"Tell me about it." Zheng Ren put his left hand flat under his armpit, put his right elbow on his left arm, held his chin, and squinted his eyes to look at the film hanging on the reader, concentrating on it.
"Here is the most typical imaging manifestation of traumatic wet lung." Su Yun tapped the film with the knuckle of his right index finger, "However, with such a severe fracture, there will be more or less hundreds of milliliters of bleeding, accompanied by a small amount of Pneumothorax is also possible.”
"Do you think it's strange that the patient doesn't have a hemothorax?"
"Yes." Su Yun didn't shy away from it. If he was being hypocritical and polite, he had to say it from the perspective of hoping that the patient's condition would be as mild as possible.
But,
He didn't.
To put it bluntly,
Not shy.
"There is indeed a problem." Zheng Ren pondered and followed Su Yun's train of thought: "The patient's blood pressure is not high. Normally at his age, the blood pressure should fluctuate between 120 and 130. Multiple rib fractures, severe pain, and low blood pressure. It should be between 150 and 160. But the patient’s blood pressure is between 90 and 100, which is worth considering.”
Lowered blood pressure means bleeding.
However, bleeding in the chest, whether due to pulmonary rupture or intercostal artery rupture and bleeding, will cause imaging manifestations of pleural effusion.
However, this manifestation did not appear on the patient's lung CT scan.
Even the big pig's hooves of the system did not indicate how serious the traumatic complications were. Pulmonary rupture is a diagnosis. It may be serious and may heal on its own.
According to general conditions, this patient can now be sent to the thoracic surgery ward for hospitalization and observation. Take it step by step in the future, and if there are any problems, deal with them at any time.
But Zheng Ren and Su Yun are worried that once a problem occurs, it will be a big problem. If they want to solve it, now is the best time!
"Su Yun, do you want me to consult you for this kind of disease?" The two of them were struggling when a voice came.
Looking back, it was Cao Guozhen, the chief resident of the cardiothoracic surgery department.
He was tall and strong, like a black bear, and he walked with great speed.
Speaking of…
It's also a general ups and downs.
There was a tinge in the words, probably because when they were rescuing Yang Lili, Su Yun and Zheng Ren had disgraced the cardiothoracic surgery department on the operating table, and they are still feeling unhappy now.
He glanced at the film, with a contemptuous smile on his lips.
"The most typical traumatic wet lung disease, this is it. Do you need two giants in the emergency department to study it together?"
Zheng Ren thought about countless possibilities in his mind. Su Yun ignored Cao Guozhen's provocative words and frowned in thought.
"You are trying to keep the patient in the emergency ward." Cao Guozhen sneered, "Just keep him, no problem. I tell you, first use hormone shock, and then 10mg of dexamethasone every day, plus anti-inflammatory, aerosol, Phlegm-reducing treatment. Don’t give Muscotan according to the instructions. Take 100 tubes a day and pump it in with an intravenous pump. It’s totally fine.” (Note 1)
Zheng Ren and Su Yun are still thinking about it.
"Follow the instructions and give Mucotropin. Severe pneumonia will definitely appear in three days. Don't say I didn't warn you." Cao Guozhen kept chattering.
What he said makes sense and is a conscientious suggestion.
Su Yun knew that imported drugs like Muscotan were cheap and had almost zero side effects. In the Imperial Capital, he used up to 300 tubes a day, and the intravenous pump continued to pump in 24 hours a day.
After that, pay attention to turning over, knocking on the back and coughing up phlegm to prevent accumulation of pneumonia. The patient will be discharged from the hospital in one week.
However, the problem is that Zheng Ren and Su Yun did not consider that the patient simply had multiple rib fractures on the right side and traumatic wet lung.
Whether in the emergency ward or the cardiothoracic surgery ward, once this opportunity is missed, patients...
There may be danger.
But, it's just possible.
Medicine is an empirical science and an evidence-based science.
There is no evidence. You told me to open the chest for exploration. Are you afraid that the postoperative patient will sue you? !
After a few minutes of judgment, Zheng Ren suddenly thought of the reason why Su Yun was so stupid as to come back to him.
He wanted to open the chest to explore, but he didn't have the permission.
Just like how he always looks for Director Pan to carry the thunder, this guy is looking for him to carry the thunder!
"The patient cannot be treated like this." Zheng Ren put down his hand, looked back at Cao Guozhen, and said, "At least an emergency fracture internal fixation operation is required."
Su Yun was stunned.
What Zheng Ren said was so shameless.
The patient's fracture was well aligned and no re-fixation was required.
But... this is a particularly good reason and excuse, isn't it
"Well, look here, the dislocation is obvious, and the bone stubble may pierce the pleura and lungs when the patient turns over and knocks on his back, causing secondary hemopneumothorax." Su Yun pointed to a tiny breaking point on the film and said confidently arrive.
Under normal circumstances, lung CT is a tomographic scan and is not used to detect fractures.
If you want to see the fracture situation, you need to do a chest X-ray and a 64-slice CT three-dimensional reconstruction of the chest.
However, every section of the lung CT scan could provide a glimpse into the situation. Su Yun grabbed one of the locations and made wild claims, saying that the fracture was particularly severe.
Cao Guozhen was stunned...
In the emergency ward, in order to rush for an operation, you are so shameless? !
Paralyzed, no wonder general surgery can't handle them.
According to them, this surgery must be done in an emergency. If the patient doesn't do it, there will be trouble in the future, and they will have something to say.
Cao Guozhen's mind was spinning very quickly, and then he said: "Then put it away and I'll do it."
"You?""Will you have surgery? Will you cut through your lungs?" Ms. Su said with a wry, underwhelming smile at the corner of her mouth. Have you ever had a cuff removed? Nothing, you'll break a bone, and you'll lick your face and say you'll have surgery?"
"You..." Cao Guozhen really wanted to go up and beat Su Yun to death.
He always spoke politely, and although his tone was a bit sarcastic, he didn't use any curse words at all.
Su Yun actually scolded him directly. Is he a wild dog
"I'll send you ten rib clamps." Su Yun blew the black hair on his forehead and said calmly.
"Why!"
"Do you want to find the medical office? Or do you want to find Director Pan? We don't have time to do thoracic surgery. If we find Director Pan, he will definitely keep the emergency room of the chest department." Su Yun said with a smile: "No, that's it. Putting on a breast bottle is something that even a nurse can do, but you still have the nerve to say it’s an operation?”
These words... are really choking.
Cao Guozhen realized that what Su Yun said was true. If they took advantage of the situation and kept all the emergency rooms in the chest department, it would be strange if the director found out and couldn't kill him.
After holding his breath, Cao Guozhen turned around and left.
"Admit it to the hospital. I'll inform Yiren and they are preparing for emergency surgery." Zheng Ren said.
"Yes." Su Yun nodded. Seeing Zheng Ren turn around and leave, he suddenly said: "Thank you, boss."
"It's okay." Zheng Ren waved his hand, "I believe you."
…
…
Note 1: This usage of Muscotan was taught by Mr. Chen Houkun from the Medical University fifteen years ago. Teacher Chen is a very kind person. He used this off-label dosage method to cure several patients with very serious trauma + traumatic wet lung + accumulation pneumonia. For one of the patients, the ICU gave up and threw him on my hospital bed. On the 26th day, I was discharged from the hospital and went home. Later, the patient came to see me once while on crutches.
Note 2: This operation was performed on a patient I received in 2009. Looking at the films, there are no indications for surgery. I watched the film for an hour, made three phone calls to the director, and finally took the director from home for the surgery in the middle of the night. Fortunately, the operation was performed early, and thanks to classmate Dali who was in the intensive care unit at that time.
Note 3: Thank you Hongchen Alliance, please wait for more updates, don’t rush.