"There is a patient who suffered an injury from a fall from a height. He got it by jumping from the fourth floor. His family does not want to be hospitalized." Yuan Li explained vaguely.
Zheng Ren's heart moved. Jumping off a building and not wanting to be hospitalized. Combining these two keywords, he thought of several possibilities.
"Is it because of insurance?" Zheng Ren asked in a low voice.
Mr. Wang was very moved and admired.
Medical technology is medical technology, and what Dr. Yuan just said is about another dimension.
In the imperial capital, he rarely had any contact with insurance matters. To stay in the 912 hospital, the deposit paid in advance is 50,000. In other words, if you don't pay 50,000 yuan, you won't even be able to live in the hospital.
As for whether the patient can be reimbursed, it is not within the scope of Mr. Wang's consideration.
But the situation in Haicheng is completely different.
Whether medical treatment here can be reimbursed is definitely a major consideration for the patient's family when they choose where to be hospitalized and what kind of treatment they choose.
But Boss Zheng knew it was because of insurance as soon as he saw it. What the hell is this? Mr. Wang also realized the problem.
Yuan Lilian was stunned for a moment and nodded.
Zheng Ren smiled and said, "You guys continue talking."
After that, Mr. Wang and Mr. Wang continued to walk forward.
"Boss Zheng, what's going on?" asked Mr. Wang.
"Jumping off a building is a suicide, and insurance will not reimburse you." Zheng Rendao, "Without insurance, many steel plates in orthopedics cannot be used. If cheap domestic steel plates are used, most of the injuries will be in the lower limbs. In the future, the steel plates may have to bear weight. fold."
“…”
"This will be a medical risk in the future. So if the emergency department admits such patients, who are not very urgent and cannot be reimbursed, orthopedic surgeons will be very unhappy. If it is particularly urgent, they will not be happy.
But didn't Dr. Yuan say that if he jumped from the fourth floor, his injuries would probably not be serious. He might have a calf fracture, an intertrochanteric fracture, or a femoral shaft fracture. "
"As long as it's not open, it's not a big deal. So I moved to another hospital and told the doctor that it was an accidental fall, so I got over it."
"Uh... is this really good?" Mr. Wang has been working as a doctor in the country's top large tertiary hospital. He has been in Haicheng for a few months and has done a lot of surgeries, but he has not mastered this very subtle little idea.
"I don't know if it's good or not. To put it more seriously, this is insurance fraud." Zheng Ren said calmly: "But after all, we are treating people, which is better than those small community hospitals that hedging cash every day." . Haicheng community small hospital, hospitalization is free, and money is paid every day.”
"Giving money? So powerful?"
"Yeah." Zheng Ren nodded as he walked away, "I heard someone say that it's about one hundred a day, which is about the price. The hospital prescribes medicine in a hanging bed, and the hospital takes it and sells it. This is a hedging method. There are many ways to do it. The huge deficit in medical insurance does not lie in the tertiary hospitals, but in the community."
"This is not..." Mr. Wang was filled with indignation.
"Calm down, even at the grassroots level. It's like this for everyone. If the control is stricter, then restrain yourself. If the control is looser, then seize the time to prescribe medicine." Zheng Ren smiled, "Everyone has something good to do, and no one will do too much. It’s a matter of fact. It’s good for everyone, but in the end it’s bad for everyone. But how to do it, who knows.”
Zheng Ren acted as if he was just a doctor, responsible only for medical treatment and surgery. He had no control over such matters and could not control them.
Mr. Wang was a little sad. There were so many loopholes down there, and he didn't know about them before.
Walking to the door of the emergency room, Zheng Ren took a look.
His body stiffened slightly and he quickly walked into the emergency room.
There are nurses busy in the emergency room. The patient is lying on the emergency bed, and the numbers displayed on the ECG monitor are still very stable.
Zheng Ren walked in quickly and caught the nurse's attention.
She turned her head and said in surprise: "Mr. Zheng, you are back."
But the surprise only lasted a moment. When the little nurse looked behind Zheng Ren, she immediately fell into boundless disappointment.
Zheng Ren knew that the person who could really surprise the little nurse was Su Yun. That guy, I don’t know if he and Chang Yue have finished drinking.
Nodding, Zheng Ren came to the patient's side, stretched out his hand and said: "Stethoscope."
Mr. Wang was a little confused, so he took out the Yuyue stethoscope from the pocket of his white clothes and handed it to Zheng Ren. The patient's blood pressure was 150/100 mmHg, heart rate was 102 beats/min, respiration was 28 breaths/min, and blood oxygen saturation was 98%.
The electrocardiogram showed sinus rhythm. This was an emergency patient, but not a critically ill patient.
The patient's injury was the same as Zheng Ren judged. It was on the lower leg. Mr. Wang estimated that it was a fracture of the tibia and fibula. It's just that the fracture was a little serious, the left calf was congested and edematous, and the skin was a little shiny.
Compartment syndrome is obvious and easy to recognize.
If Mr. Wang were to deal with this patient, he would neither talk to the patient's family about medical insurance like Yuan Li did, nor would he use a stethoscope to listen to the abdominal cavity like Zheng Ren did...
Boss Zheng is having sex with his belly? Isn’t this nonsense
The vital signs were stable, and it was estimated that the abdominal organs were fine, otherwise Yuan Li would not have leisurely talked to the patient's family about medical insurance.
To put it bluntly, even if there is something wrong, you should not auscultate it.
"Bedside B-ultrasound, call right away!" Zheng Ren said in a deep voice. In an instant, he had returned to the role of the chief resident of the emergency department of Haicheng City No. 1 Hospital. "Sodium nitroprusside, lower blood pressure, keep high pressure at Under 120.”
The little nurse was startled. Although Zheng Ren had been gone for half a year, his power was still there, and his body's instinct was to obey, not to question.
She quickly asked someone to call, and she took the time to add medicine.
"Boss Zheng?"
"It is suspected that the thoracic and abdominal aorta are torn." Zheng Ren gave the diagnosis directly, "Go and ask Yuan Li to come in."
Zheng Ren just took a look at the emergency room, and the bright red background color of the system panel attracted him in. The system diagnosis was so serious that Zheng Ren did not dare to waste time.
Auscultation is just a method that few people use. Because the patient is relatively thin, if he presses the stethoscope hard, he can hear the sound of blood flow in the aorta. But there are so many murmurs that the real diagnosis is not done in this way.
This is just a way of Zheng Ren's retrograde inference, and others cannot learn from it.
"..." Mr. Wang looked at Zheng Ren in surprise and then at the patient, speechless. Where is this going
However, the experience of diagnosis and treatment of patients with pj syndrome tells Mr. Wang that he must obey.
He quickly walked to the door and called Yuan Li in.
Yuan Li was a little unhappy. He had just finished explaining the matter to the patient's family in a cryptic manner, and he let the patient's family know what to do without saying anything himself.
The next step is to sign a statement saying that you will be responsible for any consequences, and then be sent by the 120 ambulance to another hospital in the city for diagnosis and treatment.
In Yuan Li's opinion, it was just a fracture. Which hospital wouldn't treat it
Did Zheng Ren come back to cause trouble for me? ! He was a little angry.
…
…
Note: This is a patient received in 10 years. My skills are not high. I looked at the chest CT and could not find the dissection. To explain, dissecting aneurysms are more difficult to distinguish at the beginning. I just had doubts in my heart and had to leave home, so I waited until dawn the next day and contacted the emergency department for vascular CT reconstruction.
Finally, I was diagnosed with dissection and went directly to the ICU. What happened next is also true. The person survived, but he spent a lot of money and the family was in a mess. When I was discharged from the hospital, his wife looked at me in a wrong way, viciously.
But that's it, smile.
As a side note, my physique is more susceptible to dissecting aneurysms. There have been 8 patients with rib fractures and aortic dissection in the department over the past ten years, and I was always on duty.
This is very speechless.