Auto chess in the operating room

Chapter 59 The Girl with Mysterious Abdominal Pain

Yang Ming was still the first to enter the ward.

After entering the room, Yang Ming looked at the scene inside and was slightly stunned. This time, except for the patient in the middle who was a model, the rest of the equipment was fully equipped, and there were three or four medical staff waiting nearby.It's exactly like a real scene in the emergency room.

When Yang Ming entered, the head nurse stepped forward and handed a medical record to Yang Ming.

In order for Yang Ming to better judge the condition, a demonstration TV was placed on one side of the room, on which the nurse selected several photos of the patient.

"Doctor, half an hour ago, a 52-year-old male patient was sent to the emergency room by ambulance because he fainted in the studio. According to his colleagues, when he stood up from the table, his feet were unstable and then fell. He fell to the ground, but did not lose consciousness."

While reporting to Yang Ming, the nurse swipe on the demo screen and found a few photos:

"The patient reported abdominal pain for several hours and vomited some black substances. This is the picture."

Yang Ming looked at the photo selected by the nurse, and there was a lump of black vomit on it.

"Patient has chronic back pain and has self-purchased medicine from pharmacy. This is a picture of the medicine."

The nurse drew another picture, and Yang Ming quickly recognized that it was ibuprofen tablets, a commonly used anti-inflammatory and analgesic drug.

"Any other symptoms?"

Yang Ming flipped through the patient's vital signs report.

The nurse thought for a while, and then drew two other photos, which were a bit harsh.

"Hematemesis, black stool?"

Looking at these photos, Yang Ming basically came to a conclusion. The vital signs are:

Body temperature, 36.5°C blood pressure, 85/50, heart rate 125 beats, respiration 28 breaths, SaO2 96% Physical examination showed that the patient was pale, with moderate pain, upper abdominal tenderness, no rebound tenderness, and no muscle guard.

Digital rectal examination revealed melena

"First question, ask the doctor to diagnose the patient's symptoms immediately and explain the reason."

Yang Ming nodded, and calmly passed the case to the nurse: "The patient manifested as fainting, vomiting blood and black stools, which are the characteristics of upper gastrointestinal bleeding. Black is caused by the decomposition of hemoglobin. Upper gastrointestinal bleeding, the most important The cause was peptic ulcer, malignant tumor of upper gastrointestinal tract, rupture and bleeding of portal hypertension varices, and esophageal cardia mucosal tear syndrome."

Yang Ming pointed to the photo of ibuprofen on the display screen: "Combined with the patient's long-term use of ibuprofen, peptic ulcer is the most likely cause."

"The answer to the first question is correct, +2"

"Question two, the condition of the patient is getting worse, please ask the doctor to give emergency treatment immediately!"

Yang Ming nodded. Although he had never personally led first aid, he had been with the instructor many times. After a brief recollection, he began to issue instructions.

In the review room, the directors were also very satisfied with Yang Ming's response. At least so far, his performance was perfect, calm, professional, and orderly.

The judgment of the patient's condition is also very accurate.

While everyone was staring at Yang Ming's performance on the screen, Cheng Jian's phone vibrated, and when he saw the number, he frowned.

"Excuse me, I have to go out."

Cheng Jian whispered to the director beside him.

"What's wrong?" Niu Bolin looked at the anxious Cheng Jian with some confusion.

"A disease relapsed again, and my family members called me and needed to see it."

Cheng Jian was very helpless. Apparently this patient had relapsed many times, but the cause could not be found.

When Cheng Jian passed by Yang Xiaodong, he explained again.

Yang Xiaodong nodded: "Go, go, the patient's condition is critical."

After Cheng Jian left, Yang Xiaodong raised his gold-rimmed glasses: "Speaking of which, Director Cheng's patient is really a headache. It has been several months and the cause has not been found out. The patient's family members are about to make a fuss."

"Is that the little girl?" Lin Fang also thought of the patient.

"That's right, it's the girl with abdominal pain, and the cause has never been found out."

"What's the situation?"

Diao Xiwen suddenly became interested. After all, diagnosing intractable diseases and giving hope to patients in trouble is a very fulfilling thing, and it is enough to make any doctor curious.

"Director Lin, it just so happens that all the experts are here. If you talk about it and let everyone give their opinions, we might be able to solve the problems that have been plaguing various departments for a long time."

Yang Xiaodong looked at Lin Fang, who nodded.

"This case started three months ago. When I came here, I was accompanied by a male classmate. According to the nurse at the triage desk at that time, the boy was tall, thin, and handsome. The male classmate was accompanied by a man with abdominal pain. A 16-year-old girl, the doctor's natural first reaction was to do a urine pregnancy test."

"This age group is very worrying. Even if the girl tells the doctor that she is not married, has no boyfriend, and has no sex life, the doctor will definitely not believe it. After all, little girls often lie about this kind of thing."

Several directors in the field smiled knowingly, especially the doctors in the emergency department, who had suffered from this before. Lin Fang continued:

The boy explained that they were classmates, and the girl had a stomachache, so he just accompanied her to see a doctor.The boy was a little shy and did not dare to look up to see the doctor.

The emergency doctor asked how long she had been in pain.

The girl told the doctor that she had just been shopping outside, and then she started to have pain, and it has been almost half an hour now.

Moreover, the girl said that she has had pain several times this month. This is an old problem. She has had recurring pain in the past few years, but this month the pain is more frequent and lasts longer.

The emergency doctor just auscultated her heart and lungs, and also checked her abdominal condition. There was a slight tenderness in the lower right abdomen, which was not too obvious, and there was no rebound tenderness.

The emergency doctor preliminarily guessed that it might be acute appendicitis, but other possibilities could not be ruled out. To be on the safe side, he asked her to urinate, and insisted on checking the pregnancy test.

The emergency doctor asked her again when her period ended last month.

The girl lowered her head and said in a low voice, she should be coming in these two days, but she hasn't come yet.

After the emergency doctor listened, he asked the girl to do a urine pregnancy test with a firm attitude.

After all, for such a beautiful girl, delayed menstruation may mean pregnancy. If she is pregnant, she will suffer if she is misdiagnosed and treated incorrectly.

Ectopic pregnancy can cause severe abdominal pain. Many emergency doctors have suffered. It can be said that once bitten by a snake for ten years, they are afraid of well ropes.

Although the girl was a little reluctant, she still followed the doctor's request.

A urine pregnancy test soon came out, negative.

After ruling out pregnancy, the emergency doctor asked the girl to do a B-ultrasound, including a gynecological B-ultrasound. No obvious problems were found. The appendix seemed to be a little thicker, and the gallbladder, kidneys, and ureters were all fine, with no stones.

After questioning, it was found that the girl had no history of overeating, and the pain was not mainly on the left side. It should not be acute pancreatitis. However, for safety reasons, blood was drawn to check for blood amylase, and the results were normal.

Lin Fang continued to discuss that the directors were also thinking about the cause.

"Is it appendicitis?" Calmly asked anxiously.

"At the beginning, the emergency doctor suspected appendicitis just like director Leng, but the girl explained that the abdominal pain was right lower quadrant pain at the beginning, and it didn't mean that appendicitis started from around the navel and then turned to the right lower quadrant." Lin Fang replied calmly. .

"what is that?"

Calm is also in doubt.

"After a round of investigation in the emergency department, the illness was not found, so I consulted with a surgeon. Since then, the patient has been transferred to Director Cheng's department."

(End of this chapter)