"Boss Zheng, please take a look at the test report." The young doctor diligently turned the iron medical record folder to the position where the test report was pasted, handed it to Zheng Ren, and then reported the medical history.
“The patient visited our hospital 5 days ago due to abdominal pain for 4 hours. He was diagnosed with acute appendicitis and underwent emergency appendectomy.
During the operation, atypical appendiceal inflammation was found, and the appendix was successfully removed. The patient still felt abdominal pain after the operation, and abdominal distension occurred a few hours later. Because he could tolerate it, he did not pay attention to it and did not receive special treatment. After that, the abdominal distension gradually worsened and the abdominal pain gradually decreased. "
"Wait a moment. During the operation, I asked you to aspirate 20ML of light yellow exudate. Did you follow the operation?" Zheng Ren did not look at the test sheet directly, but found the operation record.
After a quick glance, Zheng Ren saw a sentence that made him question.
"Boss Zheng, I followed you for the operation." The young doctor said: "When the peritoneum was incised during the operation, a small amount of light yellow exudate did come out. I used a suction device to suck it clean. There was no pus and no pus. Relatively clear, not turbid.”
He felt that Zheng Ren was making a fuss. It was just a little leakage, which might be caused by inflammatory appendic leakage.
Although there was a lot of exudation, it was estimated to be only 20ml, so it didn't seem to be anything to be alarmed about.
This is not the main point. The main problems are intestinal obstruction and large amounts of abdominal fluid in the back.
But before the report could be made, Boss Zheng interrupted himself.
"Well, I'll think about it again, you continue." Zheng Ren said casually while flipping through the medical records.
"The subsequent abdominal plain X-ray examination showed intestinal obstruction. According to the intestinal obstruction, fasting, continuous gastrointestinal decompression, fluid replenishment and other treatments were given. Three days after the operation, the patient ventilated and defecated, but the abdominal distension continued to worsen, and there was obvious abdominal pain. Bloating. After consultation with the director, it was recommended that the patient’s family be transferred to the provincial hospital for continued diagnosis and treatment.”
"The patient's current physical examination: clear consciousness, low spirit, and stable vital signs. Left lower quadrant tenderness is positive, no rebound tenderness, Murphy's sign is negative, liver and spleen are not palpable under the ribs, no mass is palpable in the entire abdomen, and there is no tenderness in any ureteral tenderness point , there is no percussion pain in the liver and kidney area, there is dullness when percussion in the abdomen, positive shifting dullness, and normal bowel sounds, about 4 times/min.”
The little doctor was a little proud. He said these things casually, but he had put in a lot of effort.
It's really hard to find a clinician as serious as myself.
The tiger's body was shaken, and Boss Zheng bowed before he could even accept it, crying and shouting that he wanted to take him to the imperial capital
It is said that Liu Xuzhi, the coward from the Radiology Department, was invited many times by Boss Zheng to work in the Imperial Capital. Not even going to work, there is still preparation!
That is the establishment of the imperial capital.
Liu Xuzhi can go, what can't he do
After reporting the medical history, the young doctor thought with some pride.
"Past history... Li Yong, has your wife had hepatitis B or tuberculosis before?" Zheng Ren asked.
"No."
The young doctor was a little puzzled. Past history was not important. It's all in the past, there's nothing to ask.
Hepatitis B tuberculosis and appendicitis have nothing to do with each other.
Even if it's tuberculous intestinal obstruction... that's very rare. Boss Zheng is nitpicking, just because he reported the medical history well
"Have you had any surgery?" Zheng Ren continued to ask.
The little doctor looked at Li Yong with a confused face.
"No..." Li Yong hesitated.
"Think about it again, caesarean section and the like will count." Zheng Ren looked helplessly at the medical record, which contained almost nothing about his past history.
The medical records were too rough, eighteen miles worse than Chang Yue's.
Then do it yourself, Zheng Ren asked.
"I have never had a caesarean section... I heard my wife say that before getting married... I had an operation about 20 years ago. There was a mass on the bladder. After it was removed, it was diagnosed as a benign mass." Li Yong searched in the dust of memory. Here comes what Zheng Ren needs.
This is the case when asking patient's family members about their medical history. Many of the things the patient's family members don't pay attention to are that they feel they have nothing to do with the current condition. The second is that they have simply forgotten it. This is a kind of memory bias.
Only by finding clues and getting to the bottom of things can we ask for a clear medical history.
Treating a doctor is like solving a crime, it is really not easy.
"Bladder?" Zheng Ren pondered, "Let me take a look at the film."
The young doctor responded crisply and inserted the standing abdominal plain film into the reader.
The X-ray is very simple and contains small fluid levels. Just by looking at the X-ray, there is no problem at all in diagnosing intestinal obstruction.
But intestinal obstruction... abdominal effusion...
There is no necessary connection between these two diseases.
Zheng Ren went back and read the medical instructions again. There was a large amount of abdominal fluid, and the general surgery department of Xilin Town People's Hospital used conventional diuretic methods.
However, the urine output recorded in the course record was very small.
"Are the urine output values recorded in the disease course records correct?" Zheng Ren asked.
Sometimes, some doctors will ignore this point and write down a random value.
"Boss Zheng, I am very serious about my work." The young doctor's face was a little red. He felt very wronged by the past episode.
This is clearly the fault of the patient's family. I asked them, but they didn't say anything. Why did Boss Zheng just tell me as soon as he asked
Li Yong, this old man, just gives himself eye drops!
"Yes, I can see it." Zheng Ren said warmly.
The little doctor's face improved a little.
"But the clinical experience is not rich enough."
“…”
"I have taken 40 mg of furosemide, but the urine output is not large and the kidney function is not a problem. What are you considering?" Zheng Ren asked.
"..." The young doctor was startled for a moment, "I noticed this, so I suggested that the patient's family take the patient to the provincial hospital."
Zheng Ren already had a guess. He smiled and said, "Let's go and see the patient."
Both the young doctor and Li Yong were stunned, but seeing patients and doing physical examinations were normal diagnostic and treatment procedures, and the specific diagnosis should come out after seeing the patients.
If only Boss Zheng could understand.
If you can't understand... the possibility is very high.
The young doctor led Zheng Ren to the ward. Zheng Ren asked, "Where is your director?"
"There is a dinner party at noon, let's go out to eat."
"Want to drink again?" Zheng Ren asked.
"I guess so." The little doctor couldn't help it. His director only drank like this, and he only drank during holidays. On a normal working day, even if there is no surgery in the afternoon, he is willing to take a few sips, which is quite embarrassing.
However, in town-level hospitals, everyone has similar virtues.
When he arrived at the ward, the young doctor stood aside respectfully and watched Boss Zheng examine him.
He took a first look, his belly was distended.
Well, this is the most basic inspection. Although he didn't say anything, after watching it for nearly two seconds, he was probably thinking about the related illness.
I performed palpation three to five times a day, but the patient's pain moved to the left lower abdomen.