Chapter 80: Sharp intuition, focused patients
Using Chen's pancreaticojejunostomy, at the final stage of the operation, the pancreas will automatically be inserted into the intestinal cavity by simply pulling the suture.
And this is the only way in the world that can do this.
It is a cutting-edge suturing technique originally created by academicians of Daxia.
Other anastomoses,
Often people need to push and pull.
In surgery, "less is more" is important.
To achieve the same effect, the fewer movements and steps, the stronger the surgeon's ability and the better the surgical prognosis.
Chen's pancreaticojejunostomy requires only a few stitches and the pancreas can fall into the cavity easily when the suture is pulled.
Naturally, it can be regarded as the top surgical procedure in pancreaticojejunostomy.
…
"I didn't expect that there are so many different things in there..." Xu Qiu sighed with emotion after absorbing the knowledge in his mind.
He also knew this anastomosis technique in his previous life.
Moreover, it was done well.
But after obtaining the master-level Chen's pancreaticojejunostomy, he looked back and realized that in his previous life, he was rated as an expert at most in this technique!
Still a long way from being a master!
But Xu Qiu soon felt relieved.
In his previous life, his energy was not focused on this. It was not easy to achieve an expert level in a technique that could be regarded as "interlacing".
"Doctor, I've finished the infusion. Do I need another infusion tonight?"
At this time, a man wearing a hospital gown knocked on the door and entered the office, and Xu Qiu also came back to consciousness from the system.
In the office.
Everyone took a look and said, "He is a patient in charge of Chen Jia."
Chen Jia pulled up the medical record from the computer and replied at the same time: "No need for infusion tonight."
The patient asked tentatively: "Can I go back and take a shower?"
Chen Jia glanced at the patient and said, "Pay at your own expense or be reimbursed by medical insurance?"
"Hey, didn't you say that I don't meet the conditions for medical insurance reimbursement?"
"At your own expense?"
The patient nodded grimly.
Chen Jia stared at the computer and said intentionally or unintentionally: "You have been admitted to the hospital now. In principle, you cannot go back. If you ask me, I will advise you to stay in the hospital, but we don't have time to keep an eye on you."
The patient smiled, understood Chen Jia's hint, thanked him and left.
Chen Jia shook her head helplessly and also smiled.
She just looked at the patient's medical record, and there were no risk factors, and it was paid for at her own expense. If she didn't monitor and drink fluids at night, there wouldn't be much difference between being in the inpatient department and going home.
Of course, as a doctor, she must have the obligation to "strictly follow hospitalization procedures."
As for the specific results, the legs grew on the patient.
Many patients must personally say "you can go back" from the doctor.
When treating such people, doctors often require that they "must stay in the hospital and cannot go home."
There is another group of people that doctors will strictly prohibit leaving the ward, and they are medical insurance patients.
Because people from the Medical Insurance Bureau often come to the inpatient department in the middle of the night to order people.
Once a medical insurance patient's bed is found to be unoccupied, the hospital will be severely punished and the patient's own reimbursement qualifications will also be cancelled.
besides,
If the risk of the disease is very low and the patient has a strong desire to go home, the doctor will slightly hint that "as long as he is not hit and killed by a car on the road, it makes no difference whether the patient is hospitalized or not."
After all, rules are also flexible.
…
…
The next morning, when the morning shift was handed over, the doctor who took over the shift specially emphasized a few patients.
"There were 11 new admissions yesterday, and four were admitted last night."
“The first three are 15 beds, 21 beds and 26 beds.
Their names are Yan Jing, Deng Dexiang, and Tong Lin.
Yan Jing complained...
…”
"The fourth patient is in bed 35, named Ma Pingchuan, 31 years old.
Main Complaint: Back pain. Physical examination showed persistent and worsening pain in the middle of the upper abdomen, like a knife cutting. Nausea, vomiting, weight loss...
The patient came to see the doctor at three o'clock last night...
The diagnosis was 1. Acute pancreatitis.
2. Acute perforation of peptic ulcer.
3. Myocardial infarction.
…”
Xu Qiu sat quietly.
The condition of the others is quite clear, but for the last one, because many examinations are not available in the emergency room at night, the diagnosis cannot be fully confirmed.
At this time, Wang Ping called him by name and said: "Xu Qiu, go take a look at this Ma Pingchuan."
The director's keen intuition made him feel that this patient needed special attention.
Back pain is a dangerous sign.
Angina pectoris, acute aortic dissection, myocardial infarction, ankylosing spondylitis, acute nephritis, etc. may all cause back pain.
The first few are even more fatal diseases.
Therefore, he looked around and finally felt that Xu Qiu was the most reassuring.
"Okay." Xu Qiu also agreed.
There are no teaching rounds this morning.
Wang Ping has to go to the clinic.
Therefore, the attending physician and deputy director took on the task of ward rounds.
Xu Qiu did not participate, but took Chen Qiao and a nurse to Ma Pingchuan's ward.
The patient's face looked very bad, his lips were gray, and the trash can next to him was full of his vomit.
There is also half a steamed bun and an unopened pack of pickles on the bedside——
The patient's financial situation may not be very good.
At this time, in the ward.
Ma Pingchuan complained as he sat up: "Doctor, please let me go back. I just have gastroenteritis. Just give me some painkillers and stomach medicine. There is no need to do this or that test!"
Xu Qiu ignored him and said, "Check the individual first."
Ma Pingchuan was a little angry when he saw that Xu Qiu ignored his words.
But after Xu Qiu put on the gloves, his anger suddenly dissipated a lot, and he felt that this doctor was very responsible.
"It's not easy for the doctor, so let's cooperate with him..." Ma Pingchuan compromised.
On the side, Ma Pingchuan's wife was surprised.
When did my husband, who usually has a bad temper, become so easy to talk to?
…
On this side, Xu Qiu quickly completed the physical examination.
What is more characteristic is that the skin on both sides of the patient's flanks and abdomen is dark in color and is faintly gray-blue.
If Xu Qiu's judgment was correct, it should be Grey-Tumer syndrome.
The mechanism is: pancreatic enzymes, necrotic tissue and bleeding penetrate into the abdominal wall along the peritoneal space and muscle layer, causing the skin on both sides of the ribs and abdomen to appear dark gray-blue.
And these are the special signs of acute pancreatitis.
In addition, the patient also had positive signs of pancreatitis such as decreased bowel sounds and shifting dullness.
Nine times out of ten, it's acute pancreatitis.
Xu Qiu took off his gloves and threw them into the medical trash can. At the same time, he said, "It's acute pancreatitis. We need to do another blood and urine amylase test to confirm the diagnosis."
Considering the patient's financial situation, Xu Qiu only prescribed the most valuable examination.
He put aside things like "serum lipase measurement", "amylase endogenous creatinine clearance ratio", "blood sugar", "biochemistry", etc.
"Doctor, please don't do the examination. Can you help us save some money? Our community hospital just prescribes some painkillers and stomach medicine..." Ma Pingchuan looked a little dissatisfied, but he said more. A little room for negotiation.
Without waiting for Xu Qiu to explain, Chen Qiao explained: "Uncle, acute pancreatitis is no worse than a minor illness. If not treated in time, it will lead to multiple organ failure. Once it develops into severe acute pancreatitis, it will be very difficult to cure. , and it will be life-threatening.”
Xu Qiu nodded, Chen Qiao's theoretical foundation was quite solid.
Ma Pingchuan's eyes turned from Xu Qiu to Chen Qiao, and he immediately regained his temper and said aggressively: "Who are you calling uncle? I'm only 31, not ten years older than you! Besides, your teacher is talking to me, why are you interrupting! "
Chen Qiao was a little surprised.
What's going on? I was talking to the teacher so loudly and angrily just now, but then I turned around and started scolding myself!
Here, Xu Qiu naturally knows the reason.
The low-level affinity indeed makes the communication between doctors and patients much smoother.
Since Chen Qiao couldn't explain it, Xu Qiu personally explained to Ma Pingchuan the dangers of acute pancreatitis.
Looking at the patient on the hospital bed who seemed to understand something, Xu Qiu suddenly remembered something and felt a thump in her heart.
