Great doctor starts with adding points

Lou Shanguan's face turned pale, and his forehead was immediately covered with fine sweat!

"Ah?" Hearing the words, Xiang Gong was taken aback for a moment, he didn't understand what the operation was, I just came to do an MRI? Why do you want the director to come out and judge?

But thinking of what happened to Zhu Fagen, Xiang Gong also felt that it would be safer to call the director out.

Nurse Chen understood the reason, and quickly explained with a smile: "Brother and sister, the director happens to be here at the moment, and the director will show you, don't you feel more at ease?"

She knew that the current department was suffering from severe headaches, and now the medical department of the hospital had a meeting to discuss the cause of Zhu Fagen's epilepsy during the reset process and where the root cause of the disease was, and whether it was caused by manual reset.

It didn't hurt much at the moment, so Liu Guifang also winked at Xiang Gong.

Lou Shanguan hurriedly walked into the doctor's office again.

Then he walked to the side of Lin Peiyuan, the director of trauma surgery at the county hospital, swallowed his saliva, and whispered in his ear, "Director Lin, another emergency patient came outside, and it was also dislocated by Dr. Wu Xie from Shazhen."

Lin Peiyuan's expression froze when he heard the words, and when he looked back, his eyes were filled with a murderous look.

"It was a lateral dislocation of the elbow joint, and I went through two doctors. Now it is said that they are coming for a follow-up visit, and for further examination and treatment..." Under the pressure of Lin Peiyuan, Lou Shanguan bravely introduced the brief history of the case. over.

"I don't understand this." Lou Shanguan directly threw the depression to director Lin Peiyuan.

Lin Peiyuan, who was half-Mediterranean and had thinning hair, touched his head with his hand again, tore off a strand of hair, and then looked at the strand of hair with some distress, with a stiff expression.

"The elbow is dislocated laterally? Has he been reset?" Lin Peiyuan's tone flickered, his expression uncertain.

Lateral dislocation of the elbow joint, is this extremely troublesome?

With no MRI at the town hospital, can Wu Xie rule out soft tissue damage?

Also, what the hell is he doing?

Zhu Fagen, who was sent to the county hospital before, obviously had a simple anterior dislocation of the shoulder joint. Compared with the lateral dislocation of the elbow joint, it belongs to pediatrics. The most common one is that he didn’t deal with it. Did he see something in advance? Tricky?

"The patient is now in a plaster cast, and the reduction should have been done."

"It's also reflected in the medical records, sir, look at it." Lou Shanguan had a respectful face, not daring to be presumptuous.

Today the entire department was hit by thunder, and the deputy chief physician in the department suffered from epilepsy when doing reset.

This had to make Lou Shanguan look at Wu Xie differently who had been in the group for two months before.

The director of neurosurgery in the hospital is talking freely, the comrades from the medical department are listening, and the director of the ICU, the director of the neurology department, the directors of the endocrinology department, the respiratory department, and the anesthesiology department are all taking notes for publication. Opinion!

Naturally, there were also family members who were listening. They didn't understand the professional content, and they didn't dare to let the people in the hospital hold a meeting without telling it.

"Director Li, I have something to go out here, and there is another emergency department outside. Please help me first!" Lin Peiyuan said to Li Xiaohe, the chief director of the orthopedics department and the director of the spine surgery department.

Li Xiaohe glanced at Lin Peiyuan and warned: "Be careful. I just sent Zhu Fagen's medical records to Director Tong of the State Hospital for a look. He thinks that Zhu Fagen's current situation may be a habitual shoulder that they have not considered before." Joint dislocation."

"The reason is that Zhu Fagen may have a history of epilepsy, but his family members hid it. We are currently reviewing the information to find out whether Zhu Fagen has a history of epilepsy..."

"Okay, thank you for your hard work, Director Li, the doctor Long I asked here hasn't responded yet!" Lin Peiyuan said so, and walked out.

Lin Peiyuan walked out of the office while flipping through the medical records written by Wu Xie. The handwriting was neat and not scribbled, but the content made him feel a bit pained——

"A traffic accident trauma caused pain in the right elbow joint and restricted movement for one hour. The patient complained that he was accidentally pulled by a motorcycle an hour ago and dragged for a certain distance. He immediately felt severe pain in the right elbow joint, immobilization, and swelling. The patient Self-reported no numbness, bleeding and other symptoms."

"Afterwards, I performed manual reduction in a Chinese medicine practitioner by myself (the number is three times, the method of manual reset is unknown, and the effect of reset is unknown). The pain has not been significantly relieved, and the pain is worse than when I was injured. In order to seek diagnosis and treatment, I came to our hospital for outpatient treatment."

"Examination: right elbow joint swelling, no ecchymosis and bleeding, no blood clots, tenderness on the outside of the right elbow joint, the tenderness is not obvious after application of pressure, and the abnormal relationship of the posterior elbow triangle of the right elbow joint, humerus and The position of the olecranon is deviated, and the humerus is medial."

"Active activities were obviously limited, and passive activities were not investigated due to pain. Distal limb movements were normal, extremity sensation and peripheral blood supply were normal. The internal and external rotation of the upper arm was slightly limited."

"LPS test (-), Varus Stress test (-), Valgus Stress test (-)."

Another three words of English made Lin Peiyuan frown.

"Check it out, what does this mean?" The orthopedics department of the county hospital is not as clear as the department of the prefecture-level city hospital or the third-level hospital. assessed by NMR.

"I can't find it, Director." Lou Shanguan's voice was startled.

When entering the door, Lou Shanguan took a photo of the medical records, but when he typed the relevant English information on Baidu, it showed messy things, which had nothing to do with medicine.

At present, there is no particularly perfect place that can support inquiries about special orthopedic specialties, and Lilac Garden is not professional enough. (Everyone, don’t try Baidu, you can’t find it.)

"Huh?" Lin Peiyuan raised his head and looked at Lou Shanguan.

"I can't find it, Director." Lou Shanguan repeated, with a stiff face, swallowing saliva, with a complicated expression.

Last time, when Brother Luo Wei was on duty, the inspection written by Wu Xie could at least be found on the Internet, but now? If you can't find it, how should you evaluate it?

It is mainly elbow dislocation, and lateral dislocation is really complicated. It belongs to extremely professional knowledge. To a certain extent, it is not easy to use such things as thousands of degrees and browsers.

"X-ray shows (read the film and there is no report): the humerus is slightly displaced outward, and the radius and ulna are displaced medially. The humerus is displaced laterally, with an external rotation angle of about 20° and a retroversion angle of about 15°."

"There were no obvious signs of fracture."

"Preliminary diagnosis: Suspicious lateral dislocation of the right elbow, Mayo Clinic I degree!"

"Treatment suggestions: 1. Kocher manipulation reduction to relieve symptoms."

"2. Transfer to a higher-level hospital to further improve the MRI examination, check whether there is soft tissue injury, and continue diagnosis and treatment as appropriate."

"3. Review the plain film after manual reduction, and continue to temporarily fix the shoulder joint with the forearm sling. Remove it in due course."

"4. Discomfort follow-up."

"Wu Xie. October 12th."

Lin Peiyuan felt a bit of a headache, as if he was not looking at the medical records of lower-level doctors in a lower-level hospital, but something written by a higher-level hospital: "What about the Mayo Clinic scale?"

"Hey!" Lou Shanguan showed Lin Peiyuan the Qiandu information he checked.

Mayo's classification of the different sites of distal radius fractures. Divided into four types: type I extra-articular, type II intra-articular radioscaphoid joint, type III intra-articular radiolunate joint, and type IV intra-articular radioscaphoid joint.

Lou Shanguan saw that Lin Peiyuan's expression became more and more exciting, so he hurried to remedy it: "The treatment method can be found."

"Koriob method: Hold the wrist with one hand, bend the elbow to 90 degrees to relax the biceps brachii, hold the elbow with the other hand, continue to pull, slightly abduct, and gradually rotate the upper arm outward, and then adduct the elbow along the The chest wall is close to the midline, and then the upper arm is rotated internally. At this time, it can be reset. A sound can be heard. Be careful not to use too much force to prevent humeral neck fracture.”

"It's a fart!" Lin Peiyuan rolled his eyes at Lou Shanguan.

You know how other people treat it. If you don't understand other people's diagnosis, you have a dick.

However, Lin Peiyuan could still understand the one degree in the Roman characters. After reading it, he walked towards Xiang Gong with a smile on his face: "Is the patient you? How do you feel now?"