My medical skills are a billion points

There are no patients in Xiao Chu's consulting room right now, and he is looking through some medical literature, preparing to publish a paper on double lung transplantation.

He had already had this idea.

It's just that I've been busy all the time and have no free time.

Now Xiao Chu decided to put this matter on the agenda.

After all, the double lung transplant he performed was an improvement over the previous operation method.

If he can send the paper to SCI or The Lancet, he will definitely become famous.

In this way, his popularity can go from the provincial doctor to the whole country, and even the whole world.

Of course, it is not so easy to publish papers in these top professional journals.

Even if Xiao Chu has top-notch surgical skills, he still needs to search a lot of literature to publish a paper.

For a period of time, Xiao Chu has been looking for papers and writing papers on double lung transplantation every day after get off work.

As far as this paper is concerned, it may take a month or two to write it before it can be published.

Xiao Chu was typing papers on his laptop when the urgent siren of an ambulance sounded outside the emergency room.

He closed the computer and hurried out of the consulting room to see patients.

Now Xiao Chu's main task is to receive some emergency patients and perform some difficult operations.

Of course, I also go to the ward rounds every day, mainly to see patients who have undergone surgery.

And now Chen Bin only visits clinics twice a week.Check the room once a week.

And he no longer goes to lower-level hospitals to make throwing knives.

After all, due to physical reasons, it is no longer suitable.

Most of the time, he is in his exclusive office, drinking tea and reading newspapers, enjoying the rest of his life.

Next from the ambulance was a tall, thin man under 30 years old.

A five-year-old boy and a young woman less than 30 years old were also in the car.

It seems that this should be a family of three.

The man's face was pale, and he was clutching his stomach, in great pain.

After questioning, Xiao Chu learned that the woman is the man's wife.

But the man had a severe stomachache and couldn't speak well, so his wife hurriedly explained the man's condition.

"My husband was on the bed, playing with my son, and suddenly he said he had a stomachache, and he thought he had diarrhea.

In the end, I ran to the toilet, but I didn't have diarrhea, but the pain in my stomach became more and more severe. "

"Now I'm covered in cold sweat, doctor, please check my husband quickly, what's wrong with him?"

The woman held the little boy's hand and said eagerly.

Looking at the man's expression, it was obvious that he was suffering from acute abdomen.

Xiao Chu hastily conducted a physical examination on him.

Noticeable tenderness in the right upper quadrant, but no rebound tenderness.

On percussion, a shifting dullness was found.

In the abdominal cavity of a normal person, it is impossible to detect shifting dullness by percussion.

As long as there is a shifting dull sound, it means that there is at least [-] ml of fluid in the abdominal cavity.

Xiao Chu asked the patient's wife in detail, the man was very healthy, he just had a physical examination a month ago, everything was normal.

And now, where did the fluid in his stomach come from?

Chapter 326 Children Can Seriously Injure People

Xiao Chu thought about the man's condition, looked up at the monitor, and found that the blood pressure measured on the monitor was 85/55mmhg.

This is a shock!

Although the patient is not comatose yet, he has developed shock blood pressure.

If the blood pressure dropped further, the patient would be in a coma.

Moving dullness in the abdominal cavity indicates the presence of peritoneal effusion.

Ascites, either blood in the stomach or ascites.

If there is ascites in the stomach, this situation is often caused by liver cirrhosis or tumors.

In general, there is no possibility of low blood pressure or stomach pain.

But now that the man is in shock and his stomach hurts badly, it means that his stomach may be bleeding.

There is no trauma, but there is blood in the stomach. Could it be that the liver cancer ruptured?

Because the condition is very urgent, Xiao Chu asked Wang Panpan to push the critically ill color Doppler ultrasound machine over while he was thinking.

Then Xiao Chu turned on the color ultrasound and checked the man's stomach.

It was found that there was a large amount of fluid in the abdominal cavity, and there was hematoma in the liver.

This is really a rupture of liver cancer!

Then, in order to make a further diagnosis, Xiao Chu brought a paracentesis kit.

He's going to do a diagnostic biopsy.

Diagnostic puncture is mainly used for peritoneal effusion to see whether the effusion is blood or ascites.

After routine disinfection and draping, Xiao Chu administered local anesthesia with lidocaine on the anti-McBig point of the left lower abdomen.

Then, with a [-]ml needle, it was inserted vertically into the anesthetized area.

Withdrawing the needle while inserting it, dark red blood was soon drawn out of the needle tube.

Moreover, Xiao Chu held the tube of blood, and after waiting for a while, the blood still did not coagulate.

Seeing this situation, Wang Panpan said in surprise.

"Ms. Xiao, it's not blood coagulation. Could it be that his abdominal organs are ruptured?"

Xiao Chu didn't answer Wang Panpan's words, but turned to the man's wife.

He still needs to figure out the truth about the man's illness.

It is necessary to determine how this man caused the organ rupture.

The main reason is that the possibility of liver cancer rupture cannot be ruled out now.

However, after Xiao Chu's color ultrasound examination just now, it was found that there was only a hematoma around the liver, and there was no obvious sign of tumor.

This is very suspicious.

According to the patient's wife, he had no trauma, so how could he have a ruptured liver?

Xiao Chu looked at the anxious woman beside him and asked, "When your husband was at home, was he injured or did he squeeze his upper abdomen?"

The woman shook her head hastily.

"No, my husband was not injured, he was just playing with my son on the bed, and suddenly he became like this."

"You also did the doctor's examination. What's wrong with my husband now?"

Xiao Chu said: "Your husband's liver ruptured, it may be caused by trauma."

"what?"

The woman was very surprised.

"He was not injured at all, how could the liver rupture caused by trauma?"

At this moment, the patient lying on the bed had not yet fallen into a coma.

Hearing the conversation of several people, he said weakly: "Doctor, when I was playing with my son, he suddenly kicked me in the stomach. Is this considered trauma? I didn't feel anything at the time."

Xiao Chu suddenly realized.

It turns out that this is the cause of the man.He hurriedly said to Wang Panpan: "Quickly prepare the patient before the operation, draw blood to test the blood type, nine items before the operation, liver and kidney function. And a lot of blood is needed!"

"Okay, Mr. Xiao, I'll do it right away."

Wang Panpan turned around and went back to the office, ready to go.

The man's blood pressure at this time has reached 80/50mmhg.

His face was as pale as paper, Xiao Chu hastily increased the amount of fluid for him, using succinylated gelatin glue.

And the blood bank has been notified to prepare blood.

Now it is clear that the man's diagnosis requires emergency surgery.

Judging by his condition, he must have lost a lot of blood.

Xiao Chu also returned to the office, making preoperative preparations.

But the man's wife also came in.

She still has some doubts about Xiao Chu's diagnosis.

"Doctor, my husband was injured, is it because my son kicked him when he was playing around?"

Xiao Chu nodded.

"Don't think that because a child is small and has little strength, he can't hurt an adult, you are wrong.

Your husband is thinner and has less fat on his stomach. When playing with the children, his abdominal muscles are not tense and he is not prepared. If he is kicked suddenly by your son, he may have injured his liver. This is him Where the injury is. "

Xiao Chu explained to the woman how the man was injured in detail.

According to the thinking of ordinary people, the patient is playing around with his son at most.

The child is not sensible, just kicked, how could he be injured so badly?

Nothing is impossible.

And the man who suffered such a serious injury happened to be his son who kicked him all of a sudden.

After hearing Xiao Chu's explanation, the woman stopped talking.

Instead, he looked down at the five-year-old son who was holding his hand.

The child looked ignorant, looking at the things in the office curiously.

The woman really did not expect that her son's unintentional kick would seriously injure her husband.

The preoperative preparations will be completed soon.

The patient was rushed to the operating room.

Liver rupture generally has a large amount of bleeding and requires emergency surgical repair.

Otherwise, the patient's life is in danger.

This time Xiao Chu asked Zhou Ziqiang to help.

Relatively speaking, Zhou Ziqiang is quite capable in general surgery.

He can also perform such tertiary surgery on the abdomen.

But Xiao Chu used his ability once for free, and took a look at the condition of the man's abdominal cavity.

It was found that his liver rupture was serious, so Zhou Ziqiang was not appointed as the chief surgeon.

The patient had already been anesthetized, and the anesthesiologist gestured to Xiao Chu as an OK gesture.

Xiao Chu picked up the scalpel and began to perform laparotomy.

For such patients with hepatic rupture, laparoscopy must not be used, and conventional surgery is required.

Xiao Chu made a longitudinal incision about 15 cm from the rectus abdominis muscle in the right upper abdomen, incised the subcutaneous tissue of the skin, the anterior sheath of the rectus abdominis in sequence, bluntly separated the rectus abdominis muscle, incised the posterior sheath and fascia, and entered the abdomen.

As soon as it entered the abdomen, a stream of blood gushed out.

Zhou Ziqiang hurriedly took the suction device and sucked the blood into the recovery device.

Because the patient's bleeding volume must be very large, it is necessary to recover the blood in his abdominal cavity in advance.