I'm really an intern

Chapter 44 You Are Excellent

"Are you going to accept it or not?"

"receive!"

Zhang Tianyang agreed straightforwardly, and Senior Brother He was even more straightforward.

"Okay, then you can look at the past medical records first, and I will go to see the patient with you in 5 minutes."

"it is good."

After receiving a stack of medical records and various checklists from Senior Brother He, Zhang Tianyang began to look through the patient's past medical records.

The patient's family is in Zengcheng, and he had not been treated in the Dongfang Hospital before, so Zhang Tianyang could only read paper reports.

There is a whole stack, and one hand can hardly hold it, showing the patient's tear-stained medical history.

"The patient, male, 60 years old, was admitted to the hospital because of "liver cirrhosis was discovered 20 years ago, 2 months after the spleen embolism operation, and intermittent fever for more than 1 month."

Five minutes later, Zhang Tianyang and Senior Brother He appeared together in front of the 5-bed hospital.

"Come on, check the room."

Lifting off the patient's tightly wrapped quilts and clothes, he finally saw his true face.

The patient looked thin, with prominent cheekbones.

But when he opened his clothes, he saw that his stomach was so bulging that he couldn't give in to a fat man of two hundred catties.

After inquiring about the medical history in detail, Senior Brother He signaled to Zhang Tianyang.

"Physical examination, you come?"

"it is good."

Zhang Tianyang responded, and pressed his hands on the patient's stomach.

Pressing lightly, Zhang Tianyang asked while pressing, "Does it hurt here? Where is it here?"

The temperature of the skin under the hands increased significantly, and the skin tension on the patient's abdomen increased significantly when exerting force.

The shifting dullness was positive, indicating that there was at least 3000ml of ascites in his stomach.

Ascites is a common complication in patients with liver cirrhosis. Sometimes, the patient's belly can be larger than that of a pregnant woman.

In terms of imagery, it is equivalent to the amount of six bottles of mineral water, all piled up in the stomach.

It is a great burden to patients' daily life.

After seeing, touching and listening to the chest and abdomen, Zhang Tianyang lifted the quilt that wrapped the patient's legs.

Lifting off the patient gown, it was obvious that the patient's lower limbs were also white and swollen, and with a light touch, a large pit was sunken.

"Did the nurse take your temperature?"

Zhang Tianyang asked, and asked the family members to urge the little nurse to take temperature and blood pressure.

"Senior Brother?" Zhang Tianyang looked at Senior Brother He, "I think the ascites needs to be released, preferably within today."

"Wait a moment."

Although he watched Zhang Tianyang's technique all the way and didn't find any mistakes, Brother He still did a physical examination again rigorously.

Clinically, caution is paramount.

Back at the doctor's office, Zhang Tianyang began to prescribe various examinations and various treatments and medicines for the 82 beds.

This uncle has had a fever intermittently for more than a month, and now fever and chills are his daily routine.

There was too much ascites, and Zhang Tianyang suspected that the fever was related to the ascites, so a paracentesis was still required.

Just wait for the patient to quickly complete the B-ultrasound of the abdominal liver, gallbladder, pancreas and spleen, and set the puncture point.

"Blood routine, liver function, kidney function, ion six, infection two, ascites routine, ascites culture, electrocardiogram, chest X-ray, abdominal B-ultrasound"

"Liver protection, jaundice reduction, albumin, diuretic, stomach protection, antibiotics"

Brother He sat behind Zhang Tianyang and watched silently, a little surprised.

"Xiao Zhang, haven't you just entered the clinic not long ago? You look very skilled!"

He only tried to give him a patient because Zhang Tianyang was careful and discovered the problem with the 8 beds.

Unexpectedly, there was a surprise.

Zhang Tianyang said modestly, "I still need more advice from senior brother, I still don't have enough experience."

"Come on!"

Brother He scolded with a smile, and his heart moved.

"No, I have to test you. Now, let's talk about the diagnosis of fever and the condition of this patient."

As soon as the words fell, Senior Sister Chen with the afro hair quietly came over while grabbing a small notebook.

"how?"

Senior Brother He thought that there was something wrong with the patient she was managing, but Senior Sister Chen smiled embarrassedly, "If you tell me, I'll listen."

The higher-level doctors have more experience than them, and sometimes their casual words can benefit the junior doctors a lot.

Seeing that Senior Brother He is about to start giving advice to Junior Junior Brothers, Chen Shishi, as a good and motivated young man, of course cannot let go of this opportunity.

Senior Brother She was typing medical records on the computer next to him, frowning.

Of course he noticed the situation here, but his subordinates stood still.

Brother He is indeed experienced and highly skilled, but now it is the younger brother who expresses his opinion first.

"Junior brother is talking nonsense. I will affect my judgment if I hear it. Let's listen to it when Senior Brother He says it."

Even though Zhang Tianyang discovered the 8-bed problem earlier than him, Senior Brother She still didn't think highly of him.

Even more uncomfortable for some subtle reasons.

Senior Brother He cast a glance at Senior Brother She who was motionless, and motioned to Zhang Tianyang, "Tell me?"

Zhang Tianyang is not stage frightened either.

"Fever Chain, I mainly consider the following points.

First, infection, whether it is bacterial infection, fungal infection, or virus or parasite, will cause fever.At this time, inspections such as two items of infection and body fluid bacterial and fungal culture should be completed.

Second, tumors, especially hematological tumors.Such patients often have enlarged lymph nodes, which can be confirmed by blood routine examination, bone marrow aspiration, and biopsy of enlarged lymph nodes.

Third, some endocrine diseases such as hyperthyroidism can also cause body temperature to rise, and some drug fevers, etc. "

Makes sense.

Senior Sister Chen nodded vigorously, looking forward to it.

This junior looks like something, it's not at all the same as the interns she met before.

Everyone came from the internship stage, who didn't count what the hell was going on during the internship?

Normal interns are always ignorant when being questioned by the superior doctor. Even if they can say something, they often talk a little bit.

But what about this junior?

Reasonable and well-founded, I also listed 123 points for you

"Then what do you think about this patient?"

Brother He was also very surprised, so he became more interested, "Come on, let's talk about it."

Zhang Tianyang dug out the 82-bed uncle's medical records.

"The patient had a 20-year history of liver cirrhosis. He had a spleen embolism due to hypersplenism two months ago, and then had intermittent fever for more than a month.

I think the patient's fever should be related to the spleen suppository. Consider absorbing heat?

But the normal absorption heat will not burn for so long, consider an infection, or the area of ​​the spleen plug is too large. "

Brother He nodded in agreement, "Yes! I think your analysis is okay!"

He also flipped through the patient's medical records, "It's a pity that the patient didn't bring the record of the spleen plug.

But it's okay, let's give him an abdominal MRI, and look at the picture to see if what you said is true. "

"However, Xiao Zhang, are you really a five-year student?"

Zhang Tianyang blinked, "Yes."

"What did I say, the children who come out of our school can't cheat."

Brother He laughed.

"The teaching secretary also told me that the five-year students in your class are going to die, and asked us not to give you patients easily.

Let me talk about her going later, this is clearly a rumor! "

Senior Sister Chen was listening, her eyes bright.

Damn, I must have picked up the treasure!

"In the past, I was the one who patched up loopholes for the interns, but this time I finally got a reliable one!"

Thinking that she could have a more relaxed two weeks after being infected with internal medicine, Senior Sister Chen couldn't wait to give Zhang Tianyang a thumbs up.

Junior brother is doing well!

Although you are excellent, I can secretly salt fish!

　There is an event, please give me a like and vote~

　　If you don't vote, I don't vote, when will An'an be able to stand out!

　　

　

(End of this chapter)