaging data before the patient comes back.

Huang Yaqin was very confident and did not repeat the review. She just put her hands behind her back and looked Zhou Yanqing up and down, smiling: "I didn't expect that Dr. Zhou is so enthusiastic and is so good at reviewing the films of our hepatobiliary surgery diseases."

Zhou Yanqing shook her head and said, "Sister Qin, if you look at the orthopedic films, it must be the same!~"

"Mutual respect." There is no false reputation. Zhou Yanqing is sure that Huang Yaqin's film reading ability has reached the expert level, or at least close to it.

After about a minute and a half, Liao Huatong found all the injuries that Zhou Yanqing had mentioned on the CT scan, because CT scans provide more detailed images.

Turning around to report: "Sister Qin, the spleen is contused and lacerated to the second degree, and the pancreas is damaged!~"

"Can these things really be seen on a flat film?"

Huang Yaqin nodded and shook her head: "Yes, but the obstruction is very strong, and the false positive rate is higher. CT scan is a must!"

"The flat piece is just a pointer, don't be arrogant or conceited."

"If there is a simpler method, we should use it!~"

As a result, everyone's view of Zhou Yanqing changed completely.

This really is a giant Buddha and a magic needle that stabilizes the sea!
Yang Lingchong from the Department of Vascular Surgery felt that he had picked up a treasure. With Zhou Yanqing around, their work in the trauma center would be very smooth!
Just get through it!

……

Of course, in the hospital, if you want to raise the salary of a junior doctor to the level of attending physician or even "associate professor" across specialties, you need to go through very strict "screening"!

The chief resident of the dean's department does not necessarily command the attending physicians of other specialties.

It’s not like Lei Zhong can just assign an assistant to Zhou Yanqing if he wants to.

The chief resident leader can only occur within a specialty and should not occur between specialties.

……

Professors in the Department of Radiology do not actually have much pressure, because the routine film reading is handled by the junior doctors in the department.

The resident physician will make the initial review of the film, the attending physician will review or make the initial review, and the associate professor will be responsible for the final conclusion.

Professors are responsible for more difficult and complicated cases and a small number of requests for consultation and film reading from other hospitals.

Professor Meng Guangzhou, director of the Department of Imaging, hung up the phone in annoyance, then stood up thoughtfully.

"What's wrong with Dean Lei today? Why are you making fun of me for no reason?"

"Li Xiangming from the emergency department said there is a doctor in the emergency department who is very good at reading films, and asked me to go over and check it out and ask them if I can be considered as a diagnostician."

"What the hell is this?" Meng Guangzhou started to curse.

Emergency Department, with high level of film reading and scientific research.

These keywords are not adjacent to each other at all.

However, Meng Guangzhou was quite happy with this very special "consultation attendance", as it suddenly brought a bit of fun to his monotonous and boring life.

Meng Guangzhou put his hands behind his back, walked slowly with a figure-eight step, and came to the emergency department.

After finding Li Xiangming, they smoked two cigarettes and drank a cup of tea together.

Then Li Xiangming personally led Meng Guangxio around the emergency department slowly before arriving at the trauma center clinic.

This kind of "consultation and medical treatment" is not urgent, so you can take your time.

When the two arrived at the emergency trauma center, everyone inside was gathered together. There were only four or five patients in the beds, and six or seven beds were vacant.

The nurse was secretly eating snacks in the office, but when she saw Li Xiangming, she immediately put the snacks away and hid the half of her face that was exposed.

That's the point of their voyeurism.

Li Xiangming asked: "Director Meng, should I go..."

Meng Guangxiou's ears pricked up.

He made a hushing gesture to Li Xiangming.

Then I started listening to the young man inside talking about the content.

After just a quick listen, Meng Guangzhou roughly knew who Li Xiangming was talking about.

After listening for about twenty seconds, Meng Guangxiou laughed.

After listening for a minute, Meng Guangzhou pulled Li Xiangming and motioned him to go out.

Li Xiangming has been paying attention to the changes in Meng Guangxiou's expression.

So I followed him out.

After walking out, Li Xiangming asked, "Director Meng? Is this all that's needed?"

"Why not?"

"Director Li, you are not expecting me to be pinned to the ground and beaten by that young man, right?" Meng Guangzhou asked with a smile, his aura suddenly rising.

Although Li Xiangming thought so, he couldn't say it out loud. He quickly shook his head and smiled, stroking his chin: "It's mainly because the loss was too unfair."

"what?"

"How much did you lose?" Meng Guangzhou immediately understood.

"Fifty..." Li Xiangming lowered his voice.

"This is your daily ration." Meng Guangzhou cast a pitiful look...

(End of this chapter)