medical simulator

Zhou Cheng clicked the mouse.After reading it, he put his hands on his chest and frowned even more.

Not dislocated?

No fracture?

What is the child's pain?Could it be that the ligament is broken?

He touched his head, turned around and asked, "Have you done a physical examination? How is the triangle behind the elbow joint?"

Zhou Cheng hurriedly asked.

When the plain film can't give much content, you have to look for clues from the physical examination!

The child was three years old, a little girl, brought by her parents, no fractures and dislocations were seen on plain radiographs, so this is a bit like the subluxation of the radial head that cannot be diagnosed by imaging examinations and needs to be diagnosed by medical history!

However, one of the diagnostic differences between radial head subluxation and the rest of the elbow is the normality of the posterior triangle of the elbow.

If it is abnormal, it must not be radial head subluxation, but if it is normal, it may not be sure that it is radial head subluxation.

To find out this situation, you may have to ask the family members carefully.

Diagnosis can only be made by looking for clues from the medical history, physical examination results, and imaging examinations.

"I've touched it, and the triangular relationship behind the elbow is normal, not a posterior dislocation of the elbow joint." Du Yanjun nodded quickly, and even ruled out a doubt in Zhou Cheng's heart.

If the position of the elbow triangle is normal, elbow dislocation can basically be ruled out.

Then this patient is probably that thing.

Zhou Cheng breathed a sigh of relief, and said, "Let's go and see the patient's condition together, I really haven't figured it out yet."

But Zhou Cheng did not say clearly that this is just his empirical judgment. In many cases, experience cannot be simply used as a dogma, nor can it be ignored.

It is absolutely impossible to rely on empiricism to naturally give the diagnosis to death!

will suffer.

Soon, Zhou Chengcheng and Du Yanjun came to the operating room.

After walking in, Zhou Chengcheng saw that the patient was a very cute little girl with two braids tied up, her little face was pink and fleshy, she should be a very cute little girl on weekdays.

But at this moment, her eyes were red and her mouth was deflated, as if she had suffered endless grievances, and then her nose was sticking to her nostrils, looking a little dirty. Her mother was about to wipe her nose.

But the little girl kept her mother's hand on her forearm, and wouldn't let her let go, as if it would be very painful.

Seeing the white coat coming in, the little girl seemed to think of the pain of being pierced by a needle in her buttocks again, and she shuddered dominantly.

Hurry up and get into my mother's arms, crying: "Mom, mom, I'm afraid."

However, her mother still hugged her and stood up slowly. At this moment, her face was full of distress and she said, "Doctor, what happened to my daughter's hand? Did you find any problems after watching the film?"

His eyes were full of tension.

"There is no special situation at the moment. Are you her mother? When you played with her, you lifted her or pulled her, and did she cry?" Zhou Cheng asked.

The diagnosis of radial head subluxation strictly requires parents or guardians to confirm the medical history.

Children are ignorant and incompetent, so it is impossible to ask her.

Pediatrics is dumb, that's how it came about.

But the little girl's mother shook her head and said, "I didn't lift my Kiki's hand, how could I lift her hand so hard?"

"She is still so young, how can I pull her hard?"

"It's such a doctor. In fact, I don't know what's going on with her."

"I just sent her to the kindergarten, and before I drove home, her teacher called and said that my Kiki was crying. She said that she was playing with the children, and she suddenly started crying."

"Is this because the children were playing around and got hurt? Is it serious?"

She is a precious mother, and her daughter is just three years old this year, and she goes to a small class in kindergarten.

She has just stepped into the workplace again, and on weekdays, her grandparents would pick her up. Today happened to be the weekend, so in order to spend more time with her children, she went to see her off in person.But he spoiled his daughter, and agreed to take her home, and she would be obedient in the kindergarten.

It's just that she sent her daughter to kindergarten, and the teacher called her before she got home!

Fortunately, the child's grandparents don't know the situation yet, but they will definitely know, and they don't know what they will say about themselves.

It was usually fine, but I only sent it once, and this happened.

Hearing this, Zhou Cheng frowned: "You didn't pull her? Did this happen when she was playing with the children?"

"Then you didn't ask the teacher about the specific situation?"

"It's very difficult for children to fight and cause subluxation of the radial head. It shouldn't be so hard."

"Can I trouble you to call and ask her teacher carefully, because this is very important."

"We didn't find any other special conditions on the plain film, but you also saw that your daughter's hand hurts very much."

"But according to your current description, we don't have enough evidence to give a diagnosis that we think is the most likely."

Zhou Cheng was bitten by a snake for ten years and was afraid of well ropes.

Zhou Cheng still has lingering fears about the kid who was brought here by his grandparents.

Even if they gave fruits and pennants later, when they scolded, it was really ugly.

The diagnosis of radial head subluxation depends on the medical history.

The child is dumb, and it is impossible to explain the situation clearly by himself.

The parents don't know the situation, so they can't guess. If it hurts for no reason, then if they reset it rashly, the trouble will be really big.

Moreover, clinical medicine is a reasonable subject, and without corresponding incentives, one cannot make a rash diagnosis!

Otherwise, your own knowledge system will not be able to form a circle.If there is no mutual cause and effect, then there will be a big mess in the end.

Radial head subluxation requires a history of relatively violent trauma.

Without this incentive, the diagnosis cannot be made.

"Ah? You still have to call her teacher? Is this important?" The woman was about 26 or [-] years old, the same age as Zhou Cheng. Hearing this at the moment, she obviously found it rather troublesome.

In fact, she didn't want to embarrass the teacher too much, and felt that she was a difficult person, because she herself had just passed the teacher test, and knew that the teacher had to deal with many students by herself. It is to ask the teacher here and there.

To be honest, how could the teacher keep everyone from playing and contacting each other?

Isn't it normal for kids to fight each other?

Zhou Chengcheng said: "It's better to ask clearly, because the medical history is always an important evidence in the diagnosis process. How did you get injured? Will it affect the direction of diagnosis?"

If there is an incentive, that's easy to say, anyway, the patient just needs to make a phone call.

But if there is no inducement, if there is pain for no reason, the child's current age is also an age with a high incidence of osteosarcoma. What if the periosteal destruction suddenly produces severe pain?

That's not something that reset can solve...

Bone tumors will destroy the bone, and the hardness of the broken fracture is not high. Even a slight force can cause an invisible fracture. These are completely different things...

The diagnosis of radial head subluxation is easy to diagnose, but difficult to diagnose. However, Zhou Cheng discovered similar medical disputes in the past when he read the literature...

The woman dialed the phone immediately, but in the process of asking, she turned on the loudspeaker.

The other party's teacher said very firmly: "Kid Qiqi suddenly started crying when she was playing with the children. Where did you go to the hospital?"

"I'm in Shashi No. [-] Hospital." The woman replied.

The person on the other side probably didn’t know that the woman was using the loudspeaker, so he said, “Why are you going to the No. [-] Hospital? It’s better if you go to the No. [-] County Hospital or a larger hospital.”

"I asked my colleague's husband, who is also a doctor, and he said that the orthopedics department at No. [-] Hospital is not very good. Of course, as a teacher, I'm actually not very good at talking about this." The teacher on the opposite side was quite polite and cryptic. say.

The woman turned off the loudspeaker halfway through, but both Zhou Cheng and Du Yanjun heard what should be heard.

The woman also said apologetically: "I'm sorry, two doctors, maybe the teacher doesn't know the specific situation, so he is worried about my daughter's situation, so the language is a little too aggressive."

But the woman obviously believed the teacher's words, and asked again: "I don't think you two are very old, if you are not sure, can you please call your superior doctor or director to come and take a look? "

The woman's self-cultivation is not bad, and she relayed the meaning of her daughter's teacher in a rather cryptic manner.

Du Yanjun suddenly smiled wryly!

Well, here comes another one who doesn't believe in Zhou Cheng.

Zhou Cheng also nodded: "Okay, then you may have to wait for a while."

"Today is the weekend, and our director didn't come to the ward, so I have to call him. Maybe one of our superiors happens to be in the outpatient clinic today. Why don't we go to the outpatient clinic together to see him? It's better than waiting here. Be quicker."

"And you don't need to toss back and forth again. If you want to review the plain film results later, you can go directly to the outpatient clinic to do it."

"What do you think?" The woman was polite, and Zhou Cheng also gave a more pertinent suggestion.

Zhou Cheng was not angry, because anyone could find a reason to despise him because of his age. There are a lot of such things, and young doctors are not sure. It is normal to want to find an experienced doctor. Everyone will have it, not for him.

"Then thank you doctor." The woman nodded, picked up her daughter and stood up.

Although Du Yanjun was a little displeased with Zhou Cheng taking the patient away at the moment, because she wanted to see how Zhou Cheng would deal with it later, either to learn or to be an assistant.

But the patient didn't trust Zhou Cheng, so there was nothing he could do. He hadn't finished his work in the department, so he couldn't leave.

Turning around, he sighed and returned to the office to continue his work.

Soon, Zhou Chengcheng came to the outpatient clinic with the woman and the child.

There was a lot of people queuing outside the outpatient clinic. Seeing that Zhou Chengcheng was going to bring women and children in, someone immediately shouted, "Hey, doctor, what are you doing? Are you going to take your relatives to jump in line?"

Zhou Cheng hurriedly took out the emergency medical record that the woman bought in the emergency department, and explained: "It's not a queue jumping, this little girl came from the emergency department."

"It won't take you a lot of time if you understand and take care of it a little bit."

Hearing this and seeing the emergency medical records, the speaker pursed his lips.

The woman bowed slightly and said, "I'm sorry, everyone, my daughter suddenly suffered from severe hand pain, so the emergency department asked us to come here to find a doctor."

When she bent down slightly, she may have accidentally touched the elbow of the little girl in her arms, and the little girl immediately cried in a low voice: "Mom, it hurts!"

Her two hands are still trying to hide.

Seeing the little girl's expression, everyone's heart softened.

The aunt in front hurriedly said: "You go in first, don't delay here, your son. It looks pitiful, everyone understands a little bit, do you think this child is crying?"

……

When Zhou Cheng brought these two people into the consulting room, Luo Yun and Zhang Zhengquan were seeing another patient.

Luo Yun raised his head and glanced at Zhou Cheng and the others, and continued to see the doctor, Zhou Cheng didn't bother.

After the patient was sent for an examination, Luo Yun asked, "Xiao Zhou, what's your situation?"

The woman told about the child's situation, and Zhou Chengcheng also explained: "Ms. Luo, this little girl has severe pain in her elbow, but she has no history of violent stretching. She said it suddenly hurt while playing with a child."

"During the physical examination, there was tenderness, and the triangular relationship behind the elbow was normal. No fracture was found on the X-ray. The patient said that I couldn't understand it, and asked the superior doctor to look at it again."

"I'll bring them to you." Zhou Cheng explained seriously, because he was afraid that Luo Yun would naturally think of the subluxation of the radial head all of a sudden.

"Isn't this subluxation of the radial head?"

How experienced is Luo Yun?

Will this kind of disease still come to him?

A child and parents come to the department together with a history of trauma and pain in the elbow joint. This is the diagnostic formula for subluxation of the radial head.

If Zhou Cheng didn't even know how to read this, then he really looked up to Zhou Cheng.

But out of trust in Zhou Cheng, Luo Yun still said to Zhou Cheng: "Can you pass the film over and have a look?"

Zhou Cheng quickly found the plain film and put it on the film reader.

Both Luo Yun and Zhang Zhengquan stood up and came over to watch carefully.

It was only a minute later that Luo Yun turned his head and asked, "You really never mentioned your child's hand? This is very important!"

"If you haven't mentioned it, you may need to take an MRI for this problem. Think about it carefully."

"Don't complicate simple things. So as not to cause too much misunderstanding."

"Let's put it this way, in her current situation, if there is no history of violent pulling, we may have to think about cancer. It will take time and effort..." Luo Yun didn't understand other problems, so he said this to the woman talking.

I just hope that women can not hide their medical history.

When she heard the word cancer, the woman's complexion immediately changed, her eyes turned red immediately, and she said quickly:

"Doctor, I don't know the specific situation, can I call again and ask?"

"Can my daughter sit here for a while?"