Back in 2002 as a doctor

Page 459

"You said it the other way around, it's just a twitch of the brain and the diagnosis is wrong." Liu Xiaobie corrected.

"I met a patient who was in the Department of Orthopedics." Zhou Congwen said with a smile.

"Orthopedics? When you were in the third hospital of Jianghai City, you didn't have a rotation department!" Liu Xiaobie corrected immediately, "I remember you said that when the Cardiothoracic Surgery Department was just established, Wang Chengfa was in a hurry to ask for someone, so he applied to take the few of you there."

"..." Zhou Congwen really didn't know how Liu Xiaobie knew about these old things. If she hadn't mentioned it, he wouldn't even remember when he casually mentioned it to her.

"It's about going to college and doing an internship in the fifth year." Zhou Congwen said helplessly, "Can you listen carefully."

"Then tell me."

"There is a doctor in the hospital who went to the imperial capital to learn the cervical spine massage technique from the old lady."

"old lady?"

"A well-known Chinese medicine doctor, I won't tell you the details." Zhou Congwen said, "There is a patient with cervical spine discomfort, so he came to the hospital for treatment."

"At that time, Teacher Tian and I were seeing patients together. Teacher Tian was going to massage the patient to relieve symptoms. I saw that the patient had no problems at all, so... my brain twitched."

"Male patient and female patient? What did you do to the patient?" Liu Xiaobie asked.

"Don't make trouble, that's a patient." Zhou Congwen said helplessly, "At that time, Mr. Tian had a lot of patients. He was waiting in line outside, and he had no other problems except a slight discomfort in the cervical spine. I happened to be learning massage with Mr. Tian. While studying the electrocardiogram."

"Is your brain twitching? It doesn't take much trouble to make an ECG from the electrocardiogram machine in the department, so I made one for the patient."

"I was dumbfounded when I spit out the electrocardiogram, the standard tombstone line!"

"I understand this!" Liu Xiaobie said, "It's also called the black widow line. My mother said that the second uncle next door sent it to your Jianghai Third Hospital a few days ago, and the electrocardiogram showed the tombstone line."

"I thought I was wrong. I took the electrocardiogram to Teacher Tian. Teacher Tian threw away the patient in hand, checked another ECG, and pushed the patient to the Department of Cardiovascular Medicine with a flat cart."

"The patient has myocardial infarction?" Liu Xiaobie was a little surprised, "The second uncle next door had blue lips at that time, why is the patient you said okay?"

"Yes, this is the weirdest." Zhou Congwen said, "Clinically, it is called atypical symptom. Simply put, the typical symptom of myocardial infarction is precordial pain, radiating to the shoulder and back, accompanied by chest tightness and shortness of breath. But the patient It manifests as discomfort in the cervical spine, if you talk about it, if you see a doctor in the orthopedics department... you will fall down and die with a 'bang' at any time."

"Tsk tsk, I can only say that your technical level is not enough." Liu Xiaobie raised the bar.

"That's true." Zhou Congwen didn't deny it, but said with a smile, "The boss has always said that, the more knowledge you get, the more you feel ignorant."

"Socrates said it."

"It's almost the same meaning." Zhou Congwen said, "Anyway, the more clinical experience you have, the less you dare to be negligent. There are too many possibilities, although many of them are very small, but who knows."

"You are obsessive-compulsive."

"Is human life at stake? Let me give you a few more examples."

Chapter 0787 brain twitching

"I once saw a patient who complained of headaches. After a head CT scan, nothing happened. I asked her to lie on the bed for a physical examination, and the patient's parents scolded me."

"It's a girl, didn't you ask someone to take off your clothes?" Liu Xiaobie said with a smile, "Zhou Congwen, you are a stinky hooligan!"

"Oh." Zhou Congwen did not refute, but sighed.

"Go ahead." Liu Xiaobie said.

"At that time, my brain was also twitching, and my temper came up." Zhou Congwen continued, "Writing medical records requires an abdominal examination. At the time, the patient had a headache. At that time, I thought it was a disguise that I didn't want to go to school, but why should my family scold me for pressing my stomach?"

"Were you young then?"

After Zhou Congwen said this, he was startled suddenly, his scalp numb.He knew he was wrong...

"At that time? When?"

Sure enough, Liu Xiaobie looked at Zhou Congwen suspiciously and asked.

"That's not important, can you pay attention to something useful." Zhou Congwen reprimanded pretending to be relaxed, "I got angry and wrote an informed consent form. The patient's family had no choice but threatened to sue me in the hospital. "

"As a result, I found that the patient had pain in the upper abdomen after a physical examination. I did a B-ultrasound and blood tests, and found that it was pancreatitis."

"Pancreatitis? Zhou Congwen, don't bully me. I don't understand. It's just you, a rascal. You have to have a medical checkup because of the beauty of other girls."

"Don't make a fuss, the patient really has pancreatitis." Zhou Congwen smiled slightly as he recalled what happened in his last life when he was possessed by the system just after surgery.

At that time, he added a few lucky points, so every time he thought about it later, he felt really lucky.

For example, for this patient, it was indeed because the medical office had just arrived for an examination and required that the relevant examinations be completed carefully, so there was this step of pressing the stomach.

The patient's pancreatitis is very serious, and if it is missed, the next step may be diffuse peritonitis.

Sometimes seeing a doctor in the clinic is just... like the boss said, like fortune-telling.

The boss did not have CT and B-ultrasound when he was young, so many diseases were not carefully checked at all.But after thinking about it decades later, why doesn't it look very sloppy now?

"Why?" Liu Xiaobie asked.

"The patient started to vomit violently in the early morning, but she didn't mention the vomiting when she came to the hospital. She thought it wasn't important, it was just a headache." Zhou Congwen said, "I asked about the medical history carefully, but the patient and the patient's family members didn't say anything, just said Waking up with a headache."

"I'm not the medical department, why are you telling me this?"

"..." Zhou Congwen smiled helplessly, he was used to it, and always had to explain.

"The headache caused by severe vomiting, and the signs were not obvious, so I almost ignored it."

"Tsk tsk, you doctors are really unreliable." Liu Xiaobie said.

"No way, the current level of technology is like this." Zhou Congwen said helplessly.

Standing at the peak of the existing technical level and looking up, there are many mountains and mountains, but I am actually just standing on a small hill.

Zhou Congwen has a clear understanding of himself.

"I'll tell you one more thing. The patient complained of a stomachache. After my physical examination, I found nothing wrong."

"and after?"

"The patient was lying on the bed clutching his stomach and vomiting from time to time. I had an idea and asked for a CT scan of the head, which turned out to be cerebral hemorrhage caused by intracranial hypertension."

"It's just that you are not careful, and you still have an idea. It's really nice to say it. Change to an experienced doctor, and he will be able to tell at a glance."

"hey-hey."

Zhou Congwen did not refute that there are definitely no more than five doctors with more experience than himself in the whole country.

Even in his heart, only his own boss can crush him in terms of experience points, and it doesn't matter if he doesn't talk about others.

"That's it, do you enjoy it every day?"

"It's very interesting, don't you think?" Zhou Congwen said with a smile, "It's all simple. Let me tell you one of the most dangerous things."

"Still in the orthopedics department, one day a patient was sent by 120, saying that he accidentally slipped to the waist while walking." Zhou Congwen recalled the situation at that time, and recounted lightly.

Even though it has been many years, he still has lingering fears when he talks about it.

"At that time, the patient said that he had back pain. The MRI of the lumbar spine and the CT scan of the head showed nothing. The spinal canal was normal, but the patient was in so much pain that he couldn't walk."

"So I had to call the doctors in all departments for a consultation."

"Zhou Congwen, what kind of patient? You can call all the doctors from all departments for a consultation because of your back pain? Don't you, a cardiothoracic surgeon, know how to scold your mother?" Liu Xiaobie asked.

"..."

Zhou Congwen sighed.

This happened in Shuai's mansion, and it's normal to have a consultation.

Liu Xiaobie's intuition is really sharp, no matter what she says, as long as there is a little bit of falsehood, she can immediately detect it.

"Go on, why don't you stop talking? It's really annoying to listen to you tell a story. I'm listening with my ears up, and my ears are tired."

"Auriculomotor muscles are also called special ear muscles or external ear muscles, including supraauricular muscles, anterior auricular muscles, and posterior auricular muscles. This muscle in many animals allows their ears to rotate freely in order to change the direction of the pinna and collect a certain amount. sounds in the area.

Although humans also have this kind of muscle, due to the structure of the human ear and head, it is obviously not functional. Like the ligament, it only plays the role of fixing the pinna.

If you can move it lightly, it means that the ear muscles are well developed, and the nerves there are underdeveloped, so you won't feel tired. "

"Hey, Zhou Congwen, I feel that you are connoting me." Liu Xiaobie said contemptuously.

"No, I'll continue." Zhou Congwen felt much better after the connotation, and continued, "I don't have any good diagnosis, so let's keep going. When you encounter a disease that you don't understand, it's best to talk less. Besides, patients It has nothing to do with my heart, why should I stand up and beep beep."

"After the consultation, go to the bathroom and wash your hands."

"When I saw the water flowing from the faucet, I suddenly froze."

"Huh? You...hahahaha." Liu Xiaobie suddenly laughed.

Zhou Congwen sighed, although Liu Xiaobie didn't say it clearly, she must mean that she peed on her hand.

I don't know where this girl got so much miscellaneous knowledge...

"The subarachnoid hemorrhage formed by the rupture of the aneurysm can be manifested as no hemorrhage in the ventricle, and the blood circulates along the subarachnoid space, stimulating the nerves and causing corresponding symptoms."

Zhou Congwen explained.

"I went back and asked. The patient remembered that he had a history of transient headache a few days ago. But it only hurt for a while, so he didn't care."

"I immediately took the patient for an examination, and the MRI revealed a ruptured 5mm aneurysm near the patient's cerebellum."

"The patient is also fatal, and I was reminded of it when I went to the bathroom and saw the water flowing from the faucet."

"Are you sure it wasn't when you peed that you suddenly remembered that the water was flowing downhill?"

"..."

Zhou Congwen sighed deeply, unexpectedly Liu Xiaobie was right again.

Chapter 0788 Arrogant

"Back pain, can't walk, diagnosed as an aneurysm, how do you think the next door is like doing a Mathematical Olympiad? Where is this Oudu?"

Liu Xiaobie asked.

"These are rare cases, in other words, they are clinical experiences that doctors often talk about." Zhou Congwen was glad that Liu Xiaobie didn't continue to ask.

"Does it make sense to know about these rare diseases?"

"Of course there is. For example, I saw a patient with purple urine a few years ago. At that time, Director Tang of the Department of Respiratory Medicine was stunned, and he had no idea why this happened."

"What's going on? Did you eat violets?" Liu Xiaobie asked.

"No, I ate black sesame seeds." Zhou Congwen explained to Liu Xiaobie how black sesame seeds and other foods can cause purple urine.

"Cut." Liu Xiaobie gave Zhou Congwen a disdainful look.

"Clinical experience can really save lives in many cases, because patients will forget a lot of things. When asking about medical history, patients can't tell the whole story. There is no one to blame for this." Zhou Congwen said.

"for example?"

"I told you just now, the headache caused by severe vomiting, the patient and the family members of the patient forget the severe vomiting and think it is not important. The occasional headache caused by the patient only pays attention to the occasional, and forgets the headache." Zhou Congwen said.

"To give another example, when I hear you say these things, I feel that your face is shining, and you are very handsome."

This is the first time Zhou Congwen heard Liu Xiaobie praise himself.

"Ahem, cough, for example, I met a patient who was hit by a bicycle and had a hematoma in his waist." Zhou Congwen has rich clinical experience, and the "game" of case diagnosis with his boss has further enriched his clinical experience. Come at your fingertips.

"After the examination, it was found that the patient had subarachnoid hemorrhage and abnormal blood coagulation."

"The waist was hit, accompanied by cerebral hemorrhage?"

"It can be understood in this way, although there are some problems in your understanding." Zhou Congwen said, "The key lies in the patient's blood coagulation problem, so we organized a hospital-wide consultation, but it has nothing to do with heart and chest. In a word, guess what I asked?"

"..." Liu Xiaobie's white teeth were clear and her lips were bright, as if she was guessing.

"I asked him if you took the wrong medicine."

"!!!" Liu Xiaobie laughed, "Zhou Congwen, are you looking for scolding?"

"Then I violated the clinical regulations that patients cannot be induced to state their symptoms, and asked the patient directly—did you take rat poison?" Zhou Congwen said softly, recalling what happened back then.

Occasionally thinking about the past, Zhou Congwen still has some nostalgia.

"!!!" Liu Xiaobie was surprised.

"The patient said yes, so he was transferred to the gastroenterology department, and the problem was solved smoothly."

"First of all." Liu Xiaobie thought for a while, "How do you know the rat poison you ate?"

"Because there are not many diseases that cause blood coagulation disorders in young people, the emergency department has also done a comprehensive examination. There is nothing suspicious, only the symptoms after eating rat poison are more similar."

"What you said is logical." Liu Xiaobie thought for a while, "Secondly, the patients all took rat poison, why didn't you say it before?"

"I also asked this question at the time, and the patient said that the doctor didn't ask him so he didn't say it."