"Boss Zheng, isn't that how lipiodol behaves on CT images?" Lin Yuan asked.
"What kind of thing is it not?" Zheng Ren asked casually.
"It looks like a stone. I always think there's something wrong with what you said." Lin Yuan asked, "Boss Zheng, don't be angry. I just don't understand."
Zheng Ren glanced sideways at Lin Yuan. This kid's talent was good, but he was still much worse than Su Yun.
Lin Yuan was startled for a moment and subconsciously raised his hand.
"Have you ever done a CT scan?" Zheng Ren asked, staring at the radial styloid process of Lin Yuan's left hand.
Lin Yuan felt as if there was an invisible hemostatic forceps hitting the styloid process of the radius. He was "snapped" by Boss Zheng, and his heart trembled.
"I have a question for you." Zheng Ren stopped looking at him and found Director Luo's phone number and called him.
"I did, Boss Zheng, what do you mean..."
"Director Luo, there is a patient here who needs emergency gastroscopy."
"Yeah, it's an emergency, hemorrhagic shock. It should be a hepatitis B patient. I'll go with the medical records and we'll talk about it then."
"Yes, it is suspected to be liver cancer rupture and bleeding. There is no way to confirm it."
"No, no, I suspect it flows back along the bile duct to the pancreas and gallbladder. If so, there may be bleeding in the descending duodenum."
"Yes, okay, let's meet and chat."
After saying that, Zheng Ren hung up the phone.
"What did you say?" Zheng Ren asked.
"I said duodenum... uh, I've had a CT scan. What questions do you want to ask, Boss Zheng?" Lin Yuan asked.
"Head CT, how did you determine the window frame and window position?" Zheng Ren asked casually.
"The general window width for the head is 100, and the window level is 37."
"Where's the belly?"
"The window frame is 400, and the window seat is 40." Lin Yuan answered fluently.
Well, the basic skills are pretty solid, Zheng Ren thought to himself. If you look at domestic clinicians, few of them know the concept of CT window frame and window level.
However, it is also conceivable that this person has a PhD from Harvard Medical School, and there is still nothing to compare with the average undergraduate in China. Even if I am not a top student, I cannot go to a top international medical school.
“Why are the window frames and window levels given different?”
"Because of the visual contrast..." After saying this, Lin Yuan was startled for a moment. She immediately shook her head and said excitedly: "That's it, I know!"
Zheng Ren ignored her and strode forward.
"Boss Zheng, wait a moment!" Lin Yuan chased after him. Although he was tall and had long legs, she was a girl after all. It was normal that she couldn't catch Boss Zheng.
"It's because lipiodol is gathered together in the liver, so it looks very bright. And when it flows back into the gallbladder along the blood flow, it's just a little bit of high-density shadow like sand." Lin Yuan jumped excitedly. Jumping said.
"That's right."
Lin Yuan kept asking, but Zheng Ren just nodded lightly without saying a word.
"Wow, how did you think so far ahead!" Lin Yuan asked in surprise.
"I thought of it based on the various complications." Zheng Ren said.
Arriving at the endoscopy room, Director Luo was changing clothes.
"Director Luo, please excuse me. Just say hello, why are you here in person?" Zheng Ren said with a smile.
"Look at your skills, Boss Zheng." Director Luo said with a smile, "The liver transplant operation was very beautiful two days ago."
"Su Yun still needs to be here. The patient's condition is too bad and his heart has stopped. If he hadn't performed heart compressions, the operation would not have been possible." Zheng Ren smiled honestly.
Director Luo smiled and looked at Zheng Ren. Boss Zheng was so humble.
It was quite good that he was able to undergo an emergency liver transplant in a poor condition and still be so calm.
"Is he your patient?" Director Luo asked, "Didn't I say that you flew to London for intrauterine interventional surgery? You just came back and didn't rest. There are still things in the ward, but you are busy enough."
"Oh, my patient is fine. He is Professor Zhao's patient."
Director Luo was slightly startled, feeling a little weird. But he didn't ask, just smiled, changed clothes and followed Zheng Ren to the endoscopy room.
The two of them didn't talk about their condition. It was pointless to say more at this time. They just chatted about the surgery two days ago.
Lin Yuan also changed her clothes and followed in. She wanted to ask Boss Zheng several times, but with Director Luo around, she couldn't interrupt, so she could only hold back.
More than twenty minutes later, Zhao Wenhua came up with the patient.
If Su Yun were here, he would definitely get a slap in the face. But Zheng Ren knew that this was because there were still various pre-operative instructions to be made, not because Zhao Wenhua was careless in doing things.
If you really don't care, just seek consultation if a problem arises, and then treat it step by step.
In the end, the patient's condition became worse and worse, so he sought consultation from the whole hospital or was sent to the ICU.
Follow the standard procedure and deal with things without using your brain at all.
If he can think about the film carefully, he is pretty good. Although he is timid and afraid of getting into trouble and is unwilling to take responsibility, he makes excuses when something goes wrong and makes trouble for his own treatment team.
Zheng Ren keeps all these things in his heart. He doesn't need to think about them specially. He will never forget them.
Boss Zheng’s little black book that holds a grudge has been filled with things about Zhao Wenhua.
but,
Today is different from the past.
The levels are different, the realms are different, and the things you think about are naturally different.
Within a few months, Zhao Wenhua had become a little doctor in Haicheng, posing no threat to himself. Moreover, he was very clever and avoided him, and Zheng Ren was too lazy to dig up old scores.
Moreover, this is a case of misdiagnosis and mistreatment. We cannot treat it as if we didn’t see it, stand aside and watch the joke coldly, and finally use the case to slap Zhao Wenhua in the face.
The price of a human life is too high, Zhao Wenhua is not worth it.
"Boss Zheng, I'm sorry, I'm late." Zhao Wenhua sent the patient in and apologized repeatedly.
"It's okay. You go change clothes, and I'll start working on it." Zheng Ren pushed the patient inside, with Lin Yuan leading the way.
Zhao Wenhua looked at Boss Zheng's figure with mixed feelings in his heart.
Zheng Ren took the patient to the emergency endoscopy room, put him on the bed, and the anesthesiologist gave him inhalation anesthesia.
Director Luo didn't say anything, and he didn't care who did the endoscopic examination.
If he were an ordinary doctor, or even the director of a certain department, Director Luo would not allow him to do it himself in his endoscopy room.
But Boss Zheng is different.
A few minutes later, when Zhao Wenhua changed his clothes and hurried in, the gastroscope had already passed through the pylorus and entered the descending part of the duodenum.
The descending part has longitudinal folds, and the lower end is a round bulge, which is usually called the large R head of the duodenum. It is the common opening of the common bile duct and the pancreatic duct.
On the screen, tube after tube of blood was continuously coming out of the large R head of the duodenum. The gastroscopy was quite clear.
Zhao Wenhua felt happy for a while.
Fortunately, I didn't refuse Boss Zheng's help for the sake of face. He was bleeding like this. The patient's hemorrhagic shock would definitely worsen tonight and he would be sent to the ICU. If he continued to be treated like this, he would definitely die in the end.
…
…
Note: The cases from the past few days were patients after radiofrequency ablation. Xiao Dier, who has performed more than a hundred cases of radiofrequency ablation, has only seen such a patient with concurrent bleeding. In fact, the accident occurred 7 days after the operation, when the patient was preparing to be discharged.
After consultation in various departments, the diagnosis was also clear - gallstones and acute pancreatitis. Later, our director went against everyone’s advice and did a gastroscopy to confirm the diagnosis.
Objective inspection is sometimes unreliable~~~