This doctor has a system

Chapter 9 9. Multidisciplinary consultation is crazy
Arriving at the ward at 7:[-], Gao Feng first went through the patients under his care, and the overall condition was not bad.

After the shift was over at 8 o'clock, Gao Feng went to extubate Mr. Jia, and Qi Nannan consciously went to prepare the supplies. She now regarded Gao Feng as a superior doctor.This girl is very self-aware and has a clear position for herself.

Extubation is actually very simple. Gao Feng explained the precautions to the three people of Qi Nannan: 3. Aseptic operation is required to avoid infection;

2. Cut off the sutures that fix the chest tube before extubation, and hold the chest tube well to prevent it from slipping off by itself and causing pneumothorax;

3. Prepare Vaseline gauze, instruct the patient to inhale deeply, and hold the breath at the end of hard inhalation. At this time, immediately pull out the chest drainage tube, cover the drainage port with Vaseline gauze almost simultaneously, cover the outer cover with sterile dressing, and stick it with cloth glue Secure to prevent air leaks.

The nurse next to him also knew about Gao Feng, and couldn't help saying, "You know more than the doctors in this hospital."

Gao Feng smiled at her, "So handsome!" The little nurse was a little excited, but unfortunately I was already married, so the little nurse was a little bit self-pitying.

The extubation was successfully completed, and Mr. Jia didn't feel uncomfortable at all. Gao Feng told him to ring the bell in time for any situation.

When it was almost 10 o'clock, a skinny graduate student under Director Zhao came to look for Gao Feng.Gao Feng hadn't seen him before, but he could feel that he seemed to be hostile to him.

The voice of the system rang: Director Zhao Xianqin's respect for you has aroused the hostility of his graduate student Li Youliang. Mission objective: How can Yinghuo compete with Haoyue, please let this small character realize the huge gap between himself and you, The system will settle the reward according to the degree of completion.

Li Youliang, it seems that you are not very kind to your friends.

The multidisciplinary consultation was conducted in the central meeting room of the oncology department, and the patient was the mother of a city leader.

The patient is 77 years old this year. He has a history of hypertension, coronary heart disease, and diabetes. He was diagnosed with breast cancer 12 years ago. He underwent bilateral mastectomy plus axillary and inguinal lymph node dissection. One year ago, he was admitted to the hospital because of fever, fatigue, general bone pain, and weight loss as the main symptoms. He was diagnosed as breast cancer with bone metastasis.

After chemotherapy and targeted therapy, the patient improved and was discharged. One week ago, the patient developed fever and cough without any obvious cause. At the beginning, he didn't pay attention to it. He prescribed medicine in the outpatient clinic. As a result, the symptoms became more and more serious, and he also experienced chest tightness and poor appetite.

After being admitted to the hospital, a detailed examination was done. The chest CT report showed: multiple nodules in the lungs, metastatic tumors were not excluded, and multiple liver metastases.Due to fever, poor diet, and hypoglycemic and antihypertensive drugs, the patient did not take on time, and his blood pressure and blood sugar were also poorly controlled recently.

So the oncology department organized a multidisciplinary consultation.

Everyone looked at the patient together. The old lady looked very sluggish and thin. The family members responded that their condition was getting worse day by day. The old lady's son came here on special leave today and bowed to the experts repeatedly.

The deputy director of the nutrition department, Zeng, spoke first: a gastric tube needs to be inserted, and nutrient solution is poured into it, otherwise the patient will not be able to survive for long in this state.

Director Wang of the Medical and Political Department gave him a wink: the family members are here too, please be more tactful.

Hypertension Department: The patient's current blood pressure is still acceptable, let's monitor it dynamically.

Director Cao of the Department of Endocrinology is a very charming middle-aged woman. She is the most well-dressed among all of them. She also wears a small and exquisite green watch, which looks not cheap. There is a graduate student standing behind her.

Director Cao believes that it is unrealistic for the patient to take hypoglycemic drugs orally with so many basic diseases, and insulin therapy is needed. "You can wear an insulin pump for the patient, and we can adjust the dosage for her at any time according to the blood sugar."

After Director Cao finished his speech, he turned his attention to Director Zhao, "I think the situation on the lungs is the most serious. So many metastases indicate that the tumor has recurred."

"You see, Director Zhao brought three students with him for consultation. There is no way. He has a high level and recruits more graduate students than us every year. I don't know what good method Director Zhao has for these metastatic tumors?"

Director Cao and Director Zhao are not dealing with each other, Gao Feng can see it.Director Wang of the Medical and Political Department laughed, "Director Zhao, you also have to express your opinion."

Zhao Xianqin was very angry. Cao Yonghui, a slut, did not get along with her when she just graduated and came to the hospital. Decades have passed, and the relationship between the two is still on fire.I brought a few students to block your eyes, what a shrew.

Looking at the patient's chest CT film, Director Zhao is also a little bit troubled. The patient is still taking targeted drugs, so he can't control it, and there is no good way for the gods.

Seeing Director Zhao's embarrassment, it seemed that it was his turn to play, Gao Feng said: "This patient's lung is not a metastatic tumor, it should be caused by infection."

As soon as these words came out, several directors turned their attention to Gao Feng.Director Cao of endocrinology sneered disdainfully: "I said, Lao Zhao, you don't care about your own students. Does this place have his voice? How do you usually teach."

Director Zhao also thought it was inappropriate for Gao Feng to speak out at this time, but he felt very uncomfortable when he heard Director Cao say that. This is the person I brought. Is it your turn to let this lesson go?

"The atmosphere in our department is relatively good. Everyone can talk freely about everything, unlike Director Cao, who talks about seniority all day long." Director Zhao pushed back neither soft nor hard.

"Since you said it was an infection, let me tell you about your evidence. I still don't believe that you, a graduate student, can still watch movies!" They are all from graduate students. Director Cao thought that I haven't fully understood it yet, you can see 1234?

Director Wang of the Medical and Political Department looked at Gao Feng, "Young man, speak up boldly, it doesn't matter if you are wrong, discuss it, everyone can express their opinions." Gao Feng felt that Director Wang seemed to be pretty good.

Li Youliang's face was flushed at this time, good guy, you dare to speak out in this place, you are looking for death.Gao Feng, I regarded you as my opponent, but I didn't expect you to be just a SX, after all, I paid by mistake.I have to comfort him for a while, Li Youliang decided not to make trouble.

That's right, a doctor can be so bad no matter how bad it is.

Gao Feng was very calm, and Director Cao's words did not arouse his mood swings, he was just a bunch of chickens and dogs.

Gao Feng stepped forward and magnified the patient's chest CT.Are you ready?Back off, I'm going to start pretending.

"Let me just talk about it from the chest CT. First of all, the lesion must be spread through blood flow, distributed randomly, and vascular nourishment can also be seen, so at first glance, it is easy to mistake it for a tumor."

"The lesions in the lower lung have a large range, and most of them are still close to the subpleura. They are small wedge-shaped. When you see this, you should think of pulmonary embolism. If it is caused by infection, it is also called sepsis embolism."

"So how do we distinguish between a tumor and an infection? Tumor cells spread through blood, planting one by one and then dividing, 1 becomes 2, 2 becomes 4"

"However, no matter how it is split, the edges of the lesion are generally spherical, relatively smooth and round. But the imaging characteristics of this patient are obviously not like this, it is triangular." Gao Feng slowly adjusted the slices of the chest CT, so that Everyone can see it.

"There is also a relatively strong evidence. If you look at the mediastinum window, the patient's liver also has several metastases, but this place should be an abscess. Its CT value is different from others."

"Thinking it all together, it should be a lung gram transmitted through blood." After the narration was over and work was over, unfortunately no one applauded, Gao Feng felt a little regretful.

"You mean you are a student who is better at watching movies than in the imaging department?" I don't believe every word you said, Director Cao thought to himself.

Director Wang of the Medical Administration Department glanced at everyone, "Who is here in the Imaging Department? Why didn't I see anyone?" "Hurry up and call Director Li and ask him to send someone over!"

Soon Li Xianmin, the chief director of the Imaging Department, arrived. There was no way, the Medical Political Department had to sell its face.

"Director Li, look at this film. Director Zhao's students don't know the heights of heaven and earth, and question the level of the report produced by the Imaging Department!" Director Cao seized the opportunity and quickly put on eye drops.

These girls are pretty nasty.

After hearing this, Director Li's face pulled down.Director Zhao hurriedly remedied, "The students are just expressing their opinions. They are young and rarely seen, but they don't mean to question your imaging department!"

Director Li didn't say a word, and began to scroll carefully on the computer. After watching the CT for 2 minutes, he called up the report again.

Director Wang saw that his face was a little uncertain, and said: "Director Li, don't be as knowledgeable as the students. They have the courage to express their own judgments. This kind of behavior should be encouraged! Isn't this the purpose of learning!"

"Ah? No, there is indeed something wrong with this report." Director Li was a little embarrassed. "It should be an infection. The people below are not good at learning, so they reported it as metastases, which made everyone laugh."

What, can you speak?Director Cao is in a hurry, that's it, you bastard!
"Oh, people make mistakes. This really looks like a metastatic tumor, and I look like it too." Director Zhao couldn't hide the complacency in his words, "My student usually likes to get CT scans, so let him give it a try this time." It's up to Director Li to come over to make a final decision!"

After hearing this, Director Li's face looked much better.

"Director Cao, I'm not talking about you. When you lead graduate students, you have to let them talk more and teach them more. Look at me, I let them speak freely in the department!" Director Zhao began to diss Director Cao.

Director Cao's face turned pale. Zhao Xianqin, what are you proud of? I don't know how much you weigh. It's shameless to rely on students to support the situation!
"The patient's blood sugar is also high, and there is an abscess on the liver. Combined with the chest CT findings, it should be Klebsiella pneumonia, which is transmitted by blood." Director Li said again.

Li Youliang is numb all over. Director Li of the imaging department is an extra actor invited by Gao Feng, right? ? ?

The lines are all right, that must be it.It is also possible that Gao Feng is his son! ! !As for why one person's surname is Gao and the other's surname is Li, it must be his mother's surname.Is it reasonable?Li Youliang wants to go out now and tell everyone this "fact".

Gao Feng didn't know Li Youliang's inner activities, otherwise he would definitely think that this little brat had a lot of inner drama.

(End of this chapter)