Zhou Litao still had questions to ask, but when he saw the patient's family looking over at him, he refrained from continuing.
When we came to the CT room, we still waited for a short while. The CT doctor explained the situation to the patients behind him and added the emergency patients.
Other patients also understood that when they saw the patient coming up lying on a flat car, with three doctors and a nurse accompanying him, everyone felt that this patient was going to die.
There are people who are unreasonable and inconsiderate of others, but they are uncommon.
It's just that in front of this window of the emergency department, there are many contacts, and it has become normal.
The patient was sent to the CT room, and several people came to the operating room.
Zheng Ren didn't take action either. After all, it is not good to always override others. He stood quietly behind the doctor in the CT room, watching the film.
"Boss Zheng, the patient has no bloody stool. I think if the diagnosis is isolated superior mesenteric artery dissection, conservative treatment is better." There was no family member of the patient at this time, so Zhou Litao immediately expressed his thoughts.
Su Yun raised his eyebrows and was about to retaliate when Zheng Ren touched him lightly with his elbow and said with a smile: "If there is no thrombus in the cavity, there is no problem in being conservative. After all, the dissection pressure of the superior mesenteric artery is relatively low, and There’s no comparison with the aorta.”
Zhou Litao was also a little confused. Didn't Boss Zheng just recommend surgery? Why did you change your tune so quickly
"It's just a possibility, Cui Lao asked, so I said it." Zheng Ren said with a smile: "Each has its own benefits. Surgery can avoid the possibility of unmonitored necrosis of large sections of the patient's intestines and other complications. . If it is conservative, it can reduce the damage of the operation and save money for the patient and the patient's family."
What he said was so smooth that Zhou Litao didn't know how to answer the question.
"Let's look at the diagnosis first. It's up to the patient's family to decide what to do," Zheng Ren said.
The 64-slice CT scan took a long time, and the patient had obvious abdominal pain and agitation, so it took half an hour before the patient was pushed out.
Then Zheng Ren said: "Mr. Zhou, please push the patient back first, and I will take a look at the reconstruction results."
Seeing Zhou Litao leaving, Su Yun asked in confusion: "Boss, this guy talks too much."
Zheng Ren felt that Su Yun just said the opposite. It wasn't that Zhou Litao talked more, but that he talked more. He smiled and said, "What they said is true."
"Tch." Su Yun scorned, "The pain of dissection is not something that most people can bear. I met a patient and asked him after the operation. He said that the pain was like a knife in his chest, and he didn't want to live at that time. If you can die directly, it would be easier to die."
"Well, if you can have surgery, you still need to do it. I don't agree with conservative treatment." Zheng Rendao.
"Then why don't you confront him?" Su Yun expressed disdain for the attitude of a good old man like Zheng Ren.
"It makes no sense. This kind of patient cannot be admitted to our department. General surgery should be more experienced." Zheng Ren said: "If we need to go on stage, we will do it. If not, the vascular department can also do it. In CT room, talk to the chief resident of the emergency department, do you have anything to do?"
"You keep your tail between your legs." Su Yun looked at Zheng Ren with a half-smile, and said, "Do you need to be so low-key?"
"This is low-key and connotative. And didn't you say you didn't want to go to the emergency department? Why are you so arrogant?" Zheng Ren asked back.
"..." Su Yun was speechless.
This was really a dilemma. He thought about it carefully and realized that what Zheng Ren said made sense, but he didn't agree with it.
It’s really suffocating.
"There are two views in the academic world, surgery and conservative. But I still prefer surgery. I will analyze the specific situation. If treated conservatively, there is a risk of recurrence." Zheng Rendao: "For this, we still need to wait for the 64-row vascular CT We can’t decide until we come out.”
Su Yun nodded and quietly watched the doctor in the CT room doing the examination, his black hair floating feebly on his forehead.
Because it was an emergency, the 64-slice CT three-dimensional reconstruction was completed quickly.
There are true and false double lumen in the superior mesenteric artery. There is no thrombus in the true lumen, but thrombosis can be seen in the false lumen.
The false lumen is not large enough and compresses the blood vessels, causing occlusion of the superior mesenteric artery.
The superior mesenteric artery supplies blood to all of the small intestine and 2/3 of the large intestine. Once ischemic, it will cause ischemic pain in the small intestine.
Zheng Ren in Haicheng treated a patient with intestinal bleeding. He embolized part of the superior mesenteric artery and actively caused necrosis of the small intestine and then removed it. This was the reason.
But in the past, patients wanted to find the bleeding point and remove the intestinal necrosis. Today's patients are trying to avoid this situation.
Judging from the patient's condition, surgery or not is in between.
If he were in the emergency department of Haicheng City No. 1 Hospital, Zheng Ren would definitely tell his family members and perform the operation without hesitation. But this is 912, and Zheng Ren only gives opinions on ambiguous matters and is not responsible for making decisions.
After sending the film back, Zhou Litao had already sent the patient to the general surgery department and was not there. Cui Lao inserted the film into the reader, put on his spectacles, and looked at it carefully frame by frame.
After more than ten minutes, Mr. Cui said: "Xiao Zheng, what do you think?"
"You can be conservative, or you can..."
"I'm asking for your opinion, not to ask you to kick the ball." Cui Lao was displeased and glanced at Zheng Ren.
His hair is as white as snow and his eyes are like knives.
"I suggest surgery." Zheng Ren immediately returned. "I observed on the way that the patient's pain threshold was relatively low and his blood pressure was not well controlled. Although there is no thrombus in the true lumen of the superior mesenteric artery in this patient, conservative treatment can cure the disease. The possibility of recovery will be further reduced.”
Mr. Cui said nothing, sat down and looked at Zheng Ren quietly.
"The surgery is relatively simple, just insert a stent. Superior mesenteric arteriography + PTA + stent angioplasty. If the patient's family has no financial problems, he can be discharged from the hospital after three days of observation."
"Well, is this right?" Mr. Cui said, "Young people, you should be energetic and don't pretend to be serious."
"..." This was the first time Zheng Ren heard someone commenting on himself like this.
Mr. Cui is really different.
However, the difficulty of practicing medicine in his time was incomparable to what it is now. The contradiction between doctors and patients has become more acute as medical treatment is introduced to the market.
"The patient has a history of smoking and hypertension, and his blood pressure is not well controlled. In my experience, patients with a history of smoking are basically unable to survive. Now they are given low-molecular-weight heparin for anticoagulation, alprostadil to dilate blood vessels, and papaverine for antispasmodic treatment. , you go to the general surgery department and prepare for surgery." Mr. Cui said.
Not only did he provide a diagnosis, he also determined the next course of treatment.
With a history of smoking, it is difficult to keep the saying that success is worth ten thousand dollars to Zheng Ren. It’s not like a doctor would say something so certain.
But that’s what Mr. Cui said.
This is a summary of experience. Although this sentence is not rigorous, it is precisely because of this that it cannot appear in journal articles.
This is just a summary of Mr. Cui's life experience, and it cannot be learned from other places.
Zheng Ren felt shocked, nodded, and bowed deeply.