I'm really an intern

Chapter 467 Hiss! (Da Zhang~)

"what?"

The seemingly untimely question caught senior brother Qiu Ming by surprise.

"This... the first time I didn't know, I didn't do the emergency gastroscopy last time. But the last gastroscopy..."

Although it is not very clear why Zhang Tianyang asked such a question, Senior Brother Qiu Ming still recalled it seriously.

"I didn't teach him how to position for the gastroscopy last time. He just lay there by himself."

"What about usual times?"

Zhang Tianyang felt that he vaguely grasped the key point.

"I remember that it was mentioned in the patient's medical record that hemoglobin was low, and he was ordered to rest in bed. How did he lie down when he was in bed?"

"This one……"

Senior brother Qiu Ming couldn't answer.

He is an attending physician. If you want to ask about the patient's condition and follow-up treatment, he can speak clearly and clearly.

But he really didn't have time to pay attention to these details.

So Chen Jiajie, who had just been kicked out, was called in again.

"You are the doctor in charge of this patient, now Dr. Zhang has some questions to ask, please answer them carefully."

The irritable senior brother Qiu Ming even forgot that Chen Jiajie and Zhang Tianyang were actually roommates, and directly treated him as an ordinary intern.

Zhang Tianyang didn't have time to explain, so he just repeated the question just now.

The patient has just had a bleeding, and now is the best time to look for the bleeding point.

No time to explain so much!

"Yes, the patient has been bedridden most of the time since admission."

Chen Jiajie could also distinguish the seriousness of the matter, and when he was kicked out before, he had already had a vague guess in his heart, but now he straightened his attitude and looked serious.

"I haven't really asked this question, but every time I see the patient, he is lying on the left side!"

Zhang Tianyang's eyes lit up. "Sure?"

"Sure!"

Chen Jiajie nodded firmly, "I asked once, and the patient said that lying on the left side is more comfortable and less prone to nausea."

Not easy to throw up!

Brother Zhang Tianyang and Qiu Ming subconsciously looked at each other.

The patient had active gastrointestinal bleeding recently, and it was clearly written in the medical record that he was clearly fasting!

Three meals a day are all replaced by needle water.

How can there be anything to spit out for him!

unless

is blood!

Moreover, if the left side lying position is not easy to vomit, it means

It is the positional factor that hinders the bleeding!

The bleeding point should be covered up or even firmly pressed when lying on the left side!

It turned out to be the case.

No wonder no bleeding point was found in several gastroscopy.

There was a clear look of surprise in the eyes of Senior Brother Qiu Ming.

At the same time, there is a trace of regret.

Such a simple question, why didn't I think of it!

"bring it on."

Zhang Tianyang said, "Try to turn the patient over."

Chen Jiajie kept his mouth shut, but his eyes widened.

He is the patient's bed doctor.

Although he is just an intern and lacks experience, experience and even basic skills, his basic condition is still clear.

Even if it was half a beat late, after the two of them showed the expressions of "finally found the reason", after Zhang Tianyang directly said that he would "turn over" the patient, they could always react.

It was so!

At the same time, he subconsciously looked at Zhang Tianyang.

The key point of the matter was discovered by my roommate first

Somewhat surprised.

But if you think about it carefully, it seems to be expected again?

Chen Jiajie's mind quickly flashed through these things, and then suddenly his eyes widened again.

Because Zhang Tianyang stretched out his hand towards Senior Brother Qiu Ming: "Give it to me."

Now that there was a major breakthrough in his condition, an intern extended his hand to the attending doctor?

This is not equivalent to saying: You can't do it, let me do it.

However, what shocked Chen Jiajie even more was that Senior Brother Qiu Ming gave up his position without saying anything.

The gastroscope didn't even come out of the patient's mouth.

The screen shakes for a while, but it can be clearly felt that the camera does not move much.

It was so easy, the handle of the gastroscope fell into Zhang Tianyang's hands.

There is no contempt from the superiors, no anger from embarrassment, no roar of "Dare!", no surrender from the boss outside the world, and no shock of two-level reversal.

Not even a crooked smile.

It was flat as if Zhang Tianyang was actually the superior doctor.

"What are you doing in a daze, come and help me!"

Brother Qiu Ming frowned, but not at Zhang Tianyang, but at Chen Jiajie who was in a daze.

"Oh, oh!"

Chen Jiajie finally came to his senses, and quickly took two steps forward, together with Qiu Ming, using his old strength.

"Slow down, turn over little by little, be careful not to overturn the camera!"

Fortunately, the patient was just an underdeveloped boy, and because of anemia and malnutrition, his figure was quite light.

With the joint efforts of the two, the patient's body was slowly turned around.

Zhang Tianyang held the operating handle with one hand, and controlled the depth and angle of the gastroscope with the other. The lens rotated with the content, and the picture on the screen was not too bumpy.

"Turn it over, did you find the bleeding point?"

Senior brother Qiu Ming came over.

A little out of breath.

"It's time for you to exercise."

Zhang Tianyang glanced at him, moved his hands slightly, and soon the camera was close to a small piece of stomach wall.

"It should be here."

On the screen, there is still a flesh-colored background.

In the middle, a small depression appeared before the eyes.

"is it here?"

Senior Brother Qiu Ming took two steps towards the screen, "It looks like"

"Dieulafoy's disease."

Zhang Tianyang helped to fill in the second half of the sentence.

So Senior Brother Qiu Ming only had to nod his head like a chicken pecking rice.

While nodding, he sighed softly, "Really."

And mumbled even more quietly.

"Why didn't I think of that?"

"Use titanium clips?"

Zhang Tianyang turned his head to ask the little nurse who was cooperating.

"Are you ready?"

"Ready!"

The little nurse nodded like a chicken pecking at rice.

She didn't know Zhang Tianyang, and Zhang Tianyang was wearing a surgical gown when he came, so she directly regarded him as a foreign aid invited by Senior Brother Qiu Ming.

The foreign aid invited by the attending doctor must at least be above the attending doctor, right?

Besides, he looks so young!

Be nice. That's right.

What if you don't have a girlfriend yet?

Even if there is, what if we break up?

Even if we didn't break up, what if we want to have two?

"Come on then."

Zhang Tianyang nodded to the little nurse.

During the short period of preparation, he took the time to look at his old friend Chen Jiajie.

Sure enough, there was a little bewilderment on his face.

"Dieulafoy's disease accounts for 1.2% to 5.8% of the causes of acute upper gastrointestinal bleeding. The clinical manifestations of typical cases are intermittent and recurrent massive hematemesis or melena, and peripheral circulatory failure such as shock is prone to occur."

Zhang Tianyang sighed softly and began to explain.

"Under normal circumstances, the blood supply to the gastric wall mainly comes from the short gastric artery, and after entering the gastric wall, the branches gradually become thinner, and finally form a capillary system in the gastric mucosa.

However, in patients with this disease, the short gastric artery branch maintains a constant diameter after entering the gastric muscularis, so it is called a constant-diameter artery. "

After a pause, Zhang Tianyang changed to a more popular explanation.

"Just like a normal uncle, the branches should be getting thinner and thinner. But for this kind of patient, he is a thick trunk piercing the sky.

With such a thick blood vessel, and so close to the surface of the gastric mucosa, whenever there is any friction, ulcer, inflammation, etc., it will be like it is now. "

The silver titanium clip has appeared in the field of view of the screen. Zhang Tianyang manipulated the titanium clip and dangled around the small hole.

"It's no wonder the patient doesn't vomit blood when the artery is opened to let the blood out."

"I see."

Chen Jiajie nodded hastily, with a look of "I learned it".

But there was still a little confusion in his eyes.

"However, the hole is not very obvious? There is no bleeding, how could it be?"

Zhang Tianyang turned his head to look at him, blinked, "Look at the screen carefully."

"Huh? Why do you have to look at the screen carefully?"

While speaking, Chen Jiajie's eyes suddenly widened.

I saw the silver titanium clip poked forward, and poked it straight into the small hole that seemed inconspicuous at all.

Then, with a light pick——

"puff!"

A thick stream of blood spurted out instantly.

No, that's not a stream of blood, that's a column of blood!

"Old Zhang! You want to do it"

Chen Jiajie exclaimed subconsciously.

"Click"

Zhang Tianyang stepped on it, and the special effects of screenshots clearly appeared on the screen.

With a pinch in the hand, the titanium clip goes up against the current.

"Click"

After two clicks.

The blood column is gone.

In the center of the screen, the tail of the silver titanium clip still trembles slightly.

"what"

Chen Jiajie's exclamation seemed to span a century, and he finally reached the last two words.

But Zhang Tianyang blinked and asked the little nurse for two more titanium clips, one on the left and one on the right next to the first titanium clip.

Then, she turned her head, looked at him, and then at Qiu Ming.

"It's done, call it quits!"

Step on it again, another screenshot.

Zhang Tianyang leaned back slightly, and the mirror exited smoothly.

Then, put the mirror, drag the gloves, wash your hands, and leave gracefully.

Only Qiu Ming, who was moaning and sighing, and Chen Jiajie, who was still immersed in shock, stayed where they were.

"Don't be stunned, give me a hand, and send the patient back later!"

Senior brother Qiu Ming slapped Chen Jiajie.

It's like a paused movie is suddenly pressed to restart.

Chen Jiajie suddenly took a deep breath——

"hiss!"

--------

Gululululu~

　Push this book ~ "Back to Boyhood"

　　Text/Xie Buchen

　　An accident brought Xiao Feifan back to his boyhood, the summer when he was 18 years old.

　　18.

　　This is really a number that makes the corners of the mouth go up crazily.

　　(There is a surprise in the book review area (-ω-`))

　　

　

(End of this chapter)