Chapter 46 A disease that no doctor can cure
The patient has diabetes.
Moreover, before this time, he had suffered from diabetic hyperosmolar coma.
Xu Qiu said solemnly, "When you put on ventilation, the patient was already unconscious?"
Zhong Wen nodded and said, "No, he was still conscious when I put him on non-invasive ventilation. I judged it to be a pneumothorax."
Xu Qiu said without mercy: "You made a wrong judgment!"
Zhong Wen's face immediately turned ugly, and he said unconvinced: "How is that possible! The patient's pneumothorax is very typical."
At this time, the attending physician in the respiratory department suddenly remembered something and said hurriedly: "Dr. Xu, do you suspect that the patient has developed a diabetic hyperosmolar coma?"
Xu Qiu nodded.
But Zhong Wen's face turned pale instantly.
Diabetic hyperosmolar coma is a contraindication for non-invasive ventilation!
Non-invasive ventilation at this time is likely to cause pneumothorax.
Even more serious, it can even be related to atelectasis!
"I...the patient's consciousness was not completely lost at that time!" Zhong Wen was already panicking.
Xu Qiu ignored him and quickly dealt with it.
He was used to this situation.
It's normal for the emergency department, or indeed the entire hospital, to wipe each other's butts.
Once you have an idea, the next treatment will not be very difficult.
After stabilizing the patient's condition, Xu Qiu breathed a sigh of relief and said:
"The patient most likely has an esophagotracheal fistula."
"I'll take him to get a laryngoscope later and get a CT scan done at the same time."
A laryngoscope is performed to rule out problems with the gastric tube.
This is the ending that no one wants to see the most——
If it is a gastric tube, then the hospital has to bear the main responsibility for this rescue.
but……
Zhong Wen stopped Xu Qiu and said, "Laryngoscope is fine, but don't do CT."
Xu Qiu was stunned for a moment, "Why?"
Zhong Wen glanced at the patient on the bed and said after a long silence: "Image data will be left behind."
Xu Qiu's expression became strange.
At this moment, he looked at Zhong Wen again.
When something goes wrong with the patient.
Xu Qiu was subconsciously thinking about which examination would be most helpful for confirming the diagnosis.
Diagnosis can be made most quickly and patients can be cured.
but……
Zhong Wen is considering that the CT image data will be a disadvantage to them.
If something goes wrong with the patient later on, the family members will have one more piece of evidence to defend their rights.
Xu Qiu's face darkened, and she said without any doubt: "I am in charge of the patient now. If anything happens, I will be responsible. Do a CT scan."
These words were like several slaps, hitting Zhong Wen hard on the face.
He stood there, staring blankly at the unconscious patient on the bed, and suddenly felt ashamed.
…
Twenty minutes later, the expedited CT results came out.
There was fluid in the patient's left lung and mediastinum.
And there is gas in the mediastinum.
Diagnosis: Tracheoesophageal fistula.
At the same time, the causes of pneumothorax and atelectasis in the patient also appeared in Xu Qiu's mind.
Zhong Wen violated contraindications and underwent tracheal intubation while unconscious.
And the catheter was not fixed properly.
therefore,
During the movement, the catheter penetrated the trachea, causing a mediastinal pneumothorax.
At this time, the patient's performance is: the partial pressure of oxygen drops rapidly and the oxygen supply is insufficient.
Zhong Wen panicked and subconsciously thought there was insufficient oxygen supply, so he increased the pressure on the ventilator.
As a result, the alveoli are broken, causing pneumothorax and atelectasis.
Primary disease/main disease: tracheoesophageal fistula.
Complications: pneumothorax, atelectasis.
Now, the complications have been resolved.
The only thing that needs to be done now is to address the underlying disease.
After learning the final diagnosis, the respiratory department quickly held a joint consultation.
The first doctor, Zhong Wen, was also there.
Family members also participated.
The director of the respiratory department looked at Xu Qiu and asked quietly: "Xu Qiu, can you be a Leonardo da Vinci?"
Xu Qiu nodded.
He had obtained this surgery in a previous check-in.
Coupled with master-level intervention experience, it is enough to easily win.
Seeing Xu Qiu's confident expression, the director of the respiratory department straightened his waist unconsciously.
Soon, the meeting began.
First, basic situation introduction and discussion.
Ten minutes later, the final treatment plan was finally arrived.
The director of the respiratory department said: "Based on the patient's condition, it is best to perform da Vinci surgery, which is less invasive and highly accurate!"
The family member lowered his head and asked in a low voice: "Doctor, what is Da Vinci surgery?"
The director gave a simple explanation.
The so-called da Vinci surgery consists of a console, a robotic arm and an imaging system.
It can be understood as a medical mecha.
The surgeon controls the robotic arm to complete a series of precise movements.
Since the core is mechanical,
Da Vinci surgery has extremely high precision, minimal trauma, fast postoperative recovery, and better healing effects than ordinary surgery.
The family members understood and asked tentatively, "Isn't it expensive?"
The director hesitated for a moment and said, "About 150,000."
Upon hearing this number, the family members' faces suddenly turned pale.
She trembled and said: "Doctor, we don't have that much money anymore... The family is already heavily in debt, and relatives also owe more than 100,000 yuan..."
The conference room suddenly became extremely quiet.
Everyone lowered their heads and kept silent, sighing in their hearts.
No money——
This is a "disease" that no doctor can cure.
At this moment, a voice sounded, "You can try regular surgery to repair it. About five thousand to ten thousand."
The expressions of the doctors present changed.
The family member suddenly raised his head, as if grasping the last straw, and looked at Xu Qiu in surprise: "Really, is it really possible?"
Xu Qiu nodded: "Yes."
Master-level esophageal tracheal fistula repair is also within his ability.
On the other side, the family member who heard this immediately stood up, held Xu Qiu's hand tightly, wiped his tears, and was about to kneel down.
Xu Qiu hurriedly supported him and said, "I am a doctor."
The panicked heart of the female family member suddenly calmed down.
At this moment, she only felt that these four words were the most beautiful language.
She couldn't control it, tears fell, and she cried and said: "Thank you... Thank you, if... If my father really can't do it, I won't blame your hospital. Thank you!"
In the distance, Zhong Wen heard this and lowered his head silently.
...
After the discussion, the family members followed Zhong Wen to sign the consent form.
In the meeting room, everyone also dispersed one after another.
At this time, the director who had been silent all the time suddenly called Xu Qiu.
He said solemnly: "Xu Qiu, what are you doing? This is too childish!"
The deputy director and others were also full of regret.
The director said:
"No matter how steady the doctor's hands are, they can't be better than a robot.
What's more, the patient's overall condition is very poor, and he must rely on the advantages of Da Vinci surgery, "fast recovery and good healing", to survive!"
How can human hands be better than mechanical procedures?
The other doctors also shook their heads.
Conventional surgery saves patients 140,000 yuan, but it transfers the risk to the doctor himself!
Xu Qiu said: "I am sure."
The director shook his head.
The key at the moment is not whether Xu Qiu is sure...
There is a more fatal problem!
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