When doctors have a simulated operating room

After the patient was lifted onto the flatbed, Zhang Yi asked: "Where does he feel pain?" The migrant worker next to him said: "He has a stomachache, so painful that he feels weak all over, and sweats a lot. His forehead feels a little hot. I don't know if he has a fever. The pain started yesterday at noon. He went to the clinic to buy some stomach medicine, but he still felt pain when he woke up today. We originally asked him to come to the hospital, but he was reluctant to spend the money. That's how it turned out. He fainted while working on the construction site. He woke up only after we pinched his Ren Zhong acupoint. Then we immediately brought him to the hospital." Zhang Yi took out the flashlight in his hand and stimulated the old man's pupils. Fortunately, it is sensitive to light.

He carefully checked his whole body again.

Only then did he find that there was something wrong with the pancreas.

He quickly put on a pair of gloves and lifted the clothes on the migrant worker's abdomen.

While pressing, he asked:

"Uncle, where does it hurt? Does it hurt when I press here?"

Zhang Yi pressed the location near the pancreas in the upper abdomen.

As a result, the uncle, who was originally drowsy, suddenly cried out!

"Ouch... It hurts, it hurts here."

"What about here?"

Zhang Yi pressed the center of the pancreas.

As a result, the uncle's face became even more painful.

"It hurts, doctor, it hurts a lot..."

"What about the chest? Does it hurt here in the chest?"

"It doesn't hurt in the chest."

"What about here?" Zhang Yi pressed the appendix again.

"No pain..."

"Diarrhea?"

"No diarrhea... It just hurts here... It hurts so much that I can't stand it..."

At this time, watching Zhang Yi's series of palpations, basically all the doctors present had a direction of suspicion.

No other parts hurt, only the stomach and pancreas.

That means it's either gastric ulcer or pancreatitis.

Combined with the fact that the patient did not have diarrhea, blood in the stool, and digestive tract reactions, the result is closer to a pancreatic problem.

Thinking of this, Deng Wei and Xiao Zhiwen looked at each other.

Deng Wei: Go, apprentice!

We lost the game just now, and now there is a patient with pancreatitis. You have to go up and show your clinical experience? ?

Go!

Take it back to our place!

Xiao Zhiwen instructed that he was indeed not as good as Zhang Yi in operation.

But he himself has passed the examination for attending physician.

The clinical experience of attending physicians is richer than that of regular trainees, right? ?

Before Zhang Yi could speak, Xiao Zhiwen asked first:

"Did he eat anything greasy before he had abdominal pain yesterday? Or did he drink a lot of wine?"

Other migrant workers nodded quickly:

"Yes, the boss on our construction site treated us to a meal the night before yesterday. We did have some hot pot and drank some wine.

But hot pot is not greasy, right? It's just spicy."

"Uncle, let me ask you a few questions." Xiao Zhiwen approached the patient and asked.

The uncle on the flatbed nodded: "Okay... okay."

"Do you have stomach pain often or did it start yesterday?"

"Just...just yesterday..."

"Let a nurse take his temperature."

After Xiao Zhiwen finished speaking, he lowered his head and asked:

"Uncle, do you feel nauseous when you have stomach pain? Do you feel acid reflux in your stomach?"

"No...it's just a stomachache...I don't feel uncomfortable in my stomach."

After Xiao Zhiwen asked this, he basically ruled out stomach problems.

Now the spearhead is pointing directly at pancreatitis.

Xiao Zhiwen turned his head and looked at Zhang Yi and said:

"I initially suspect pancreatitis. Let's check B-ultrasound, abdominal CT, blood and urine amylase."

Zhang Yi nodded: "I know."

After that, Zhang Yi did not rush to give medical advice, but took a stethoscope to listen to the lungs of the migrant worker for a while.

Everyone was puzzled.

Now the result is very obvious, it is probably pancreatitis.

Check amylase and then control the infusion, and the person will be fine.

Why is he listening to the chest?

Qian Zhenggang just thought Zhang Yi wanted to check more, so he didn't say anything.

After putting down the stethoscope, Zhang Yi said:

"The lung auscultation does not seem to be clear sound. I suggest adding a lung CT."

Xiao Zhiwen became curious when he heard it. He took the stethoscope from Zhang Yi and listened.

Embarrassed...

Why can't he hear anything?

Isn't this a normal clear sound?

What's wrong with it?

At this time, the old man lying on the flatbed complained when he heard that he needed to do more tests:

"Doctor...

I...I'll do less tests, I don't have much money anyway..."

But Zhang Yi shook his head and insisted:

"Uncle, I'm doing this for your own good, the lung CT must be done."

"But doctor...I don't have money...Can I do the lungs when I do the abdomen?"

"I'm afraid that's not possible, each part is separate."

"But...I'm 58 years old this year, and my family...I have elderly and children at home, I'll save as much as I can, doctor...

Please be kind, can I not do this CT?"

The patient lying on the stretcher was very weak, but he felt helpless when he thought about the high cost of going to the hospital.

Zhang Yi frowned and looked at his lungs.

"No, the lung CT must be done! Three hundred yuan...I'll pay for it for you. Quickly draw blood first, and then send it to the imaging department. "

When Zhang Yi said this, the doctors around him looked at him in surprise.

He actually took the initiative to pay for the patient's CT scan?

Should he be called stupid or kind?

Although Qian Zhenggang felt very relieved, he also felt that if this person really didn't have the money to do a lung CT scan, then it would not be done.

If it turns out to be pancreatitis, there is no need to do a lung CT scan.

At this moment, Deng Wei also stood up and asked:

"Zhang Yi, why do you insist on asking him to do a lung CT scan?"

Zhang Yi explained: "The sound of the lung auscultation is not right, just in case, so a CT scan is done to see. "

Deng Wei frowned and listened carefully with a stethoscope for a while.

He didn't hear anything wrong.

He thought, was Zhang Yi doing something unnecessary?

The patient lying on the stretcher heard that Zhang Yi was willing to pay, and wanted to sit up and bow to Zhang Yi in gratitude.

But Zhang Yi pressed him on the stretcher:

"Don't thank me, you lie down first, whoever is a family member, come to the office with me to sign, and the others will take him to the examination first. ”

Several migrant workers had no family members, but there were colleagues willing to help sign.

Half an hour later, the patient's test results came out.

Blood amylase: 378U/L

Urine amylase: 3974U/L

Blood and urine amylase were all higher than normal.

Such high values ​​can basically confirm that it is pancreatitis.

In addition, the blood sugar was not high, and the three blood lipids were normal.

This shows that pancreatitis is not caused by blood sugar and hyperlipidemia.

No bile duct and gallbladder stones were found on B-ultrasound, indicating that it was not caused by gallbladder obstruction.

Finally, CT.

The CT of the upper abdomen showed that the shadow of the pancreas was enlarged, which should be edema.

And there was free fluid around it.

It should be inflammatory exudate.

It seems that the old man's pancreatitis has developed into suppurative pancreatitis.

Finally, there is another lung CT film.

It doesn't matter if you don't look at it. Once you look at it, everyone's eyes are full of doubts!