Doctor's Life Simulator

Chapter 182 At the moment of life and death, Qin Lang made meritorious service! (seeking subscription)

Dr. Liu looked at the simplified version of the puncture instrument that Qin Lang took out, and it was outside the hospital now. He really didn't have any confidence at all, and he wanted to decline when he blushed:
"Doctor Qin, you look too high..."

Before Dr. Liu finished speaking, he saw Qin Lang directly evacuate the crowd, let them go out, and then began to position the patient.

"Could it be that he wants to do it by himself?"

Physician Liu was stunned immediately, my good fellow, I didn't let myself come here.

While Dr. Liu breathed a sigh of relief, he was also a little bit disappointed, but when did he learn how to perform paracentesis?

In my impression, I explained the paracentesis to him last time. Could it be that this kid made a surprise attack after listening to me explain it once, reviewing it and watching the video after going back?

This is impossible, Dr. Liu squatted down suspiciously, watching Qin Lang's operation.

After watching Qin Lang put the patient in a good position, he began to determine the puncture point.

Qin Lang very precisely selected the lateral edge of the right rectus abdominis, and the junction of the middle and outer 1/3 of the line connecting the right anterior superior iliac spine and the umbilical cord.

Because it is outside the hospital, it is not as formal as the hospital, but in the first aid, it is flexible and changeable.

Under the sterile gloves of Qin Lang, the left hand fixed the skin of the puncture site, and the right hand held the needle to penetrate the abdominal wall vertically through the anesthetized site.

Seeing Qin Lang's operation, Dr. Liu gasped. This kid really knows how to do it. Besides, why does he feel that he is more proficient than himself?
In Dr. Liu's astonishment, Qin Lang not only used conventional puncture, but also used a more advanced technique. In order to reduce the continuous infiltration of peritoneal fluid after the operation, mobile puncture was adopted!

"No!"

Looking at Qin Lang's high-level skills, Dr. Liu was a little dazed. He just watched Qin Lang's right hand holding the needle through the anesthesia to penetrate the skin and reach the subcutaneous level. Pierce vertically into the abdominal cavity.

When the resistance of the needle tip disappeared, the needle tip had passed through the parietal peritoneum, and Qin Lang began to extract the peritoneal effusion.

Since it was a diagnostic puncture, a 20ml syringe was used directly, and soon dark red turbid peritoneal fluid appeared in the syringe.

Qin Lang's complexion changed, and the dark red and turbid peritoneal fluid represented a particularly dangerous situation. It was likely to be strangulated intestinal obstruction, intestinal necrosis, and the most terrifying hemorrhagic necrotizing pancreatitis.

Qin Lang immediately kept the samples so that they could be sent to the hospital for examination as soon as possible, and at the same time further identified the peritoneal effusion.

Dr. Liu looked at Qin Lang's operation, not knowing why, and asked anxiously, "What did you find?"

Qin Lang smelled the smell of the peritoneal fluid again, and basically judged the patient's condition almost indistinctly, and said to Dr. Liu very seriously:
"Immediately contact Director Pang, who is on duty at the second line, and ask him to notify Director Zhuang to go to the emergency room together. We will perform a CT scan on the patient as soon as we arrive at the hospital. Now, we need to send the patient to the hospital immediately. One minute late is one more point." Danger."

"CT scan?"

Physician Liu was confused and wanted to ask, but seeing Qin Lang's serious and nervous face, he didn't dare to ask more, and immediately called Director Pang for help.

In Qin Lang, the puncture needle is pulled out after draining the patient, covered with sterile gauze, pressed with fingers for a few minutes, and then fixed with adhesive tape.

Simultaneously, Qin Lang finished the operation, Dr. Liu put down the phone, and immediately cooperated with Qin Lang to help the patient up, and walked out of the house. The family members were waiting, also anxious.

"Doctor, what's the matter with my daughter? How's it going?"

Regarding the patient's question, Qin Lang said in a low tone:

"The situation is not optimistic. I have preliminarily performed a diagnostic peritoneal puncture on the patient, and the patient is highly suspected to be hemorrhagic necrotizing pancreatitis. Now, Dr. Liu and I will immediately send the patient to the emergency department of the city's No. [-] hospital and arrange surgery as soon as possible."

"Everyone please make way, we need to board the ship immediately!"

Seeing Qin Lang's urgent tone, everyone immediately moved out of the way, and the rest of the tourists on the island also spontaneously protected Qin Lang and others to board the ship with the patient.

The boatman also paid close attention to it immediately. After Qin Lang and Dr. Liu took the patient on board, they immediately started. Everyone hoped that the patient would be sent to the hospital for treatment earlier.

Immediately, Dr. Liu and Qin Lang also kept an eye on the patient's condition.

Acute hemorrhagic necrotizing pancreatitis is a kind of acute pancreatitis, which is caused by the continuous development of acute edematous pancreatitis lesions.

The etiology is also very complex, which may be caused by gallstones, alcohol, vascular factors, trauma, high fat and other environmental factors in the pancreas and systemic inflammatory response diseases.

This type of pancreatitis is serious, develops rapidly, has many complications, and has a high mortality rate. The clinical manifestations of patients with this type of pancreatitis are relatively complicated, mainly manifested by abdominal distension, vomiting, nausea, fever, increased blood pancreatic enzymes, and hematuria. And easily confused with other acute abdomen.

Therefore, it is very important to diagnose the disease as early as possible and choose the appropriate treatment to improve the curative effect and survival rate of patients.

Dr. Liu did not regain his composure until he and Qin Lang took the patient into the ambulance, and took advantage of the gap:

"Doctor Qin, can you tell me how you came up with the temporary paracentesis and made this conclusion?"

Dr. Liu was very nervous because of Qin Lang, and he didn't know why. He felt that Dr. Qin was unpredictable and looked up to him.

Qin Lang explained:
"The identification of diagnostic peritoneal effusion is mainly based on its nature, color, clarity, smell, combined with medical history and physical symptoms. Although there are many auxiliary examination methods for the diagnosis of acute abdomen, paracentesis is still the preferred examination method. , which is simple, timely, reliable, and not limited by conditions and environments."

Dr. Liu nodded in agreement.

Qin Lang continued to analyze:

"First of all, the appearance of the peritoneal fluid can be distinguished in many ways. For example, bloody abdomen, pure blood is a sign of internal bleeding. Combined with the rest of the physical examination and medical history, it can be determined that the liver and spleen are ruptured and bleeding."

"Brown yellow or dark green turbid blood-type peritoneal fluid, especially the puncture fluid mixed with food sediment, is mostly perforated peritoneal fluid of large gastric or duodenal ulcer lesions."

"Slightly yellow and transparent peritoneal fluid is more common in simple intestinal obstruction."

"Pale yellow or milky yellow inflammatory ascites, or thin purulent ascites, is mostly seen in small duodenal ulcer holes or fasting perforation, and may also be acute suppurative appendicitis gangrene perforation, or acute suppurative mesenteric lymph node ulceration. "

"A small amount of straw-yellow and slightly dark ascites is more common in interstitial acute pancreatitis."

"The khaki-yellow purulent fluid is mostly ruptured bacterial liver abscess."

"Brown turbid inflammatory fluid is mostly seen in gangrenous exudation of gangrenous cholecystitis or gangrenous cholangitis."

"If it is bloody ascites, such as light red and slightly turbid bloody ascites, it is mostly the early stage of strangulated ileus."

"And the patient's ascites is dark red and turbid ascites, it is considered strangulated intestinal obstruction necrosis, or hemorrhagic necrotizing pancreatitis. And combined with the odor of the puncture fluid, it is not a foul smell, nor is it feces, then Strangulated intestinal obstruction necrosis is basically ruled out, so the last remaining possibility is the most dangerous hemorrhagic necrotizing pancreatitis!"

After listening to Qin Lang's eloquent, systematic and detailed diagnosis ideas, Dr. Liu really admired him.

How much time does it usually take to settle and memorize and recite, after all, Qin Lang's age is there, not by years of experience, so it can only be memorized and recited in private time.

Dr. Liu felt admiration and respect for Qin Lang in his heart.

"There is another question. Why, do you suggest that patients should undergo CT examination as soon as they arrive at the hospital?"

Just as Qin Lang was about to answer Dr. Liu's question, the ambulance had already arrived at the city's No. [-] hospital, and the two of them stopped talking, and immediately pushed the flat cart and sent the patient to the emergency department.

After arriving at the emergency department, Qin Lang went to send the paracentesis fluid for examination as soon as possible, while Dr. Liu followed Qin Lang's instructions, although he didn't quite understand the reason. Go for a CT scan.

At the same time, the second-line Deputy Director Pang has also arrived, and Director Zhuang Tong also rushed to the emergency department immediately after receiving a call. It was in Dongfang Xinfeng, which is a community in Qinlang, that I bought a house.

Several people were also worried. After Director Pang and Director Zhuang arrived, Dr. Liu arranged for the patient to undergo a CT examination, and he came to meet the two directors to report the situation.

When Dr. Liu saw the two directors, he directly stated Qin Lang's judgment:

"Director Zhuang, Director Pang, the patient's condition is urgent. According to our judgment, it is highly suspected to be acute hemorrhagic necrotizing pancreatitis!"

Hearing Dr. Liu's words, the faces of the two directors changed drastically:

"Doctor Liu, you have to be clear about the consequences of your judgments. Acute hemorrhagic necrotizing pancreatitis is one of the common acute abdominal diseases in clinical practice, and the mortality rate of severe acute pancreatitis is as high as 50%-70%!"

Director Zhuang is very experienced: "Everyone, we need to diagnose the patient immediately. Acute hemorrhagic necrotizing pancreatitis deteriorates very rapidly. If the diagnosis is not timely and the treatment cannot keep up, the patient may die suddenly. "

"Moreover, 120 dispatched an ambulance according to the patient's family member's request for help. The time on the way, according to the patient's condition, left us with little time."

"In this way, Director Pang, you should prepare first and perform a paracentesis on the patient. I will immediately contact the director of general surgery and go to the operating room to diagnose and identify peritoneal effusion. After completion, an abdominal color Doppler ultrasound will be performed immediately! "

After Director Zhuang's order was given, Dr. Liu was taken aback for a moment, then his face changed drastically, and he blurted out:

"Director Zhuang, you mean to do an abdominal color ultrasound instead of a CT scan?"

Hearing Dr. Liu's words, Zhuang Tong was a little surprised. When did this kid become so enlightened? He explained helplessly:

"Indeed, for acute hemorrhagic necrotizing pancreatitis, it is true that CT examination is the gold standard. When CT scans patients with acute hemorrhagic necrotizing pancreatitis, there will be patchy shadows and low-density dots on the picture. When pancreatic hemorrhage It can also be clearly displayed on the picture, and the patient can be judged more intuitively. It can improve the accuracy of clinical diagnosis and have a sufficient understanding of the degree and scope of pancreatic lesions, but the time is too long."

"Besides, this is only your preliminary judgment now, and there are other possibilities of lesions, so we still cannot rule out other possibilities. First of all, we still need to complete the diagnostic puncture of the peritoneal effusion. And this will take time."

"Therefore, we can only settle for the next best thing and use the shortest abdominal color ultrasound test to make up for the lack of methods through the rich clinical experience of Director Lin and me."

For that, Director Zhuang also has no choice. If he can perform paracentesis earlier, he can still do CT diagnosis calmly.

Just as Director Pang was going to prepare for abdominal puncture, Director Zhuang contacted Director Lin, the director of general surgery.

Dr. Liu was overjoyed and said:

"Don't worry, the two directors. We have already sent the patient for CT examination as soon as possible, and Dr. Qin has already sent the fluid collected from the paracentesis for examination."

Hearing Dr. Liu's words, Director Pang and Director Zhuang couldn't believe it: "What you said is true!"

"How did you do it?"

"Doctor Liu, you have done a great job!"

(End of this chapter)