Since 1981 Health School

  Chapter 415 Selfish not to be transferred

  I heard that Chen Qi has a simpler detection method, not to mention Qi Zhiyi is curious, even Dean Gai, Director Lu, Director Yao and other old experts are full of curiosity.

  Qi Zhiyi packed the debridement kit and asked, "What detection method?"

  Chen Qi joked:

   "Why are you the one asking me the question? Isn't this the opposite? Come on, Comrade Xiao Qi, Teacher Chen also wants to ask you a few questions."

  Qi Zhiyi was dumbfounded when he heard it.

  His personality is a bit carefree, and his relationship with Chen Qi has always been very close, even Chen Qi's wedding wine is one of the few classmates who can drink.

  So in his mind, Chen Qi has never been regarded as the dean, or a superior doctor.

   Now that Chen Qi suddenly wants to ask him a question, Qi Zhiyi is nervous and upset.

   If no one was around, he would definitely have a crazy meal with Chen Qi, but now that the leaders of the unit are watching, he doesn't dare to be presumptuous, so he can only shake his fist at Chen Qi.

  But he really couldn't answer Chen Qi's question, so he could only say with a bitter face:

   "Mr. Chen, please forgive me. Don't say that I don't know how to check chylothorax. I haven't even heard of the disease chylothorax. I'm ashamed."

  Chen Qi nodded, pretending to be a leader and saying:

   "Comrade Xiao Qi is not good at medical studies, but his attitude is still very sincere. If we have something, we can change it if we don't. Today, Teacher Chen will teach you!"

  Qi Zhiyi suddenly ran to Chen Qi's side, strangled his neck like a fight in a medical school, and shouted:

   "Say it quickly, if you don't say it, I will kill you if you don't say it!"

   "I say, I say, I recruit everything~~~"

  Hahaha, everyone in the consultation room laughed. At this time, Chen Qi's mischievous side was exposed, and everyone realized that the international double director in front of them was just a 24-year-old young man.

  Seeing that Chen Qi was preparing to give a lecture on the spot, let alone Qi Zhiyi was listening carefully, even a few veteran directors pricked up their ears.

  They know about chylothorax and the prognosis of chylothorax, but they don’t know exactly how chylothorax comes from and how to treat it.

  After all, the domestic textbooks from the 1950s and 1960s are there, and the types of diseases are only those, and they are not the latest textbooks from the 10th edition of the People's Medical Publishing House.

  Medicine is too specialized, and there is no end to learning. Every year, innovative research is produced, and a batch of old knowledge is eliminated every year.

  But as long as you have experienced it once in the clinic and treated it once, it will be hard to forget later, so it is also called "empirical medicine".

  Chen Qi pointed to the remaining half bottle of chyle and said:

   "This chyle-like effusion is actually the lymph fluid leaking out of the lymphatic vessels in the chest. We all know that ordinary lymph fluid is transparent. Why is this lymph fluid milky white?

   This is because the fatty acids absorbed from the gastrointestinal tract are absorbed through the lymphatic vessels and mixed with ordinary lymph fluid. The pleural effusion formed when chyle fluid enters the chest cavity is called chylothorax, and if it enters the abdomen, it is also called chylothorax, so it makes sense, and it’s all right, right? "

  Draw the key point, here is a new disease: chylous abdomen.

   This is also a very troublesome and rare disease.

  Chen Qi raised some knowledge points about chylothorax before continuing to talk about chylothorax.

   "Just now I asked the laboratory to focus on checking the fat content such as triglycerides, because as long as the fat content exceeds 4 grams per liter, then we can preliminarily diagnose it as true chylothorax. This is also a very simple detection method."

  Qi Zhiyi asked again: "How did the lymph fluid enter the chest cavity or abdominal cavity? What is the cause?"

  Chen Qi smacked his lips:

"There are too many reasons, and it's really hard to say. Generally, adult chylothorax is considered to be caused by trauma, such as neck and chest injuries; there is also lymphatic vessel obstruction, such as lymphoma, metastatic cancer, etc.; in addition, some people are congenital. The thoracic duct is underdeveloped or fistulaed."

  Qi Zhiyi pointed to the sleeping baby who was already tired from crying on the hospital bed and asked:

   "Then there is a high possibility of the cause of this little patient? After all, it is impossible for him to have trauma or cancer, and he was only born less than 2 months ago."

  Chen Qi thought for a while, then continued to explain:

"The chylothorax in newborns is mostly caused by congenital abnormalities of the thoracic duct or birth trauma, and it is less spontaneous in older children. Some children may also have thoracic duct obstruction due to tumors, especially lymphangioma, and persistent severe cough may also cause It leads to chylorrhea. It’s really hard to say what kind of cause this little baby is, unless it’s surgically cut open.”

  Director Lu said helplessly:

   "The parents object to being a chest piercer. Now you want to use a knife on this little baby to open the chest cavity. I'm afraid the parents will fight you desperately. It seems that the reason for this is unclear."

  Chen Qi shook his head:

   "That's not necessarily the case. Conservative treatment for chylothorax is not very effective, especially the condition of this little baby is no longer good. I think surgery is very likely, and it is the only way to be cured."

  Dean Gai saw that they were chatting wildly, so he quickly brought it back to the topic:

   "Chen Qi, you haven't said which method can be used to quickly detect chyle fluid?"

   "Oh, this is simple, Zhiyi, you go to the anesthesiology department and get me some ether."

   Qi Zhiyi was taken aback: "Why do you want ether? You don't want to do something bad, do you?"

  What can ether do?

   Have you read the social news, but a stranger ran over and covered your mouth and nose with a cloth, and then the person who was covered fainted immediately, and there was ether in the cloth.

  The anesthesiology department of the hospital has regular medicines for clinical needs, so doctors commit crimes, hum, it is definitely a crime with a high IQ, and the tools for committing crimes are all ready-made.

  Chen Qi kicked it angrily:

   "Get out, I want ether from the fourth hospital, and I need your second hospital to provide it. Hurry up, don't you want to know the rapid detection method, my brother will teach you a trick."

   After a while, Qi Zhiyi ran back with ether in his hand, which can be used to kill and set fire.

  Chen Qi extracted a part of the chylus, put it into a test tube, and then added ether one by one and shook it. After a while, the milky white liquid turned into a colorless liquid, and a layer of fat floated on the liquid.

  Everyone quickly gathered around to check the situation inside the test tube.

  Chen Qi taught everyone patiently:

   "In the future, you should remember clinically that milky pleural effusion is not all chylothorax, it may also be pseudochylous fluid formed by empyema or cholesterol pleurisy.

  After the true chylofluid is shaken with ether, the fat precipitates and becomes clear, with high fat and triglyceride content, Sudan III staining is positive, and chylomicron bands can be seen in lipoprotein electrophoresis.

  If it is pseudo-chyle plus ether shaking, it is impossible for the pleural effusion to become clear. Do you understand the difference between the two now? "

  Qi Zhiyi nodded sharply, then took out a small notebook from his pocket, and quickly recorded it.

  Chen Qi looked back at Dean Gai and said:

   "Dean Gai, I can be sure that it is chylothorax. Combined with the clinical symptoms, the diagnosis of chylothorax can be preliminarily established now."

   Unexpectedly relieved, everyone in the consultation room still frowned.

  Dean Gai asked a little embarrassedly:

   "Chen Qi, if you want to say that your medical skills are really like this, there is nothing to say. But even if the diagnosis is made now, how do you treat it? We really have no experience with such a small baby."

   Director Yao quickly echoed:

   "The death rate of chylothorax is too high. At present, there is no record of a child being rescued in the entire Vietnam Central region. This little patient is quite special. We can't explain it to the child's father."

   "Yes, yes, this matter is settled..."

   "It's mainly because of bad luck. It's not good to have any disease. I have this disease..."

   Several directors in the consulting room were talking a lot, obviously not confident in the treatment, and they were not very willing to take over this patient.

  Chen Qi's eyeballs were rolling.

  He didn’t expect that celiac disease, which is relatively common in later generations, was so rare in the 1980s, which made doctors daunted. Could there be a fuss about it?

  Being able to cure diseases that others dare not cure, not only dare to cure, but also cured, shows the true qualities of a hero.

  Chen Qi made up his mind when he thought of this. Anyway, such a difficult and miscellaneous disease is something that your Second Hospital doesn’t want, so you can’t blame Chen Qi for cutting it off.

   "How about this, I still have some experience in the treatment of chylothorax, then transfer this patient to our fourth hospital?"

  Directors Yao and Director Lu were overjoyed when they heard it. They were about to agree when they heard Dean Gai cough a few times:

"Ahem, um, um, the patients should be placed in the second hospital. We can't cause trouble for the brother unit. What's Comrade Chen Qi's experience? Let's share and separate together. We are all hospitals in the same county and make progress together. "

  Chen Qi cursed in his heart: Old fox, do you want to **** for nothing?

   At the same time, I was a little regretful, after all, I was too young and too impatient, and I was immediately noticed by others. Otherwise, why would the fourth hospital take the initiative to take over a critically ill patient that everyone avoids?

  At this moment, Chen Qi wanted to turn his head and leave, let your Second Court have a hard time, and see if you will be transferred.

   But when he thought about it, what he did was taking the patient as a hostage. How was that different from those old hooligans in hand surgery? It's too unethical.

"Okay, Dean Gai said so, then you can treat this patient yourself. The treatment plan consists of a few principles. One is to do chest tube drainage, pump pleural effusion every day, and then inject tetracycline or erythromycin directly into the chest cavity. Mycin.

In addition, there is another important point, that is to do a good job of nutritional support for the baby, and not to infuse too much fluid. If you infuse too much fluid and leak more, it will be troublesome. Finally, give plasma transfusion, protein supplement and blood coagulation when necessary. Factor, improve internal circulation. "

  Newborns with chylothorax in future generations will all need to be put on a ventilator, which is the key to treatment. The problem is that the Second Hospital doesn't have this equipment now, so he doesn't bother to say it.

   Dean Gai rubbed his hands excitedly after hearing this: "Then how likely is it to be cured after this treatment?"

  Chen Qi stretched out two fingers.

  Qi Zhiyi asked from the side: "Does this mean OK? Is it okay to be cured?"

  Chen Qi rolled his eyes at him: "Idiot, I mean a 20% cure rate."

  The doctors of the Second Hospital in the room exclaimed in unison: "Ah, is it so low?"

  Chen Qi thought, now the nature of the pleural effusion has been determined, without radionuclide lymphangiography, CT, X-ray lymphangiography, the location and cause of lymphatic obstruction and lymphatic overflow cannot be determined.

  This treatment is the same as the blind man touching an elephant, giving a 20% chance of healing is not bad.

  Based on Chen Qi’s previous life experience, the newborn’s chylothorax could not be cured at all if surgery was not performed to ligate the thoracic duct leaking lymph fluid.

  Even if you pump out all the pleural fluid every day, you have injected drugs and provided nutritional support, but the thoracic duct is always leaking, and the condition will only worsen after a long time.

  Like a boat, if you don’t plug the leaks, the boat will sink sooner or later.

  But now the dean of the Second Hospital wants to try it himself, and he doesn't want to pour cold water on it. It will make him appear unmannered and have ulterior motives, so he can only keep his words in his heart.

   "Then let's leave it at that for today. You guys deal with it first, and if you can't, then come to me."

  Dean Gai winked, and Director Lu and Qi Zhiyi immediately stopped Chen Qi: "I invited an expert to come for a consultation and gave a lecture for half a day. There is no reason for you to go home empty-handed."

  Chen Qi smiled: "Yo, there is also a doctor's fee, how much?"

  Dean Gai smiled awkwardly:

   "We are not those big dogs abroad, who pay tens of thousands of dollars for an operation, but we are a social brother unit. In this way, I invite a private treat, let's go to the county guest house for dinner."

  Chen Qi thought that this old man was really stingy, he didn't go to Lanxiang Restaurant or Zhuangyuan Building for dinner, but went to a guest house.

   "That's it. It's rare for Dean Gai to recover his blood. Today we will try to wipe out his salary for this month. Haha."

  Dean Gai touched his pocket and started to feel a little worried...

  In the ward.

  Because the little patient had just had a pleural effusion, the heart and lungs were no longer tightly compressed, so the breathing became more gentle, which made the family members very happy.

  Shen Lifen hugged her child, staying up all night, monitoring her condition all the time.

  The Second Hospital also dispatched the strongest team of experts, led by Dean Gai himself. Directors Lu Yue, Director Yao Jinju, and Director Ge Xinliang conducted intensive ward rounds twice a day.

   On the second day, 100ml of pleural fluid was extracted, and the child's breathing became more stable than the previous day, which made the doctors of the Second Hospital very happy.

   As a result, on the third day, 120ml of chylous pleural fluid was induced in 24 hours, which was more than the previous day.

  Director Yao was worried, but Dean Gai felt that the pleural effusion would reach a peak before slowly decreasing, so he thought there was no need to worry.

   On the fourth day, the volume of pleural fluid increased further, reaching 150ml, which is not a good sign.

  At the same time, the child's condition suddenly worsened again, with shortness of breath, cyanosis, and obvious three concave signs. An emergency chest X-ray was performed, and it was found that the left pleural effusion was full, the mediastinum shifted to the right, and the right lung field squeezed and became smaller.

  A shadow hangs over the heads of the expert group of the Second Academy.

   On the fifth day, 140ml/24h, slightly improved.

  But on the sixth day, the pumped pleural fluid reached 200ml/24h, which was the highest value in the past week.

   And the child started to have a high fever and refused to breastfeed. Just listening to the sound of breathing was like a broken bellows.

  No accident, accident happened, conservative treatment failed...

  (end of this chapter)