super anesthesiologist

Chapter 99 The first show is so difficult (please recommend, please collect, thank you!)

"Aortic dissection?" Li Aiguo and Bian Wengang's expressions changed drastically upon hearing this.

This is the most troublesome case for doctors.Aortic dissection is a very insidious disease, just like a crack in a normal wall.

Patients without this disease are the same as normal people. They rarely have the typical symptoms of chest pain and abdominal pain mentioned in textbooks. Even if most people have chest and abdominal pain, it is very mild and sporadic, so it is easy to be ignored.

But once it happens, the interlayer ruptures, and even gods can't save it.

However, this occult disease is indeed rare in clinical practice, and it may be related to its occult nature.

It cannot be said that whenever a patient feels discomfort in the chest and abdomen, he should be advised to go for CT and other related examinations, which will increase the patient's additional financial burden, and it is not a little bit.

Therefore, aortic dissection is a very easily missed diagnosis in clinical practice.

The middle-aged man didn't understand the risks of this disease. Seeing that Director Li Aiguo's expression was wrong, he was secretly startled and asked, "Director Li, is my mother okay?"

In his mind, an appendicitis is not a problem for doctors in such a large hospital.

Indeed, in Li Aiguo's eyes, appendicitis is not even on the stage.

Li Aiguo was also secretly shocked. Even if Lin Xiaobei's diagnosis was a misdiagnosis or a joke, he would take it very seriously.

But Bian Wengang was young after all, not as stable as Li Aiguo, he questioned: "Doctor Lin, are you—"

The patient's son was present, and he was unwilling to speak so bluntly, but he undoubtedly did not approve of Lin Xiaobei's diagnosis, and even felt that he was a bit alarmist.

There is indeed a situation where doctors often exaggerate the severity of the disease in order to prevent it from happening. This is a means of self-protection for doctors. back road.

Lin Xiaobei is well aware of this.

But today he didn't know why he was so outraged that he spoke so absolutely.

Lin Xiaobei ignored him, and urged Li Aiguo directly: "Director Li, it's not too late, hurry up and transfer to another department."

Li Aiguo's mind raced rapidly.His original wish was the same as Bian Wengang's, hoping to keep the old lady in the emergency department for the first time, but Lin Xiaobei said it so seriously, he couldn't help but not consider the seriousness.

"Please ask the ultrasound department to do an emergency echocardiogram!" After careful consideration, he made such an instruction, neither objecting nor supporting Lin Xiaobei's diagnosis, and waiting for the results of the ultrasound diagnosis before making a conclusion.

Lin Xiaobei had nothing to say, and Director Li Aiguo's treatment did not affect the grandmother's treatment.Because even if she is transferred to cardiac surgery immediately, it is impossible to operate on her immediately, and the operation will only be performed after the diagnosis and accurate positioning are confirmed by imaging.

The ECG monitoring showed that the old woman's condition was getting worse and her heart rate rhythm had become disordered.She was still humming at the beginning, but now her voice is like a mosquito or a fly, and her consciousness is very indifferent.

"Doctor, what should my mother do? Should I have an operation right away?" Waiting is the most torturous thing, and the old man's son became anxious.

Director Li Aiguo patiently explained the grandmother's current condition to him: Appendicitis is serious, but it is not fatal. Now it is necessary to rule out whether she has aortic dissection and whether the dissection is ruptured. The latter two points are the key to determine how the grandmother should deal with it next. .

Sometimes doctors are faced with such an embarrassment. You kindly explain to patients and their families, but they always think that you are delaying the disease and shirking responsibility.

The man was a little patient at first, but then he broke down and roared, "Will you treat it? My mother has appendicitis. She is usually in good health. How could it be as exaggerated as you said! Lord, Lord, Lord What's the matter? I still have to go to the heart surgery, I think you are just confusing right and wrong."

"Calm down, aortic dissection can be diagnosed later. Everyone hopes it is not, but we have to rule out that at the age of a grandmother, the chance of suffering from this disease is very high, and the potential risk is also great." Lin Xiaobei advised road.

Fortunately, the sonographer came quickly, arriving in less than 10 minutes.

The result of the diagnosis was more serious than Lin Xiaobei estimated. It was Stanford type A. A small tear was found in the ascending aorta of the old man, and emergency surgery was required immediately!

"Notify the Cardiac Surgery Department! Notify the Anesthesiology Department!" Li Aiguo immediately instructed the nurse at the front desk, and then said to the man: "Now you should believe it? Your mother's appendicitis is secondary now, and her ruptured aortic dissection must be dealt with first." question."

The man seemed unable to accept this fact, and muttered to himself: "How is it possible? My mother has always been in good health, and usually has no heart problems at all. In the past, no heart problems were found in the annual physical examination!"

Lin Xiaobei didn't have the heart to talk nonsense with him.There are too many things that are medically impossible. Who should explain to those young and strong people who suddenly collapse and die?

This old lady is almost 90, and the probability of suffering from aortic dissection is much higher than that of ordinary people.The reason why Lin Xiaobei considered this issue cautiously was because the old man's son inadvertently said that his mother usually took painkillers for stomach pains.

Combined with medical history, electrocardiogram, and heart auscultation, he can be sure of such a diagnosis.

Li Aiguo was also not in the mood to explain to him, and urged: "Now that the diagnosis results are out, what is impossible? We will transfer your mother to another department now, and you sign."

The man hesitated and finally agreed to her mother to undergo heart surgery.

……

After sending the old lady away, Li Aiguo still had lingering fears.If this grandma misses the diagnosis, the consequences will be disastrous.Even if an autopsy can prove that the old woman had aortic dissection in the future, the patient’s family will definitely not accept this.

Bian Wengang remained silent after the echocardiogram diagnosis result came out, and then he said with conviction, "Xiao Bei, do you have a sharp eye?"

Lin Xiaobei smiled slightly, "Be careful sailing for ten thousand years!"

Li Aiguo nodded. Is this a personality that only became available after becoming an anesthesiologist?Why do the other doctors in the emergency department look a little edgy compared to Lin Xiaobei, even including himself?
Li Aiguo and Bian Wengang were inevitably a little disappointed that the case that was supposed to be the first show was transferred, although they were more fortunate.

Seeing nothing to do with him, Lin Xiaobei turned back to the office to rest, but heard the beeping of the ambulance from the hospital heading straight to the emergency department.

Director Li Aiguo and Bian Wengang, who had just been disappointed, immediately waited at the door as if they had been beaten with chicken blood.

What was sent was a patient with acute abdomen, male, about 40 years old (I don't know if there was a wrong judgment this time).

Director Li Aiguo came to check first. The patient's lower abdomen was soft, and he had no signs of peritonitis, nor obvious abdominal tenderness and rebound pain.

The patient complained of sudden abdominal pain one day before, intermittent, obviously after meals...

Bian Wengang walked away disappointed before he finished listening.

After Li Aiguo's examination, his face was also not reconciled. This was an obvious acute attack of cholecystitis.

Emergency departments are not authorized to perform gallbladder surgery.

Is it so difficult to make the first live broadcast of the emergency department?
After Li Aiguo left, Lin Xiaobei also came over to examine the patient carefully, touching the upper and lower abdomen, and after comparing, he said to Li Aiguo, "Director Li, we can do a live broadcast for this patient."

　It's a pity that the Left Bank Army has been on duty since yesterday (23rd) morning and didn't go home until 24 pm today (2th). The speed is too slow. By the time I finish coding Chapter 25, it will already be number [-].

　　Sorry guys!
　　
　
(End of this chapter)