When doctors have a simulated operating room

The doctor said, "How can this be the case with pancreatitis lung CT?" Qian Zhenggang said after staring at the film for a long time. At this moment, the gray-black film was stuck in front of the slide. The film of the migrant worker showed diffuse ground glass density shadows in both lungs, with fine grids inside. Deng Wei also thought to himself: "This person doesn't cough, and there are no dry or wet rales in the lungs. How can this be the case with the CT film?" In fact, Zhang Yi had already noticed the abnormality of the patient's lungs at the beginning. That's why he insisted on having a lung CT. At this moment, while everyone was puzzled, Zhang Yi stood up. "When I listened to the stethoscope, I noticed something was wrong. It sounded like a clear sound, but it didn't sound like it, but it wasn't dry or wet rales.

That's why I insisted on doing the test.

Now the results are out, which shows that my insistence was indeed right.

The patient's lungs had no dry or wet rales when auscultated, and pancreatitis was very clear.

It also further shows that the shadow on this CT scan is a lesion in the interstitial lungs, not the alveoli.

So, I think this patient should have interstitial pneumonia in addition to the diagnosis of pancreatitis!"

"Ah? Interstitial pneumonia?"

"Pancreatitis Adenitis combined with interstitial pneumonia? It's rare. "

Xiao Zhiwen hesitated for a moment and asked:

"It's not that serious, right? ! If you say it's interstitial pneumonia, why doesn't the patient have any respiratory symptoms?"

Deng Wei also doubted:

"It's just suppurative pancreatitis, and the area of ​​the glass density shadow in the lungs is also very small. The patient has no symptoms, neither hypoxia nor coughing. How can you be so sure?"

Seeing everyone's doubts, Zhang Yi was also prepared. He said:

"It may sound a bit far-fetched, but it's true.

This old man did not show up Symptoms of shortness of breath or hypoxia may be because it is still in the early stage.

If you come to the hospital later, or one day later, the shadows on the lung CT may become denser.

Another point is that the cause of this interstitial pneumonia is actually related to pancreatitis.

During the course of pancreatitis, the body will produce a large number of inflammatory cytokines and inflammatory mediators.

Its degradation products can easily cause drastic contraction of the capillaries in the lungs, leading to increased permeability of vascular endothelial cells, causing poor lung perfusion, and thus cell damage and dysfunction in the lungs.

It is just for now It is the early stage, and the patient's symptoms are very mild, or there are no obvious symptoms yet.

In addition, pancreatitis is also one of the many causes of ARDS.

And its mechanism of occurrence is very similar to that of interstitial pneumonia.

Both are caused by lung damage caused by inflammatory cytokines and inflammatory mediators.

But the reason why I ruled out ARDS is that ARDS will definitely have respiratory symptoms.

But interstitial pneumonia will not have such symptoms in the early stage, so in addition to drugs such as octreotide and omeprazole for the treatment of pancreatitis, glucocorticoids plus diuretics should also be used. "

After the words fell.

Everyone in the office stared at Zhang Yi in a daze.

Especially Deng Wei and Xiao Zhiwen.

This guy...

How did this guy react so quickly that lung inflammation was caused by pancreatitis??

And!

Regarding the auscultation of the lungs, Deng Wei has been practicing medicine for decades and he has never heard any abnormalities.

As a result, this kid heard it right away!!

For a moment, Deng Wei felt that he had goose bumps on his arms!!

This guy's observation and judgment are really strong!

Just now, the two of them were thinking about getting back at the plate in the area of ​​pancreatitis...

Unexpectedly...

Zhang Yi defeated him again!

In patients with severe pancreatitis or low immunity, this kind of disease in which inflammatory cytokines damage the lungs does occur.

But the probability is very, very small.

It is so small that it is difficult for ordinary doctors to find that the cause of the lung problem is pancreatitis.

Either they will suspect that it is a sequelae of previous lung disease, or they will suspect that it is a viral infection of the lungs.

In short, it is difficult to link the shadows on the lung CT with pancreatitis.

Oh...

I have to say that this young man Zhang Yi is really amazing.

So amazing that Deng Wei is a little tempted!

I don't know why Zhang Yi wants to stay in such a small place?

If he is recruited to Huaxi Hospital, will he go? ?

After a period of silence, Zhang Yi wrote a medical prescription under the watchful eyes of the doctors.

At this time, the nurse from the emergency room also ran over.

Come and say:

"I don't know what happened to the patient with pancreatitis just now. I feel that he is breathing a little fast? And the fingertip oxygen saturation is 85%. Should he be given oxygen?

Also, he still has a slight fever, the temperature is 38.1℃, and other vital signs are normal."

Zhang Yi quickly replied:

"Yes, give high-flow oxygen for one hour first, and switch to low-flow oxygen when the oxygen saturation reaches 90%."

"Okay!"

The nurse responded and turned around to get busy.

In the office, the doctors of our hospital all looked at Zhang Yi with admiration.

Oh my, the boss is worthy of being the boss!

Just said there were no symptoms, but the patient's symptoms came immediately!

It's amazing!

Zhang Yi really deserves the position of assistant director~

Soon, the migrant worker's temperature dropped after the infusion.

The amylase index was rechecked and it also dropped.

The next step is to arrange surgery.

In cases of suppurative pancreatitis with free fluid, the suppurative and necrotic pancreatic tissues need to be drained and removed.

Originally, I should have returned to West China Hospital in the afternoon after giving a speech in Tianhe.

But when I heard the director of the emergency department say that Zhang Yi would do the surgery, Deng Wei immediately became interested!

Zhang Yi is such a strong suture and clinical observation guy!

Then... what about the operation in the operating room?

Deng Wei was very curious!

So, he said to Qian Zhenggang:

"Dean Qian, since we have been here for so long today, why don't I go up and watch the operation later?"

Qian Zhenggang smiled politely:

"It's just watching, it's okay, Professor Deng, don't be so polite! After all, the milk tea and fruits in our department are all invited by you."

While speaking, Qian Zhenggang also looked at the large amount of milk tea and fruits in the doctor's office.

Each department was given nearly thirty cups of milk tea and some cut watermelon and mango.

People have spent so much money, what's the big deal about an operation?

The smile on Deng Wei's face froze instantly.

You old man, you are deliberately making fun of me, right?

"Hehe..."

After two dry laughs, Deng Wei rolled his eyes in his heart!

Humph, wait, I will go back and find the dean to poach Zhang Yi!

Wait until we poach Zhang Yi, and see if Qian Zhenggang can still laugh~

The two old men were calculating in their hearts.

Soon, the migrant worker was sent to the operating room.

He didn't have much money, and it was all collected by the guys who came with him.

In addition, the family members were also notified. The people who came were a boy in a high school uniform and a middle-aged woman who looked a little demented.

The middle-aged woman should be the patient's wife...

She looked like a disabled person, and she couldn't talk or walk very well.

No wonder the patient kept saying that he had no money.

Judging from the family conditions, it was indeed poor.

Before entering the operating room, Zhang Yi tried his best to explain the patient's main problem and the surgical plan to the two family members.

The expression on the face of the high school student was very flat, as if he understood, but also as if he didn't understand.

Not to mention the middle-aged woman, she kept grabbing Zhang Yi's hand, excited to speak, but couldn't say a complete sentence for a long time.

Zhang Yi nodded and looked at them:

"Don't worry, the operation is not difficult and will be over soon."

The two family members nodded in unison.

"Doctor, wait!"

Just as Zhang Yi was about to enter the operating room, the high school student suddenly called him.

Zhang Yi looked back at him.

The boy hesitantly said:

"Doctor... I... Our family is not well off, and we don't have money to give you a gift... But... But if you cure my dad...

I... I can be your slave, thank you!"

After that, the boy bowed to Zhang Yi at a 90-degree angle.