【My medical skills can add experience points】【】
"Okay, I'll go over right away! Please also tell your boss Shang that if you mess up, you can't scold me."
Zhou Can and Luo Jingyin are very familiar now, so they dare to joke with her.
Graduate students mix with their tutors, and some like to call their tutors their bosses.
In formal occasions, they generally refer to the tutor as a certain director, or a certain professor. In private, behind his back, he likes to be called the boss.
Graduate students are more like free long-term labor for tutors.
This is determined by the relationship between demand and demand.
To a certain extent, the tutor decides the fate of the graduate students under him. There was once a graduate student who offended his supervisor, and that supervisor happened to be a narrow-minded person, so he refused to issue a letter of recommendation.
Life and death delayed the future of that graduate student.
"Hehe, if you want to avoid being scolded by Director Shang, then you have to show your skills! I believe you will shock the doctors in the Department of Vascular Medicine."
She covered her mouth and said with a smile.
"Aren't you rushing ducks to the shelves! I'm such a regular trainee, how can you use me as the chief physician!" Zhou Can was speechless for a while.
When I met a teacher like Director Shang, I put him ahead of everything and never worried about accidents.
I don't know if it's lucky or unlucky.
When it comes to educating children, Director Shang's education method of daring to delegate power and letting students experience and grow by themselves is definitely very good. It's just that doctors have zero chance of trial and error in clinical practice.
In the event of an accident, not only Zhou Can will be unlucky, but Director Shang will also be unlucky.
Why is he so relieved?
Zhou Can bit the bullet and went to the Department of Vascular Medicine alone.
To be more precise, it should be called Cardiovascular Medicine. It is a combination of cardiothoracic medicine and vascular medicine.
It is estimated that as long as the experiment of setting up multiple sub-departments in the General Surgery Department is successful, the Department of Cardiovascular Medicine should be dismembered. Just one Department of Vascular Medicine can be subdivided into multiple sub-departments.
Cardiothoracic Medicine can also be divided into Cardiology and Thoracic Medicine.
The two most powerful departments of internal medicine are cardiovascular medicine and neurology.
This is the first time that the Department of Cardiovascular Medicine has invited a doctor from the Department of Gastroenterology for consultation. Judging from the comprehensive strength of the departments, the Department of Cardiovascular Medicine is definitely full of masters and talents.
Zhou Can is relatively familiar with Shennei, but he is not familiar with cardiovascular medicine.
In his impression, the doctors in the Department of Cardiovascular Medicine are as good as the supernatural, all of them are arrogant and look down on doctors from other departments.
Whether it was the one-month experience in the Department of Cardiovascular Medicine during the internship, or the consultation with a doctor from the Department of Cardiovascular Medicine during the emergency department training, Zhou Can did not have a good impression.
Many doctors in the Department of Cardiovascular Medicine raise their eyes when they see doctors in other departments.
Director Shang sent him over to attend the consultation of the Department of Cardiovascular Medicine this time, probably because Zhou Can's hand was used to let the doctors in this department gain some insight. So as not to raise your eyes to look at people again.
"Beauty, may I ask where your cardiology department consults?"
Zhou Can asked the female nurse at the nurse station.
Three female nurses sat in a row, all young and beautiful, with very pretty faces.
"Are you also the doctor who came to attend the consultation?"
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【My medical skills can add experience points】【】
The oval-faced female nurse sitting on the farthest side looked Zhou Can up and down, her face full of surprise.
The other two female nurses looked up curiously at this young doctor from another department.
"That's right, I'm a regular training doctor in the Department of Gastroenterology." Zhou Can nodded for confirmation.
"Where's your teacher? Director Luo and the others have been waiting for Director Shang to come over in the consultation room." The nurses seemed to be doing some inconspicuous nursing work, but they had good eyes and ears.
There are few things in the department that they don't know.
This may be related to women's love of gossip.
As long as there is any trouble in the department, it is guaranteed that the nurses will soon whisper in private and spread it to everyone.
"Director Shang really couldn't get away, so he sent me to attend the consultation instead of him."
Zhou Can replied honestly.
"I heard that right! That patient is a patient with cerebral infarction. Almost all the chief physicians in our Department of Cardiovascular Medicine participated in the discussion and thought that patient was very difficult, so we invited Director Shang from your Department of Gastroenterology to come over for consultation." No matter how busy he is, he must send a chief physician over!"
The nurse looked around and lowered her voice.
"I advise you to go back quickly and invite a chief physician to come over, otherwise Director Luo will definitely get angry. Be careful scolding you then!"
For such a difficult patient, the Department of Gastroenterology only sent one Gui Peisheng, which was simply a joke with the patient's life.
It can be seen that the nurse has a good heart.
Zhou Can said calmly, "It's okay, I'll go in and have a look first. If it's beyond my ability, it's not too late to go back and invite Director Shang." After finishing speaking, he asked directly.
"Where is the consultation room?"
"Here, walk in from here, the fourth room on the left. Many directors of our Cardiovascular Medicine Department are in there, please ask yourself!"
Seeing that she couldn't persuade him, the nurse let him go.
"Thanks!"
Zhou Can didn't realize that he was about to be scolded at all, so he went straight into the consultation room.
Dongdongdong!
He knocked on the door.
"Hello, directors, I am a doctor sent by the Department of Gastroenterology to participate in the consultation. My teacher, Director Shang, has something to do and really can't get away, so he sent me to participate in the consultation."
As soon as Zhou Can entered, all the doctors in the consultation room looked at him.
Just took this opportunity to make a brief self-introduction.
"Is there any mistake? Why did Director Shang send a Gui Peisheng to attend the consultation?"
A male doctor in his forties, with a red face and eyebrows, got angry on the spot.
"Director Jiang, don't rush to get angry. I know this Gui Peisheng, Zhou Can who has been popular in the whole hospital recently." Someone recognized Zhou Can at a glance.
Speak out for Zhou Can.
"Is he the sweet potato that both internal medicine and surgery want to recruit?" Director Jiang not only spoke aggressively, but also didn't care about Zhou Can's feelings at all.
He is obviously alone, how can he say that he is a sweet potato in front of Zhou Can?
Although it is a compliment.
It still seems a little disrespectful to Zhou Can.
"Cough...I'm just an ordinary, ordinary Pearson, not as exaggerated as the two directors said." Zhou Canqing coughed and walked into the consultation room.
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【My medical skills can add experience points】【】
His gaze was already looking at the plain film of the abdomen on the screen.
The basic information of the patient is also projected on the screen.
A 66-year-old female with diabetes and gallbladder stones was hospitalized for lacunar infarction.
The specific treatment plan is temporarily unknown, but such elderly patients have cerebral infarction, and thrombolytic therapy is usually the first choice.
The risk of surgical treatment is extremely high, and no doctor dares to use it lightly unless it is absolutely necessary.
What is now displayed on the screen is a plain abdominal film, which should not have much to do with cerebral infarction.
Zhou Can secretly guessed that the patient's cerebral infarction should have been cured, and now complications are likely to occur, so he hurriedly invited a doctor from the Department of Gastroenterology for consultation.
"Zhou Can, no matter how good you are, you are still just a regular trainee with very limited skills and experience. You should call Director Shang and ask him to come over in person. We not only invited a doctor from the Department of Gastroenterology this time , and invited a doctor from the Department of Endocrinology. This director Hong is from the Department of Endocrinology, and he pays more attention to it than your digestive department."
Director Jiang's face was full of displeasure.
He felt that it was disrespectful to the Department of Cardiovascular Medicine to send a regular trainee from the Department of Gastroenterology.
"Let me try it first. If I can't do it, I'll invite Director Shang later. He really doesn't have time to do it now." Zhou Can said seriously.
"Okay, next time the Department of Gastroenterology invites us to go over for a consultation, and we will also send a regular trainee there."
Director Jiang's face was livid with anger.
"You want to try it, don't you? Here, the plain X-ray of the patient's abdomen is just shown on the screen. Tell me, what's wrong with the patient now?"
There are several chief physicians sitting in the consultation room, but only Director Jiang is the most angry.
"If you can diagnose the specific cause just by looking at an abdominal plain film, I believe that with the strength of the directors of the Department of Cardiovascular Medicine, there is no need to invite doctors from other departments to come for consultation. I am here to help, not to be scolded Out of anger, Director Jiang is very worried about the patient's condition, I can understand. But please give me the most basic respect."
Zhou Can's voice was very calm, without a trace of anger.
But it was enough to make Director Jiang feel ashamed and blush.
"Director Jiang, please sit down and rest for a while, and I'll introduce the patient's basic situation to Dr. Zhou." The chief physician who helped Zhou Can speak twice was at least in his fifties.
He has a kind face, all white hair, and a thin figure, only his eyes are still shining with a frightening light.
Bright as the stars in the night.
"Please sit down, Doctor Zhou! Here are the patient's examination materials and medical records. You can first understand the basic situation of the patient. If you don't understand anything, you can ask me. By the way, my surname is Luo, and I am the director of this department. "
It turned out that this was Director Luo, and he was much more approachable than expected.
"OK, thanks!"
After Zhou Can took the information, he read it seriously.
The patient had a physical examination, and there was mild tenderness in the upper right quadrant, and no mass or mass was palpable. When the area where the liver is located is lightly tapped, the patient feels obvious pain.
The patient presently presents with chills, high fever, and jaundice.
Bilirubin was significantly elevated.
The patient has undergone multiple examinations, including blood routine, b-ultrasound, and ct.
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【My medical skills can add experience points】【】
Considering that the patient had gallbladder stones, the doctors in the Department of Cardiovascular Medicine initially suspected that gallbladder contraction led to obstruction of the common bile duct after the gallstones were discharged into the common bile duct, which caused jaundice.
The results of B-ultrasound for the patient indicated that the internal and external bile ducts were not dilated, the pancreatic duct was normal, and the blood amylase did not increase significantly.
Seeing this, Zhou Can can basically line up the possibility of jaundice caused by common bile duct obstruction by virtue of what he has learned.
For jaundice, check the gallbladder and liver.
With all sincerity, these two organs are a pair of good brothers.
CT showed that the patient's lungs were normal when he was just admitted to the hospital, and there was no obvious inflammatory reaction.
The ct review done today showed an abnormal chest image.
Cotton-like shadows were present in both lungs.
What does this mean?
Zhou Can immediately suspected that a lung abscess had occurred in the patient's lungs.
The directors of the Department of Cardiology no longer cared about Zhou Can, but continued to discuss the patient's condition and possible causes.
The chief physician of the endocrinology department basically came here to make soy sauce.
Because it does not involve the field of endocrinology that he is good at, it is impossible to provide some useful reference opinions.
It is probably because this patient has diabetes that the doctors in the Department of Cardiovascular Medicine invited him here.
The treatment of diabetes is often better in endocrinology.
But the patient's symptoms at the moment have nothing to do with diabetes.
This made the chief physician of the endocrinology department just sit there and make soy sauce. The key is that the cause of the disease has not been found out, and everyone has not discussed a result yet, and he still has no way to leave.
Zhou Can continued to check other examination results of the patient.
The b-ultrasound re-examination showed that the right lobe of the liver was huge and showed a solid space-occupying lesion.
The b-ultrasound before the patient was admitted to the hospital for cerebral infarction showed that the liver was basically normal.
In other words, all the lesions in the patient's lungs and liver occurred after the treatment of cerebral infarction.
It's not hard to understand that Director Jiang jumped in a hurry.
For any doctor, if the patient he is treating has such a serious condition, he must be in a hurry!
If things go wrong, the patient is particularly vulnerable to death.
Especially for patients who are older and have multiple underlying diseases.
"Directors, can I share my diagnostic opinion?"
Zhou Can raised his hand and asked.
Director Jiang looked at Zhou Can in surprise. He didn't expect Zhou Can to have a diagnosis opinion so soon. But he didn't hold out much hope.
How good a diagnostic opinion can a regular trainer provide?
Director Luo also turned to look at Zhou Can and said, "Please tell me!"
"Just now I read all the patient's information, and I have a few immature opinions. First, the patient has cotton wool-like shadows in both lungs. Is it considered lung abscess? I suggest taking the patient's sputum sample for sputum Culture test. Second, the right lobe of the patient’s liver is huge and has a solid space-occupying lesion. I suspect it is also an abscess. It is recommended to puncture the pus under B-ultrasound. If necessary, I can do this puncture.”
Zhou Can is sure that if he does this piercing, there is a high probability that he will earn 100 experience points as a reward.
"The patient's sputum culture experiment is already being done, and the results are expected to come out soon. I didn't expect Dr. Zhou to be so smart." After listening to Zhou Can's diagnosis opinion, Director Luo couldn't help but admire him greatly.
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【My medical skills can add experience points】【】
None of the other chief physicians dared to underestimate this Gui Peisheng.
"You can propose a targeted examination plan, indicating that the cause has been diagnosed to a certain extent. Tell me about your diagnosis results! There may be abscesses in the liver and lungs. We have already diagnosed these. What we want now is the cause. , Try to treat patients with precision in the shortest possible time.”
Although Director Jiang's tone was still somewhat condescending, his attitude had clearly changed.
At least he has taken the initiative to learn about Zhou Can's diagnosis.
"The patient is likely to be infected with bacteria in the blood and develop sepsis. Then, because of the failure to take timely and accurate medication, it will eventually deteriorate and turn into sepsis."
Zhou Can stated his diagnosis conclusion.
The disease is actually not as difficult to diagnose as you might think.
I don't understand that so many chief physicians in the Department of Cardiovascular Medicine failed to diagnose the cause. Is it their level of dishonesty, or is there something else hidden?
"In the beginning, I also suspected that the patient was infected due to diabetes, and then developed sepsis during the infusion of antithrombotic drugs. However, blood culture and infusion culture cultures all showed sterile growth. Therefore, we ruled out the possibility of sepsis."
The red director of the endocrinology department was the first to raise objections.
After Zhou Can heard this, he suddenly realized.
No wonder so many chief physicians failed to diagnose the cause of the patient.
This kind of disease that can be ruled out by only looking at the test results once is very harmful.
Sometimes, there is no problem in the first inspection, and there may be problems after a day or two.
At least Zhou Can encountered many similar cases when diagnosing some intractable diseases.
The most feared thing about being a doctor is to stick to the rules.
It's easy to get blindsided.
It is necessary to have the courage to doubt the test results and overthrow the test results with facts in order to avoid the formation of "diagnostic blind spots".
"I have seen the inspection reports of blood culture and transfusion culture, which happened four days ago. After the patient was infused with antithrombotic fluid, he developed high fever, chills and other symptoms not long after. In fact, at this time, he may have just been infected and cannot be detected. It's normal."
Zhou Can stated his own point of view~www.mtlnovel.com~Since the sputum culture experiment has been done on the patient, even if we don’t invite our gastroenterology department to come for consultation this time, the cause can still be found out. "
As long as the results of the sputum culture test confirm that the lung infection is sepsis, the patient can be diagnosed with sepsis immediately in turn.
"Isn't this worrying about the patient's death? The patient's illness has been dragging on for four days, and it's getting worse every day. I'm as anxious as a cat scratching." Director Jiang's attitude towards Zhou Can has completely changed.
He even took the initiative to explain why he was so anxious to get angry.
The red director of the Department of Endocrinology still stubbornly said, "It's hard to say whether it's sepsis. There are also many diseases that cause sepsis-like symptoms in the lungs and liver. The patients with liver cancer I have seen have similar symptoms." .”
This kind of dead duck-mouthed refutation is actually very pale and weak.
It's nothing more than trying to save a little face.
There are many old doctors like this director Hong in the hospital, and they are used to being pampered on weekdays. Being hugged by others every day, all kinds of flattery can make the ears hear cocoons.
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【My medical skills can add experience points】【】
After a long time, it is easy to make people feel flustered.
It's hard to think about it after losing face.
This red director is a typical example. Knowing that Zhou Can's diagnosis is likely to become a fact, he still excused himself for the sake of saving face.
"Other diseases may also have similar symptoms. Director Luo, can you perform a liver puncture on the patient and extract pus for further diagnosis?"
Zhou Can tried his best to save Director Hong's face.