Sleepless Doctor

"Director Liang, look at the patient first." Wu Mian smiled and stood in the corner.

　　The outpatient clinic has always been very busy. Teacher Wu is not here to talk about things. It is impossible to talk about things here, Director Liang understands.

　　 "The check is back." Director Liang stood by the table, and reached out to take the B-ultrasound report form and the blood routine list.

　　 He watched it for 2 minutes, very carefully, and watched all the important points once, even the B-ultrasound image was given a special glance.

　　The gallbladder wall of the patient is vaguely rough, and cholecystitis can barely be diagnosed.

　　 "Little girl, sit and talk." Director Liang was very gentle, without a trace of impatience. He smiled and said, "Your situation is very clear, now it is considered cholecystitis."

　　 "Director, is the situation serious?" The little girl's face was a little pale, and she asked in a low voice.

"It's not heavy, you have tenderness in your upper right abdomen, but there is no rebound pain or muscle tension. The gallbladder wall on the ultrasound is somewhat rough, but it is not very heavy. Diagnosis of cholecystitis is okay, surgery... I don't think it is necessary, first take it for a day or two Antibiotics will do."

　　 "What if it's not okay?" The little girl continued to ask timidly.

　　 "You can go to the community hospital for some drips, but I guess the possibility of problems is unlikely." Director Liang tried his best to have some affinity for himself, and said to the patient with a smile.

　　 After all, Mr. Wu is on the side, it is estimated that he is here to dig someone. Whether you want to go or not, you have to be kind, and you can't let Teacher Wu underestimate your clinical skills.

　　 "Thank you." The patient said very hard, with a little voice and full of pain, "Director Liang, how about the instillation directly, the instillation can be quicker, I can't bear the pain."

　　Patient Chu Chu said pitifully, "I can't stand the pain every night for these two days..."

　　 said, she pointed to Murphy on her right upper abdomen, and said distressedly, "Every time it hurts, I can't help but cough, which is very uncomfortable."

　　 "A little bit is fine." Director Liang said, "but I suggest you still..."

　　 was talking, Director Liang saw Wu Mian winking at him slightly.

　　 My diagnosis is wrong? Director Liang thought about it carefully, he couldn't. Could it be that I had too much drama in my heart and misunderstood what Teacher Wu meant?

Now how to do? Director Liang was taken aback.

　　 Wu Mian turned and walked out, with the back of his hand behind him, and his fingers seemed to move slightly.

　　 "Wait a moment, I'll have a stomachache and go to the bathroom." Director Liang said to the patient.

　　 "Well, I'm not in a hurry." The patient was very cooperative and understanding, and whispered.

　　 Director Liang was a little nervous, although he didn't want to show his face, don't show his butt.

　　 As he ran away, Director Liang recalled the patient.

　　 The positive signs of the physical examination are obvious. The gallbladder area is tender. Although there is no rebound pain and muscle tension, it proves that the cholecystitis is not too serious, but it does not deny the reason for the cholecystitis.

　　 Strange, what exactly did Mr. Wu tell me to do?

　　 Director Liang walked out with Wu Mian. Wu Mian didn't go very far, and stopped in the corridor, "Director Liang, can I see the results of the examination?"

　　 "Oh, look." Director Liang handed the inspection result held in his hand to Wu Mian.

Wu Mian glanced at the list quickly, barely stopping on any line of the word, and said after a few seconds, "Director Liang, I see that the breath sounds of both lungs written in your outpatient medical record are clear, do you really listen to it? ?"

　　 "..." Director Liang was taken aback.

　　 Under normal circumstances, non-specialist physical examinations are written casually. The patient has a stomachache and is still a young woman. If you have to auscultate her, don't you wait to be complained?

　　 This kind of thing is not uncommon in the hospital every year.

　　 Ms. Wu is a professional in the field. The body is not checked, and the doorway involved should be very clear. Director Liang's thoughts flashed, and immediately recalled the patient's physical signs, chief complaint and related conditions.

　　 After thinking about it again, Director Liang still found no problem.

　　 "Mr. Wu." Director Liang was taken aback, then smiled and said, "Really, I didn't auscultate, you know this."

　　 "Well, I know." Wu Mian nodded, "The patient's tone is a little weak, and she can vaguely hear the sound of airway spasms. In addition, she said she coughed when her abdomen was painful. Let's check an image of the lungs."

　　 "You think it is..." Director Liang was taken aback.

"Or listen to the patient's breath sounds. If the right side is weakened, do an examination." Wu Miandao, "The patient is not caused by cholecystitis-induced epiabdominal pain, but a large pleural effusion on the right side, which involves the pleura. Radiation pain caused."

　　 "..." Director Liang was speechless, and glanced at Wu Mian, knowing that he was serious, and not arguing, nodded and turned back.

　　 "Mr. Wu, do you hear it with your ears?" Xue Chunhe asked.

　　 Xue Chunhe also came from a gastroenterology department. He knew that Director Liang's level was not bad. Having witnessed all this just now, he didn't think that Director Liang had done anything wrong.

　　 If you are more serious, Director Liang's medical record states that the breath sounds of both lungs are clear, but there is actually no physical examination. This is indeed a mistake.

　　 However, most outpatient medical records are written in this way. Is it possible for a patient with appendicitis to check it from head to toe in accordance with the medical record writing guidelines? !

　　 Teacher Wu didn't use this reason to talk about things, but he might as well use this reason to talk about things.

　　I can hear the patient’s breath sound problem with my ears?

　　 Xue Chunhe felt a little weird. UU reading www.uukanshu. com

　　 "Dean Xue, have you observed the patient?" Wu Mian asked with a smile.

　　 "I saw that there are several main manifestations of tuberculosis patients, such as night sweats, dry cough, chest pain, and fever. The patients do not meet the same criteria. How do you judge?"

　　 "The patient's sitting posture is very formal, without hunched back and chest, right."

　　 Xue Chunhe recalled the patient's situation and nodded.

　　 "But when the patient came in, he could see the trachea deviated to the left. This is a very obvious sign."

　　"..."

　　 "In the laboratory test, the white blood cells are normal and the lymphocytes are high. Although the blood routine of patients with tuberculosis is not obvious, combined with the left trachea, you can begin to suspect that there is a right pleural effusion."

　　 "Uh...is it too far-fetched?"

"If you have been in ICU or respiratory medicine for a few years, you should be able to quickly determine the patient's condition if you hear wheeze every day." Wu Mian said, "Wait and see, Director Liang will be able to quickly determine the patient's condition after the auscultation. Sure."

　　 was talking, the young woman came out with a confused look.

　　 "Hurry up, but don't be too anxious when you walk. Don't do strenuous activities. It's nothing, you don't have to worry." Director Liang kept admonishing.

　　 He watched the young female patient leave the corridor of the outpatient clinic, then turned and walked in front of Wu Mian, with confusion and gratitude in his expression.

　　 "Ms. Wu, the patient’s right breath sound is extremely weak and almost disappears."