This doctor has a system

Chapter 7 7. Discussion of cases in the department 2
At noon, Gao Feng ate braised noodles, authentic Henan braised noodles, with coriander and pickled garlic cloves, and even drank half a bowl of soup.

During the meal, his mother called him and said that the big cherries at home were ripe, so he asked him to go back when he had time to see who liked them, and gave them 2 boxes.

Gao Feng does the math, the dormitory has at least 3 boxes, and the departments are divided into 4 groups, and a group needs at least 2 boxes. These young regular students can eat, just like pigs, excluding me, Gao Feng thought silently .

In fact, these regular trainees will gradually find out that if they come to a large hospital for regular training, they can definitely eat the buffets of these high-end hotels and conference centers in Zhengzhou several times within a year.Sometimes you can’t even eat if you don’t want to, and many times you will be forced to eat. Wrong, it’s a meeting.

Many regular trainees have been trained for three years, but their knowledge has not improved significantly, and their weight has skyrocketed.

Everyone came early in the afternoon, the back row of the conference room was full of people, and the front was empty for fish farming.

At 2:[-], the sub-specialty director of the department arrived with a group of chief physicians, deputy chief physicians, attending physicians, and residents, and Li Huizhen, the instructor of the Gaofeng group, followed behind.

Seeing that the front row was empty, Director Zhao of the sub-specialty department frowned, and the teaching secretary standing next to him hurriedly called out: All the students standing in the back should sit in the front for me!
Director Zhao said a few simple words, to the effect that the discussion of difficult cases is very important, everyone can learn a lot from it, and we will do more in the future.Students should also actively participate and ask questions later.Everyone lowered their heads, like quails.

Hao Mengpei, the 56-bed management doctor, sat in front of the computer and began to introduce the patient's situation.State the results of all inspections and tests.

It could be seen that she was a little nervous, and her words were trembling.

"This case is poorly written." Director Zhao's voice rang out as soon as Hao Mengpei finished his report.

"Why is the history of present illness written so simply? Why didn't you describe the specific circumstances of the previous hospitalization in the county hospital?"

"The patient has a history of smoking, just write a simple sentence??? How many years have you smoked, and how many cigarettes per day? Why not be specific?"

"I can't even write the course of the disease. Why didn't the daily inspections and inspection results be written in time? It looks like copy and paste."

"Teachers have nothing to do to review and review the medical records written by the students. How can they get out of the department after they are written like this!"

Hao Mengpei's teacher Zhang Xiaoli gave Hao Mengpei a look: idiot!Hao Mengpei trembled.

Everyone went to see the patient together, and returned to the conference room half an hour later.

"Let's talk to a few students first." Director Zhao's voice sounded again.

The scene became very quiet in an instant, Hu Jiaran wanted to fart at this time, but he held back, this might expose myself, insist, you can, Hu Jiaran.

The teaching secretary began to roll the roll, "That boy in the plaid shirt in the last row, tell me what's wrong with this patient?"

"Ah, um, I think, the patient had 2 bronchoscopy and a lung puncture, and no cancer cells were found. Could it be other diseases? I read in the book that there is an organizing pneumonia , could it be this?"

"Well, this student also knows about organizing pneumonia. It seems that he has taken it seriously on Baidu, but Baidu is not very reliable," Director Zhao thought.

Another lucky one was chosen, a slender and pretty girl.She said nervously: "I think lung cancer is still considered. His first symptoms were cough and blood in the sputum. The mass also had pleural traction signs, just like what was written in the book."

Many teachers laughed, and the girl blushed, just like Apple.

Hey, why does this student look so calm.Good guy, you dare to look at me, the teacher is angry, you are so handsome, you are the only one.

Gao Feng stood up, "I think this patient is still considering lung cancer. The patient has a long-term smoking history, and the clinical symptoms are also in line with the performance of lung cancer. According to imaging studies, the mass has pagination, burrs, and pleural traction. There is another layer that can A vacuolar sign was seen. The ipsilateral mediastinal lymph nodes were also enlarged."

"In the morning, I found that the patient had a swollen lymph node in the left supraclavicular fossa. I sent the patient to the dermatology department for a puncture and sent it to pathology. I don't know if I can find anything."

"In my opinion, if the pathology is still negative, bronchoscopy should be done again."

After hearing Gao Feng's speech, Director Zhao's eyes lit up. "When will the pathological specimens be delivered?" Director Zhao looked at Hao Mengpei.

"Send it at nine o'clock".

Director Zhao glanced at the secretary, who immediately made a phone call. "Hi, hello, Director Lei. I'm Xiao Zhang from the Department of Respiratory Medicine, yes. Director Lei, we have a patient who has sent a lymph node pathology. The hospital number is XXXXX. Can you help me to see if there is any preliminary diagnosis? As a result, our director asked."

"That's right, it was sent from the dermatology department. The initial consideration is the tumor, the source of the lung, are you sure? Oh, I'm doing immunohistochemistry, and the results will be available in 2 days, um, ok, thank you Director Lei, um, ok ok .”

"Yo, yes, it's settled. This year's Guipei doctor can do it!" A bald director said, Gao Feng remembered that his surname was Pan.

"What's your name? Which school did you graduate from?" Director Zhao was very satisfied with Gao Feng. He was tall and handsome, and he performed very well.

"Hi, director. My name is Gao Feng. My undergraduate degree is from Xinxiang Medical College, and my postgraduate degree is from NMG Medical University."

"So I'm a graduate student. Is breathing the major?" Director Zhao asked curiously.

"No, my major is gastroenterology."

"Yes, yes, the young man is quite capable, come on." Director Zhao boasted.

"Really pushy," Qi Nannan.

"Brother Feng is mighty" Hu Jiaran.

"Sure enough, graduate school is the right choice. When I graduate from graduate school, I will definitely be able to diao like him," Cheng Song said.

Then the directors discussed why no tumor cells were found in the two bronchoscopy examinations.

It is still considered that the superficial necrotic tissue was taken during the biopsy. Some directors think that the biopsy should be frozen, and some people think that the biopsy needle should be used to directly pierce the lesion to obtain material.

Finally, rose is mentioned, also known as rapid cytology interpretation technology.

To put it simply, after the specimen is taken, the small specimen taken is specially made into cell slides on site, and then the rapid staining technology is used to observe under the microscope to evaluate the nature of the lesion.In various biopsy operations, the eligibility of specimens and lesion types can be quickly evaluated, and even the pathological type of tumors can be initially diagnosed, and specimens with good quality can be sent to the pathology department, bacteria or fungi laboratory for inspection.

This greatly reduces the probability of patients having to undergo a second invasive examination due to insufficient material collection.

"This patient has already had a bronchoscopy at the county hospital, but he hasn't settled down. Why hasn't he paid enough attention to it after coming to our hospital?"

"We have launched the rose technology early on, why didn't we use it for this patient? From now on, all patients who are not diagnosed clearly for the first time will have to do ROSE!"

"Why didn't you have a detailed physical examination? Students can feel the swollen lymph nodes in the left supraclavicular fossa. Can't you masters and doctors feel it?"

"Don't always rely on inspection, it cannot replace a careful physical examination."

Director Zhao made the final summary.

Then began to discuss the second medical record, which is the 79-bed old man.

Peisheng, the man with black-rimmed glasses, carefully introduced the patient's condition, and this kid went out to complete the medical records, and Director Zhao didn't catch the fault.

After seeing the patient, the teacher started to call for help again. A classmate stood up and said, "I think the antibiotics should be replaced with the best ones. The patient's inflammation index is still very high, indicating that the inflammation is not under control. Antibiotics should be stepped up." Infection."

"What antibiotic do you think is more appropriate to replace?" The secretary asked again.

Crooked day, is this what I should know now? The student is madly complaining in his heart, I just graduated, and I still don’t know all about the classification of antibiotics!

Maybe knowing that I asked for nothing, the secretary called another classmate.

Due to nervousness, this classmate stood up too violently, almost overturning the table in the back row. The teaching secretary and Director Zhao frowned together.

"I think this patient needs to be intubated in the intensive care unit. He is old, he is unable to cough up sputum, and the inflammation is not well controlled. If he can be intubated, the carbon dioxide retention can be corrected quickly. Bedside bronchoscopy can also be used to suction sputum. , so that the patient can recover quickly."

This classmate had done his homework, and Director Zhao gave him an approving look.

"Gao Feng, tell me." Director Zhao called the names directly.

"I think this patient may have cerebral hemorrhage." Gao Feng

There was a buzzing sound of discussion, and even several doctors from this hospital also discussed with each other.

Director Zhao became interested, "How did you know that the patient had cerebral hemorrhage?"

"The patient's breathing type belongs to intermittent breathing, which is generally seen in intracranial lesions and respiratory center failure. This old man's condition has improved a few days ago, and the possibility of sudden respiratory center failure is relatively small."

"The patient had no previous history of cerebrovascular disease, but I found that his left Babinski sign was positive."

"The patient has been taking aspirin enteric-coated tablets orally. I think there may be a cerebral hemorrhage."

As soon as Gao Feng's voice fell, Director Zhao looked at the doctors in this hospital.

A director said directly: "Contact an emergency CT to see if it's over." The teaching secretary hurriedly called, and the feedback was very fast. The imaging department said that it can go down now.

The male student with black-rimmed glasses called two people to push the patient to do head CT. Everyone was sitting in the conference room and waiting.

At this time, a middle-aged man came in, nodded to Director Zhao and other directors, and two people behind him pushed three small carts of fruit platters.

Each Gui Peisheng gave a box, and Director Zhao asked everyone to rest.

From a distance, Gao Feng heard Director Zhao say to the middle-aged man: "You are spending too much money, we are all embarrassed."

The middle-aged man said: "The teachers have worked too hard. I am just a trivial matter. I am also happy to do something for the teachers."

Then there was another burst of business blowing.

(End of this chapter)