My medical skills are a billion points

Chapter 32 Almost Misdiagnosed

Even Zhou Ziqiang, who was looking at his phone by the side, couldn't help but not laugh.

He felt that these two girls were so funny!

Whoever takes them both is a kind of torture!

"Come on, let me explain it to you. If you don't understand, just ask. It's a good attitude. If there is anything you don't understand, just ask me!"

Gao Yingjun was very shy and waved to Liu Qing and Wang Li.

Then he drew a picture on the draft paper and explained it carefully to the two of them.

But Xiao Chu seemed to see that Liu Qing was trying hard to hold back a smile.

He suspected this girl, probably on purpose.

At this moment, the sound of an ambulance was heard outside the emergency department.

Xiao Chu and Zhou Ziqiang hurried out of the office.

Today is the main class of the two of them. If there is an emergency patient, the two of them should be treated first.

The patient was an old man in his 70s. Sitting on a stretcher, he had difficulty breathing and sweated like raindrops, appearing to be in great pain.

The patient was rushed to the emergency room, inhaled oxygen, and installed ECG monitoring.

Zhou Ziqiang asked the old man to lie down.

The old man squeezed out a few words with difficulty.

"Doctor, I, I can't lie down, and I can't breathe when I lie down!"

The old man had difficulty breathing, sitting on the bed, panting with his mouth wide open.

Even inhaling oxygen, it didn't seem to ease in the slightest.

Zhou Ziqiang hastily stepped forward to auscultate the patient, then asked the old man to lie on his back, and performed an electrocardiogram.

Electrocardiogram suggested myocardial ischemia, but not acute myocardial infarction.

Zhou Ziqiang gave the old man another check for heart failure.

The results came out quickly, and the quantitative value of heart failure was relatively high.

He asked the patient's wife again, and the wife said that the old man had coronary heart disease, a history of heart failure, and high blood pressure.

Zhou Ziqiang already had a clear diagnosis in his mind.

So he gave a verbal doctor's order and told the nurse to take medicine quickly.

"Intravenous injection of 20 mg of furosemide injection, 0.4 mg of Cedilan injection, 50 mg of sodium nitroprusside injection plus 20 ml of glucose intravenously."

He thinks the patient, or heart failure, is having it again.

As long as these medicines are used, the symptoms will be relieved within half an hour.

The nurse hurriedly brought the medicine and used it for the old man.

However, half an hour later, the old man's symptoms still haven't improved at all.

He was still sitting on the bed, panting with his mouth wide open, his face full of pain.

Zhou Ziqiang was in a daze!

Isn't this patient heart failure?

Why didn't these medicines work?

Could it be that he has the most serious heart failure and the medicine has no effect?

Then Zhou Ziqiang gave another doctor's order.

"Push another furosemide 20 mg!"

He still couldn't believe that diuretics couldn't cure heart failure.

Yet another 10 minutes passed.

The patient's condition has not improved in the slightest.

The old man seemed to roll his eyes, and he might die at any moment.

Ziqiang panicked a little this week.

He looked at Xiao Chu beside him and said, "Why don't you ask Director Chen to come over and have a look, this patient is a bit complicated!"

In fact, according to the patient's symptoms, examination results and previous medical history, Zhou Ziqiang's diagnosis of heart failure is no problem.

However, after applying these drugs to treat heart failure, the patient's symptoms did not alleviate at all. It was just that Zhou Ziqiang ignored a problem.

Xiao Chu said in a deep voice: "Brother Zhou, I don't think it's necessary to call Director Chen over, let's do a bedside x-ray first!"

Zhou Ziqiang immediately understood.

Although the patient's heart failure symptoms are relatively obvious, who knows if there is any problem with the lungs.

Soon the radiology department brought a bedside X-ray machine and took an X-ray of the patient at the bedside.

5 minutes later the film came out!

Zhou Ziqiang took the chest X-ray and patted his forehead!

Fortunately, Xiao Chu reminded me, otherwise I almost misdiagnosed it!

This patient turned out to be a spontaneous pneumothorax!

It's not exactly heart failure, the symptoms are too the same!

The X-ray showed that the patient's left lung had been compressed into a ball, and the entire chest cavity was filled with air.

The old man was not traumatized, but had spontaneous pneumothorax.

The most common cause is rupture of the bullae and air leakage.

The diagnosis has been made, and the patient is not completely heart failure.

So just using medicines for heart failure, of course the symptoms will not be alleviated.

It is also necessary to correct the patient's pneumothorax as soon as possible.

The treatment is simple.

Just give the patient a closed chest drainage.

This is the most basic operation.

Zhou Ziqiang handed over this task to Xiao Chu.

Xiao Chu pushed the patient to the debridement room, and began to prepare for closed chest drainage for the patient.

This must be done as soon as possible.

Otherwise, the patient's dyspnea will not be relieved.

Xiao Chu put the patient in a semi-sitting position, and took the second intercostal space on the right midclavicular line as the puncture point.

Routine disinfection drape, local anesthesia with 2% lidocaine,

Take a deep vein puncture needle, insert the needle into the chest cavity with negative pressure vertically from the puncture point,

After withdrawing the air bubbles, the needle is stopped, the guide wire is inserted, and the skin is expanded after the needle is withdrawn.

A single-lumen central venous catheter was inserted along the guide wire to a depth of about 10 cm.

Fix it on the chest skin with an adhesive plaster dressing, connect the chest cavity closed drainage bottle, and seal the bottle with normal saline.

Immediately, a large number of air bubbles can be seen coming out of the drainage bottle.

In just 2 minutes, the patient's symptoms of chest tightness and panting were significantly relieved.

As long as the air in his chest is exhausted, his difficulty in breathing will be greatly relieved.

Of course, since this patient had a previous history of heart failure,

This time, because of spontaneous pneumothorax, heart failure recurrence was also induced.

Therefore, the later treatment also needs to continue to treat heart failure.

After the patient was drained, he was finally stable and was not sent to the intensive care unit for observation.

Zhou Ziqiang looked at the patient once and heaved a sigh of relief.

Back in the office, he patted Xiao Chu with lingering fear.

"Xiao Chu, thank you for reminding me, otherwise, this patient would be in danger!"

Xiao Chu said: "I also thought he was suffering from heart failure. Who knew he would also be combined with spontaneous pneumothorax. This is indeed easy to be missed."

"There is no end to medicine, and it will never end. It was a mistake to choose to study medicine in the first place!"

Zhou Ziqiang sighed.

Before the two could catch their breath, the nurse called again.

It is said that a patient with acute abdomen came outside.

This time Zhou Ziqiang didn't go out, he asked Xiao Chu to see the doctor.

The patient was a middle-aged man in his 40s who came to see a doctor with pain in the lower right abdomen for three hours.

Xiao Chu checked him in detail, combined with color Doppler ultrasound and routine blood tests, he was definitely diagnosed as acute appendicitis.

It's not easy!

In order to wait for this appendicitis patient, in order to have a chance to be on stage as the chief surgeon for appendicitis, Xiao Chu waited for more than a month.

Today, he finally came!

Chapter 33 No one can deprive Xiao Chu of the right to go to the operating table

After Xiao Chu explained the situation to the patient in detail, the patient also agreed to the operation.

Then Xiao Chu told Zhou Ziqiang about the situation, and Zhou Ziqiang resolutely decided to let Xiao Chu perform the operation this time.

He wants to fulfill the promise he made to Xiao Chu a month ago.

What's more, Xiao Chu had performed a high-quality hand surgery the day before yesterday.

In addition to his excellent suture skills, Xiao Chu can also perform operations on hand injuries.

Zhou Ziqiang wanted to see if Xiao Chu even worked in general surgery, he was so awesome!

When sending the patient to the operating room, unexpectedly, he ran into Sun Guodong.

Before, Sun Guodong also heard that Xiao Chu performed a hand surgery, but he never saw it with his own eyes.

What's more, he felt that Xiao Chu was now his nephew Zhou Lixuan's competitor, so naturally he would not let Xiao Chu grow up.

As soon as Sun Guodong heard that Zhou Ziqiang had let Xiao Chu be the main knife, he immediately became angry.

Immediately reprimanded Zhou Ziqiang.

"Zhou Ziqiang, it's you who don't understand, or Xiao Chu doesn't understand, how can he be the chief surgeon for a hospitalized trainee?

It's just nonsense, in case he makes some mistakes on the operating table, who can take the responsibility? "

Sun Guodong didn't ask indiscriminately, but criticized Zhou Ziqiang severely.

Of course Zhou Ziqiang was also very dissatisfied with Sun Guodong's actions, but he is the deputy director of the emergency department after all, so he can't do anything to him.

Xiao Chu looked at Sun Guodong who was still furious, and said unhurriedly:

"Director Sun, although I am a regular doctor, I have already passed the examination for a doctor's license, and I am legally allowed to perform surgery on stage. You can't deprive me of my qualifications to perform surgery just because I am a regular doctor! "

Sun Guodong's face was gloomy.

"You've made sense to me, haven't you? I don't care if the law is legal or not. This operation, if I say you can't do it, you can't do it. What can you do?"

This old boy Sun Guodong is completely shameless.

Relying on his identity as the deputy director of the emergency department, he bullied Xiao Chu.

Xiao Chu really wanted to go up and punch him flat in the face.

But hitting someone is against the law, Xiao Chu could only hold back.