This doctor has a system

Chapter 6 6. Discussion of cases within the department
Today is another beautiful day. When the shift is over, the director of the subspecialty informs everyone to come to the meeting room for case discussion at 2:56 in the afternoon. Beds 79 and [-] are not patients from Gao Feng's group.

When the ward round reached the ninth bed, Hu Jiaran couldn't help shrinking his neck.When Wang Dali saw Li Huizhen and Gao Feng coming in, he quickly stood up with a smile on his face.The doctor-patient relationship is still very harmonious!

The old lady was going to have a bronchoscopy today, and Qi Nannan sent her to the bronchoscopy room after the house inspection.Li Huizhen asked Qi Nannan to watch inside. After all, the old lady is old, so she can call directly if there is any situation.

Wang Dali's wife also sent a large basket of fruit to the office, "Does eating apples in the morning make you bloated?" Hu Jiaran wrote the medical records while chewing.

"Eat it quickly, if you don't eat it in the morning, it will be gone in the afternoon." Cheng Song also took an orange.There are so many Gui Peisheng, how can it be enough.

At this time, Gao Feng was looking at the medical records of bed 56.79, which was the patient to be discussed in the afternoon.

Bed 56 is a 69-year-old male patient who went to the local county hospital half a month ago because of cough and blood in the sputum. He had a chest CT scan and the left lung occupied space. It was considered to be lung cancer.

A bronchoscopy was performed at the local county hospital, and no tumor cells were found in the pathological results.The family wanted to find out, so they came to the provincial hospital.

Gao Feng looked at the chest CT. It was very typical of lung cancer. The mass had pagination, burrs, and pleural traction, just like what was said in the book.

After arriving at the provincial hospital, the doctor in charge performed another bronchoscopy on him, and the pathological results came out three days later: no tumor cells were found.

Then do lung puncture, the doctor in charge communicated with the family members.Three days later, the pathological results of the lung biopsy came out: no tumor cells were seen.

This was a difficult time. Everyone said it was lung cancer, but after three times of tossing, no tumor cells were found.The patients are in a hurry. If you want to shoot, you can shoot. What do you mean by holding a gun to my head all the time? Do you want to scare me? !

"New task: Mr. Ge Maochang has unfortunately suffered from lung cancer, but the diagnosis seems to be not going well. Please help him confirm the diagnosis as soon as possible so that the next step of treatment will be facilitated." The system's voice rang.

It was indeed lung cancer. It seemed that Mr. Ge Maochang was not very lucky.The positive rates of both bronchoscopy and lung biopsy were over 90%, and this patient was clearly in that 10%.

Re-doing bronchoscopy and lung puncture can help improve the positive rate of diagnosis, but patients and their families may not be able to accept the second examination, which is related to their psychological tolerance.

Gao Feng decided to see the patient.Seeing the arrival of the doctor, the 56-bed Mr. Ge still tried his best to show a smile, and the attitude of the family members was relatively gentle. It can be seen that the quality of this family is still relatively high.

Gao Feng first briefly asked the old man about his diet and sleep, and then made a comprehensive physical examination of the patient.

Two enlarged lymph nodes can be felt in the left supraclavicular fossa, one of which is relatively shallow with a diameter of about 2-8 mm, and nothing else was found.After all, what Gao Feng now mastered is only basic physical examination skills.

Could these two enlarged lymph nodes be caused by lung cancer metastasis?Gao Feng fell into deep thought.

If a patient with lung cancer develops to an advanced stage, metastases may occur in multiple parts of the body and multiple organs. The most likely sites for metastasis include the following aspects: First, metastasis of mediastinal lymph nodes and supraclavicular fossa lymph nodes.Second, the transfer of the adrenal gland.Third, brain transfer.Fourth, the transfer of bones and so on.

The doctor in charge of bed 56 is Hao Mengpei, a cute little girl. When Gao Feng came back to the office and saw her eating an apple, Hu Jiaran brought it for her.

"Mengpei, there is a swollen lymph node in the left supraclavicular fossa on bed 56, and one of them is quite shallow. Can a puncture be done?" Gao Feng walked over.

"Ah, what are you talking about?" Hao Mengpei was taken aback.

You shouldn't count on these regular trainees, after all, the first department in your rotation.Basically nothing.

Gao Feng asked Cheng Song to go to the dermatology department to ask if superficial lymph node puncture could be done and the price.Cheng Song went directly to the nurse's station and asked the nurse to call and ask. This kid has a sweet mouth and a thick skin.

The answer is: 10 yuan if you can do it before 138 o'clock.

It's quite cheap. Hao Mengpei went to communicate with the patient's family, and it went smoothly. After all, it was just a very simple operation, and it didn't even require anesthesia.

Well, let's do this for bed 56 first, and then look at bed 79.

Bed 79 is a male patient with chronic obstructive pulmonary disease who has been hospitalized all year round. Before retiring, he was the leader of the ZZ City Cigarette Factory. According to his wife, he used to smoke heavily.

The old man has a long history of chronic obstructive pulmonary disease, combined with chronic respiratory failure and chronic pulmonary heart disease, and wears a non-invasive ventilator outside the hospital.

This time I also caught a cold and was infected, and the state of consciousness was a bit bad when the family members sent it.After checking the blood gas analysis, the partial pressure of carbon dioxide was as high as 103mmHg, which belonged to type II respiratory failure.

Anti-infection and other drugs were used for a week, and the condition of the old man was up and down, and his diet was poor in the past two days. The doctor in charge gave him a gastric tube.

Gao Feng carefully looked at the examination results from the time he was admitted to the hospital until now, and found that the inflammatory index C-reactive protein decreased for a few days in the middle, and it rose again after the re-examination yesterday.The patient's state of consciousness has deteriorated again in the past two days, and he will respond when he speaks loudly, or he is sleeping.

Drowsiness is considered to be pulmonary encephalopathy caused by carbon dioxide retention.The patient's course of disease is too long, and he has been in a state of chronic respiratory failure, and the carbon dioxide retention is not easy to correct.

The purpose of this patient's discussion is: whether it is necessary to adjust and upgrade the use of antibiotics, and whether it is necessary to turn the severity of the disease into invasive ventilation therapy, that is, endotracheal intubation.

Gao Feng and others went to see this patient together. In the case discussion in the afternoon, Gui Peisheng also had to speak. Everyone had to make preparations in advance.

There were wet and dry rales on lung auscultation, but no other abnormalities were found.

Just as he was about to leave the ward, the system sounded: "Doctor Gao, what is the patient's breathing pattern?"

type of breathing?Gao Feng thought about it carefully, and the breathing condition of this patient was indeed different from others.

He seemed to breathe a few times, stop for a few seconds, and then start breathing again after a short interval.At first Gao Feng thought it was sleep apnea.Thinking about it now, this should be called intermittent breathing, which is common in patients with intracranial lesions and respiratory center failure.

Thinking of this, Gao Feng hurriedly went to see the patient again. After talking with the patient's wife, he learned that the patient's consciousness was still good a few days ago, and he was clamoring to drink mutton soup. He had slept badly in the past two days.

Use a cotton swab to scratch the outside of the patient's sole, and find that the left thumb is dorsiflexed, and the other toes are fan-shaped, which suggests a positive Babinski sign.

The patient took the anti-platelet aggregation drug aspirin orally. Could it be cerebral hemorrhage? Of course, it may also be cerebral infarction.Gao Feng picked up the note and wrote it down.

If it is a cerebrovascular disease, it is better to deal with it in time.Gao Feng communicated with the doctor Gui Pei who was in charge of the bed. The male Gui Peisheng wearing black-rimmed glasses was obviously a little flustered.

"It may have happened during the hospitalization. We can't take him to have another one. This patient is not short of money." Gao Feng followed the temptation.

The black-framed man hurriedly called his teacher, and the reply was to wait for the case discussion in the afternoon.

Forget it, write the medical record.

By the way, the system rewarded a skill point just now.Gao Feng thought about it and added it to the physical examination skills: the primary physical examination was promoted to the intermediate physical examination.In an instant, a lot of experiences flooded into his mind, and Gao Feng was eye-opened by seeing, touching, tapping, and listening to every feeling.

If you let yourself learn this, when will you have to learn it.Life is about hanging up!
　Brothers, please save it if you see it.Writing a book for the first time requires encouragement.

　　
　
(End of this chapter)