super anesthesiologist

Chapter 100 Displaced Appendicitis
100 Displaced appendicitis
"Director Li, we can do a live broadcast for this patient." Lin Xiaobei repeated, his tone calm and confident.

Li Aiguo: "..."

He looked at Lin Xiaobei, are you doubting my ability?It was indeed my negligence that the old lady misdiagnosed just now, but this patient is [-]% acute attack of cholecystitis.If I'm wrong about my diagnosis, I...

For an experienced doctor, although misdiagnosis is inevitable, it is very uncomfortable in the heart.

And still at the same time.

Li Aiguo firmly believed that he had not misdiagnosed himself.

"Do you want to ask the sonographer for a consultation?" he suggested.

Lin Xiaobei nodded and said, "Yes."

This patient is very confusing, misdiagnosis is a normal phenomenon, and doctors with a little common sense in this misdiagnosis will take it for granted.

Because if it were him, he would make such a diagnosis.

Just like when A asked B what to eat with, everyone took it for granted that I used chopsticks, but B said that I was eating with my hands... Then everyone suddenly realized, oh, it turns out that this guy is a crooked nut.

Lin Xiaobei strongly advocated using this patient as the first live show of the emergency department, because he felt that the opportunity was rare. With a unique live show, the effect must be leveraged.

After the sonographer came for the examination, he said in amazement: "This patient's gallbladder is very special. The gallbladder is obviously inflamed, and it can be seen that it is already swollen."

"Okay, we got it." Lin Xiaobei sent the sonographer away.

He was also watching when the sonographer was doing the examination just now, and Director Li Aiguo and Deputy Director Bian Wengang were watching together.

The two of them were very unfamiliar with the subject of ultrasound and were no longer in the mood to learn it again.They just watched with curiosity, just curiosity.

Lin Xiaobei could see clearly, and he was more professional than a sonographer at the moment.Because the doctors who make the consultation first understand the condition, and then give suggestions or conclusions based on their own professional knowledge.

After listening to Director Li Aiguo's general introduction, the sonographer subconsciously believed that the biggest problem of this patient was the gallbladder. On the ultrasound, the gallbladder was indeed enlarged, which was different from the normal size, so he took it for granted that it was the gallbladder. Acute cholecystitis.

"Ready to transfer—" Before Li Aiguo finished speaking, Lin Xiaobei immediately interrupted him: "Director Li, this patient's condition is a bit special."

If it had been someone else, Li Aiguo would have been impatient a long time ago. I am a director with a high professional title, so am I still not clear about the problem to you?Don't think that because I value you, you are arrogant. I also get angry sometimes.

Li Aiguo's displeasure was already evident on his face, and he was about to say "I have the final say on this matter", when the phone rang.

"Hey, Director Li, your emergency department is impressive now!" The person speaking was Huang Jinzhong, director of the Cardiac Surgery Department.

Li Aiguo didn't understand for a while, he and Huang Jinzhong were classmates and colleagues, and they usually like to bicker with each other.

"Are you talking nonsense? Is my emergency department worse than yours?" he said.

Huang Jinzhong was stunned on the phone and said with a smile: "Old Li, are you drunk too much or something? I didn't mess with you today."

At this time, Li Aiguo was upset, where Youxin and Huang Jinzhong were poor, and said impatiently: "I'm busy, I'm dead."

Huang Jinzhong hurriedly said on the phone: "Hey, don't hang up first. I mean, the patient you transferred just now really has a ruptured upper border of the aorta. I want to ask how you found out?"

Li Aiguo: "..., we invited the ultrasound department for consultation."

"That's why I said that the level of your emergency department has improved. You see, in this case, it can be considered that it may be aortic dissection——"

For doctors of the same level, this kind of praise was like ridicule, which made people feel ironic. Li Aiguo hung up the phone before Huang Jinzhong finished speaking.

Then he looked at Lin Xiaobei hesitantly, this kid's vision is really accurate!
Now, is there anything special about this patient?Impossible. After so many years of practicing medicine, it is not uncommon for him to encounter strange things in succession. He has encountered cases in which CT examinations were normal but cancerous ascites was extracted by paracentesis.

This patient's symptoms of cholecystitis were so obvious that he had no doubts about his own diagnosis, but Lin Xiaobei persuaded him so firmly that he felt a little shaken.

"Xiaobei, what do you think about him?" He asked tactfully.

The patient was lying on the bed and moaning, with obvious symptoms of abdominal pain. The family member, a woman, asked anxiously, "Doctor, what's wrong with my husband?"

Lin Xiaobei said calmly: "Your husband seems to have cholecystitis, but it is actually an acute attack of appendicitis. He blames the special position of the appendix. His appendix is ​​different from normal people. It is displaced and covers the liver. The gallbladder area, so the clinical symptoms look like cholecystitis, but it is actually appendicitis."

The woman couldn't understand what he said about the gallbladder-appendix relationship, but the conclusion was that she understood that her husband had acute appendicitis.

She felt much relieved, and said eagerly, "Then you need to have an operation?"

"It's definitely going to be an operation." Bian Wengang interjected.

Li Aiguo was very troubled at this moment.

Diagnosing the symptoms of cholecystitis as appendicitis seemed to be the first time he encountered such a situation.After practicing medicine for so many years, it is not uncommon to see a displaced appendix. In fact, he has treated many displaced appendixes, including those in the pelvis, small intestine, colon, and even the spleen, but he has never seen one on the liver. Pass.

The key is that the sonographer didn’t find it during the consultation just now!
"Xiao Bei, come to my office." Li Aiguo felt that it was inconvenient to say something in front of the patient and his family.

In his office, the two can have open and honest conversations.

"Are you sure that patient has appendicitis?" Li Aiguo asked for proof.

"Yes, the symptoms of cholecystitis appear because the inflamed appendix covers the gallbladder, which may stimulate the gallbladder with inflammation."

Secondary disease covers up the primary lesion, which is actually very common in clinical practice.

Li Aiguo finally understood why Lin Xiaobei urged him to keep the patient in the emergency department.It is true that if it is true what Lin Xiaobei said, then this case will definitely cause a sensation, and their live broadcast debut in the emergency department will undoubtedly be a blockbuster.

However, we should not only think about the bright side of everything, what if Lin Xiaobei misdiagnosed him?He is an experienced doctor and it is inevitable that he will miss or misdiagnose. Lin Xiaobei is so young, the probability of missed diagnosis or misdiagnosis is even greater.

Usually as long as it does not cause medical accidents and does not cause injury or disability to patients, missed diagnosis and misdiagnosis are acceptable.No one in medicine can make a [-]% correct diagnosis.

But Lin Xiaobei suggested to broadcast live. As the director, Li Aiguo, he is calm. The live broadcast is to face the medical colleagues all over the country. It became the laughing stock of Fu Er and Provincial Doctor.

"Why are you so sure that this is a patient with appendicitis?" Li Aiguo asked Lin Xiaobei. This is the reason he has been unable to understand. He knows that there is a popular word now called "brain hole", but Lin Xiaobei's brain hole is really open. A little big, too big for him to accept.

Lin Xiaobei: "..."

If you really want him to talk about it, he can't explain why. You can't say "I just rely on my feeling"?In fact, he just goes by feel.

"I suspected it at the beginning. When the sonographer checked just now, I looked at it. The enlarged one was not the gallbladder, but the appendix. So I was sure it was a case of appendicitis."

Li Aiguo was very surprised by his explanation. Why didn't you communicate with the sonographer at that time?
"Director Li, if you don't believe it's okay, then transfer this patient away. I just feel very sorry, this is a good opportunity." Lin Xiaobei persuaded tactfully.

Li Aiguo thought about it, nodded and said, "I'll communicate with the family first."

The final result was that the patient was willing to undergo surgery in the emergency department, but Director Li Aiguo said very veiledly: "It may be appendicitis complicated by cholecystitis, and the symptoms of cholecystitis may disappear after removing the appendix."

This is very interesting, that is to prepare double insurance in advance, even if it is finally confirmed to be cholecystitis, it does not matter, because it is planned in advance.But if it is confirmed that it is appendicitis, that would be amazing. Performing an appendectomy on the liver in the live broadcast, I feel tall when I think about it.

Director Li Aiguo asked to turn on the live broadcast, but at first he did not mark the specific content to be broadcast.After Lin Xiaobei was anesthetized, he made an incision in the liver area according to Lin Xiaobei's instructions, and then pulled out a suppurated appendix from the gallbladder.

Really appendicitis!

Li Aiguo remained calm and signaled with his eyes, and the live broadcast debugger immediately typed in the title: "appendectomy".

(End of this chapter)