Auto chess in the operating room

Chapter 97 Suppurative portal phlebitis

When Tang Lou walked to the patient's ward, a nurse stopped Tang Lou.

Nurse Yuan Xun, Qi Liuhai, a pair of big watery eyes, a pointed chin, and a beauty mole.

The most memorable thing is that she has deep cheekbones like those of Westerners, and her face looks three-dimensional and distinct, with a different kind of beauty.

Yuan Xun held Tang Lou back, and said in a low voice, "You're going to see Hu Jindong, it's best not to go there now."

"what happened?"

Tang Lou asked with some doubts.

"Last night, Dr. Ma and Dr. Wang tossed the patient all night and did seven or eight examinations. In the morning, the patient still had a high fever, and his condition worsened than before. The patient's family members were already dissatisfied. , Dr. Ma finally got out."

"If the conclusion cannot be drawn in the past now, I am afraid that the family members will make trouble."

Yuan Xun is the nurse who is in charge of cooperating with Hu Jindong, but he has seen this kind of situation a lot.

The patient was asked by the doctor to undergo a series of examinations, such as CT, color Doppler ultrasound, blood test, and urine routine. There are already many patients in the first hospital in the city. Items cost a lot of money.

The patient's condition deteriorated again, and the family members naturally blamed the doctor's incompetence, and even felt that part of it was caused by the repeated inspections.

Anxiety, pain, and mistrust have reached the verge of explosion.

Tang Lou walked to the door of the ward lightly and looked inside. Sure enough, some of the patient's family members were sitting and some were standing.

The patient's mother had red eyes, and the patient's uncle was already cursing.

"It's been a few days? The county hospital couldn't do it and was transferred to the city's No. [-] hospital. I thought the third-level hospital could cure the disease, but I did a bunch of checks yesterday, and I thought I could find something. In the end, these doctors can't do it. ?”

"If you want me to say, Dr. Ma shouldn't be allowed to leave in the morning, and he won't be allowed to leave until the results are given. Look at the Near East, what to do if this continues."

"Ugh."

The patient's wife sat by the bed, and when she heard her brother's complaints, she became more and more sad. She held her husband's hand with one hand and secretly wiped her tears.

"Doctor Tang, you'd better leave quickly. Dr. Ma has already discussed with Dr. Qing. If it doesn't work, Director Cheng and other experts. You are an intern, and you can't help, so don't make trouble."

Yuan Xun kindly persuaded him.

Looking at the pain of the patient's wife, Tang Lou lowered his head and thought about it. The previous examination alone was probably futile. After all, there are too many possibilities of postoperative high fever, and many complications are very similar. To investigate the cause, sometimes it is necessary to luck.

For doctors, as long as there is enough time, they can be ruled out one by one, but for patients, time is the most unbearable delay.

In case, some complications are not timely or misdiagnosed, it is likely to lead to the death of the patient.

It will be too late to regret it when the time comes. Tang Lou figured this out and took a deep breath. Even if he knew his one-star diagnostic skill, he might not be able to find out, or the patient might spread his grievances on him.

But who makes himself a doctor?
"Doctor Tang, you!"

When Yuan Xun thought that Tang Lou was going to turn around and leave, he walked into the ward without caring about the embarrassment he would be in.

"This is."

Yuan Xun naturally didn't think that Tang Lou could find out the problems that Ma Enqingping and other experts couldn't find out.

But some admire Tang Lou's courage.

Yuan Alde gritted his teeth, and bravely followed, even if he was scolded, it would be her share.

Who made him the nurse in charge of Hu Jindong?
In the ward, the patient's family members obviously did not expect that another doctor came in at this time, and he looked younger than the previous Doctor Ma.

"Why do you need to do another inspection? Isn't it enough to check so many last night?"

The patient's uncle looked at Tang Lou very unceremoniously, with some resistance.

"Dr. Tang is an intern of Dr. Ma, come here to check the patient's vital signs, and report to Dr. Ma as soon as possible."

Yuan Xun thought for a while and found a reason for Tang Lou. After checking his physical signs, the family members couldn't say anything. Moreover, Tang Lou was just an intern under Ma En, and the family members couldn't embarrass an intern.

"Check it out! Did you find anything? Come on, let's see, let's see."

The strong man quarreled a few more words, wrinkled his nose, and looked down on Tang Lou.

"Why doesn't the director come? Always send some useless interns."

The more the strong man thought about it, the angrier he became, and he cursed in front of Tang Lou.

"Okay, brother, stop arguing. It's not easy for a little doctor."

The patient's wife has a gentle temperament, even though she is very sad, she still controls her emotions and makes room for Tang Lou.

Tang Lou's mentality is very stable, and he can understand the emotions of the patient's family members.

Under diagnostics:
[Patient: Hu Jindong, male, 24 years old

Symptoms: Persistent high fever after appendicitis resection

Symptoms of hypertoxemia, relaxation and high fever, chills, pain in the liver area, hepatomegaly, ascites, splenomegaly, nausea.

总胆红素118.1 umol/L↑，直接胆红素103.4 umol/L↑。白细胞17.01×109/L↑，中性粒细胞比率0.894↑

Diagnosis: suppurative portal phlebitis, Doppler ultrasound can show the blood flow of portal vein

Special attention: portal phlebitis is one of the serious complications of abdominal infection, and it is difficult to diagnose. Its clinical manifestations are fever, jaundice, epigastric pain, nausea and other symptoms. The high fatality rate is partly caused by delays in treatment.

Principles of treatment of acute suppurative portal phlebitis:
(1) Actively and effectively deal with the primary lesion first

(2) Early anti-infection treatment before and after surgery, choose broad-spectrum antibiotics against Gram-negative bacilli, and anti-anaerobic drugs can be used in combination

(3) Appropriate application of glucocorticoids: hormones have anti-inflammatory, anti-allergic, anti-viral, and anti-shock effects, and at the same time, hormones can reduce capillary permeability, inhibit inflammatory exudation, and stabilize lysosomal membranes.

(4) Supportive treatment and liver protection treatment can be strengthened.If the patient has no obvious bleeding disorder, anticoagulants can be used to prevent portal vein thrombosis, but attention should be paid to reexamination of coagulation function. 】

Tang Lou's hanging heart finally fell, but soon he felt a little headache again. After all, he was an intern, how could he convince the attending doctor and resident doctor of the department.

Tang Lou thought about Ma En, but Dr. Ma would definitely feel that he was talking nonsense. After all, it was too far-fetched for an intern to find the cause of the disease by guessing.

As for Qingping, seriously, if I went to tell him that I checked the patient and suspected portal phlebitis, I might be scolded by him for not preparing for the appendicitis operation and running around.

After much deliberation, Tang Lou decided to go directly to Cheng Jian for a try.

After figuring it out, Tang Lou didn't care about explaining anything, turned around and was about to rush out of the ward.

After all, the earlier the diagnosis is made, the earlier the patient will be out of danger.

"???"

Yuan Xun and the two family members looked at Tang Lou, glanced at Hu Jindong, and ran away, somewhat unexpectedly.

"Hey, what do you mean, little doctor?"

The patient's uncle was like a powder keg, and Tang Lou's actions completely ignited him!

Isn't it too perfunctory to check the vital signs and leave after a glance?

Stopped Tang Lou, aggressively: "Hey, what do you mean? Are you a doctor? You don't want to leave today without an explanation!"

Yuan Xun also felt dizzy for a while, you said you pretended to check and checked, and you also looked at it for a while, the interns are just unreliable, Yuan Xun cursed in his heart.

Fortunately, she has experienced a lot, so she hastened to make up for it:

"Doctor Tang, I forgot to bring the notebook, go back and get it."

Yuan Xun stood between Tang Lou and the patient's uncle, and laughed:
"After all, Dr. Tang has only been here for less than a month, so he's not familiar with the procedure. I'm really sorry."

While apologizing, Yuan Xun pulled Tang Lou's clothes, signaled Tang Lou to apologize, and comforted the family members.

Yuan Xun turned around and gave Tang Lou a wink, but he saw a pair of calm eyes, not at all flustered by being questioned by his family members, nor did he intend to apologize.

Yuan Xun is a bit overwhelmed, brother, what is going on here?
The atmosphere froze slightly.

The patient's uncle stared at Tang Lou, as if Tang Lou would make a fuss if he didn't give an explanation.

(End of this chapter)