My medical skills are a billion points

Seeing this, a group of family members rushed forward.

"Xiaodong, Xiaodong, wake up!"

……

Chapter 168 The Confused Gao Handsome

Xiao Chu hastily stretched out his hand to stop everyone.

"The patient is in a coma, and you can't wake him up. Now he has to be sent to the intensive care unit for further treatment. Please don't affect our treatment."

Listen to what Xiao Chu said.

The family members of the patient gave way one after another, allowing Gao Yingjun and the others to push the gurney into the intensive care unit next to it.

There are dedicated doctors and nurses in the intensive care unit, and Gao Yingjun pushed the patient in.

After explaining the patient's condition to the intensive care doctor on duty, he also left the intensive care unit.

Xiao Chu returned to the consultation room and continued to see the waiting patients.

He stayed in the emergency room for about twenty minutes.

Fortunately, these waiting patients were more qualified, and they didn't make any noise with Xiao Chu because he went to the emergency room.

When it was almost time to get off work, a middle-aged man in his forties walked into the consulting room.

The man looked very strong physically, but he was a little out of breath when he walked, and he looked very weak.

As soon as the man sat down, he began to talk about his situation to Xiao Chu.

"Doctor, I'm mainly short of breath. Three months ago, I may have suffered from a cold, and then I developed a persistent cough, which is the kind of dry cough without phlegm.

At that time, I also took a lot of cough medicine, but the effect was not obvious.After about half a month, the cough gradually subsided. "

"Because I didn't have a fever, I didn't take it seriously, and I didn't go to the hospital for an examination. But in the past month, apart from the occasional cough, I also experienced chest tightness and shortness of breath.

Especially in the past week, the chest tightness has become more and more serious. When I walk, I feel so stuffy. "

"Doctor, show me what is the disease?"

After the man finished talking about his condition, he even gasped a bit.

Xiao Chu looked at the complexion of the middle-aged man, and then carefully asked about the detailed course of the disease and some related medical history.

Then he gave him a detailed physical examination, and he already had a diagnosis of the man's disease in his heart.

Of course, the patient must go for an examination in order to have more definite evidence for the next step of treatment for him.

It is impossible for Xiao Chu not to do an examination for the patient because of his passive ability to actively diagnose the patient's condition.

To do so would be a violation of one's duty as a doctor.

He can see the patient's condition at a glance, instead of going for an examination, he treats it, so how can he explain it to others?

It's okay to say that the disease is cured.

If it can't be cured, it is a medical malpractice to treat the disease without inspection.

Therefore, there are still necessary examinations, not to mention that this man still needs to be hospitalized.

The man's symptoms were not serious, so Xiao Chu said to him directly:

"Your symptoms are already very serious. I suggest you go to the hospital directly for examination. If you are hospitalized after the outpatient examination, your medical insurance will not reimburse you for these outpatient examination expenses."

The middle-aged man gasped and said, "Doctor, you can go through the hospitalization procedures for me directly. I also wanted to come to the hospital for examination."

Xiao Chu prescribes the hospitalization procedure for the patient and asks the family members to go through it.

After entering the department, Xiao Chu prescribed relevant blood tests and chest CT for him.

After all, it's time to get off work. Now that the patient is going for an examination, the result will definitely not come out, and the soonest will be in the afternoon.

Xiao Chu is now the deputy director and no longer manages the bed, so this patient is also handed over to Gao Yingjun.

By three o'clock in the afternoon, all the test results of this patient were basically out.

And Gao Yingjun came to Xiao Chu's consulting room with the patient's test sheet and chest CT film.

Gao Yingjun put the CT film on the reading light, and before Xiao Chu could speak, he said relaxedly:

"Director Xiao, this patient turned out to be caused by a large amount of pleural effusion, causing chest tightness. I will perform a closed chest drainage for him in a while, and the pleural effusion will be released."

The film showed that there was a huge encapsulated effusion in the patient's right chest cavity.

There are many reasons for the formation of pleural effusion, some are tumorous, some are tuberculosis, and some are caused by heart failure and so on.

Like this patient, there is a huge encapsulated effusion in the right pleural cavity. As long as the pleural effusion is released, his chest tightness will be relieved.

After the pleural effusion is released, another examination is performed to confirm the nature of the pleural effusion.

In short, the patient's condition is not complicated.

As long as the pleural fluid is pumped out, his symptoms can be quickly relieved.

Because of this, Gao Yingjun directly mentioned the treatment method.

Xiao Chu stared at the film carefully for a while, then raised his head and asked, "Are you sure you want to do closed chest drainage and release pleural fluid?"

Gao Yingjun was taken aback for a moment.

He didn't understand why Xiao Chu asked such a question.

Isn't the patient's condition very clear?

It is encapsulated pleural effusion, which causes chest tightness. Wouldn’t it be cured by releasing the pleural effusion?

Gao Yingjun was stunned for a while, and then asked: "Director Xiao, this patient's pleural effusion should be very clear. If so much pleural effusion is not released, his chest tightness will not be relieved."

Xiao Chu shook his head slightly.

Although Gao Yingjun is a senior resident doctor, from this point of view, his experience is still not rich enough, and the cases he has experienced are not enough.

"Not all pleural effusions must be released."

Xiao Chu pointed to the huge encased effusion on the right side of the chest on the film, and continued:

"There is a lot of effusion, and the package is very complete. You should think about which disease may have this possibility."

Hearing this, Gao Yingjun stared at the film carefully for a while, and then said:

"This patient is so young, it should not be caused by heart failure, and the pleural effusion caused by heart failure is bilateral, but this one is unilateral.

And it doesn't look like cancerous pleural effusion.The tumor markers tested in the morning were all normal. "

"So I think it is tuberculous pleural effusion, and I have done a PPT test on the patient. Wait until the pleural effusion is released, and then check whether there are tuberculosis bacilli."

Xiao Chu was slightly disappointed.

Gao Yingjun's thoughts are still too one-sided.

"My suggestion is to prepare for the operation and prepare for thoracotomy."

"what?!"

Xiao Chu's answer was beyond Gao Yingjun's expectation.

Isn't it pleural effusion?

Do you need to open your chest?

Not so much, right?

Xiao Chu didn't care about Gao Yingjun's reaction, just continued talking.

"It's too late for me to perform this operation. I will go to the capital to hold an academic exchange meeting with Director Cheng tomorrow morning."

"I consider this patient a lung cyst rather than a true pleural effusion.

And this lung cyst is usually related to parasitic infection. If closed chest drainage is performed to release the pleural fluid, it may cause the spread of parasites.

So the only way to do this is to open the thoracotomy and take out the cyst completely. "

Chapter 169 Learn more from Xiao Chu in the future

Originally, Gao Yingjun was still a little unconvinced in his heart, but after hearing what Xiao Chu said, combined with his own lessons learned a while ago, he said:

"What you said is also reasonable. If you don't have time for this operation, then I will ask Director Chen for instructions to see if this patient should be transferred to the Thoracic Surgery Department."

Xiao Chu nodded.

It is estimated that only he can perform this thoracotomy in the emergency department.

Chen Bin is mainly in general surgery, not thoracic surgery.

Not to mention the others, most of them are also from general surgery.

If this patient wants to have a thoracotomy, I am afraid that he can only be transferred to thoracic surgery.

If Xiao Chu doesn't go to the capital for a meeting tomorrow, then he can do this operation.

Gao Yingjun went to Chen Bin's office with the checklist and chest X-ray.

"Teacher, here is a patient. Director Xiao transferred him to the Department of Thoracic Surgery. Do you need to transfer?"

Chen Bin used to be Gao Yingjun's tutor for postgraduate students, so Gao Yingjun usually called Chen Bin his teacher.

Chen Bin was stunned for a moment, and then he came to his senses.

"Oh, Xiao Chu is going to Beijing for an academic exchange meeting tomorrow. He doesn't have time to do this operation. We people are not good at thoracic surgery, so we have to switch to thoracic surgery."

"What kind of patient is it? Let me see."

Gao Yingjun hurriedly put the chest X-ray on the viewing light, and then explained the patient's medical history in detail.

Chen Bin stared at the chest X-ray carefully for a while, nodded and said, "Xiao Chu handled it well. This patient really needs to go to the thoracic surgery department for an open-chest examination instead of simply releasing the pleural effusion."

Gao Yingjun was shocked.

This Xiao Chu is really amazing!

He was able to diagnose such an uncommon disease.

Fortunately, this time, I didn't have any doubts, otherwise I would have been slapped in the face again.

Compared with Xiao Chu's judgment, Gao Yingjun believed in Chen Bin more.

After all, Chen Bin has been working in the emergency department for nearly 30 years, and his clinical experience is extremely rich.

Although he is only good at general surgery and has only a superficial knowledge of thoracic surgery, it does not hinder his ability to diagnose diseases.

What's more, Chen Bin is also his mentor.

Seeing Gao Yingjun's suddenly enlightened look, Chen Bin hated him a little bit.

"Handsome, do you simply think it's a pleural effusion, and then do a closed chest drainage to release the pleural fluid?"

Gao Yingjun nodded helplessly.

As a mentor, Chen Bin could see through his thoughts at a glance.

"You, you are still floating on the surface like when you were studying with me, and you haven't settled down to settle your academics.

In this patient's case, what appears to be a large pleural effusion.But it should actually be a lung cyst, which may be related to a parasite infection.

How can you blindly think that pleural effusion is enough? "

"I'm afraid it's Xiao Chu who saw the real illness. That's why he was transferred to the thoracic surgery department."

"In the future, you have to learn more from Xiao Chu, regardless of how much younger he is than you. But his clinical experience and surgical ability are probably better than mine."

"You have to remember that the master is the teacher. Anyone who has the ability can be your teacher, regardless of his age."

Chen Bin saw what Gao Yingjun was thinking, and suddenly hated iron for being weak.

A few years ago, Gao Yingjun was still a graduate student under him.

At that time, I saw that he studied hard, was self-motivated, and knew how to get things done, so he was given a place to stay in the hospital.

Of course, Chen Bin also knew at the time that Gao Yingjun was a little unstable and lacked clinical experience.

But he was his student after all, so he was given a chance.

But looking at it now, compared with Xiao Chu, this student of mine is vastly different!