Chapter 913 Inconsistent Physical Symptoms

"Mr. Cui is boiling a frog in warm water. He will see you as a patient first, and if you can't wipe your face, he will give you a benefit and let you work in the emergency department." Su Yun said.

Zheng Ren also thought of the careful thought here. But with a Nobel Prize project in hand, who would work in such a busy, tiring and unprofitable emergency department.

Zheng Ren just smiled and didn't answer Su Yun's words.

Both of them knew in their hearts that like Director Pan, Mr. Cui was unwilling.

There are no new people in the emergency department, but there must be. They just desperately burned what little life they had left to barely sustain themselves.

Do your best, and you can only die in the end.

But is personal power useful?

It is completely useless, even if Mr. Cui insists on giving lectures across the country at the age of 70 or 80, he will gain very little.

But to improve the treatment of emergency doctors, and other issues will cause a chain reaction, this kind of thing is not something that an academician of the Academy of Engineering can decide.

It sounds tall and academician, but it's just a signboard. It is useful to say that it is useful. It's useless to say it's useless.

Let hospitals and society regulate themselves? How much does it cost to improve?

A while ago, the matter of beating and scolding bus drivers was taken seriously, and now those who beat and scold drivers have begun to be sentenced for endangering public safety.

But when it comes to medical care, the situation is more complicated.

Forget it, I'm just a little doctor, Zheng Ren laughed.

All the way to the emergency department, Zhou Litao, the chief inpatient, was already standing in the corridor waiting.

He has a short stature, his face is full of pockmarks, and his dark face sticks together with Su Yun, forming a sharp contrast.

"Boss Zheng, there is a patient whose symptoms don't match. Mr. Cui happened to be visiting the doctor today, so I want you to have a look." Zhou Litao went up to meet him, and said very politely.

"Don't dare." Zheng Ren immediately replied: "Old Cui is in love with you, I dare not take it."

Zhou Litao said some polite words with a smile, and brought Zheng Ren to Mr. Cui's consulting room.

After entering the door, Zheng Ren saw an old man with white beard and hair sitting in the consulting room, asking for a doctor.

"Hello, Elder Cui." Zheng Ren bowed deeply, first expressing his respect.

"Well, Xiao Zheng, come and see this patient." Elder Cui nodded, "Li Tao, tell Xiao Zheng about the patient's condition."

Zhou Litao then said: "The patient came to our hospital for one day of intermittent upper abdominal pain, accompanied by nausea and vomiting once. The patient had a history of smoking for more than 30 years and a history of hypertension for 12 years. He was given Norvasc treatment and his blood pressure was well controlled. .”

"The patient had no abdominal distension, intestinal pattern and peristaltic waves, skin scars and abdominal wall varicose veins.

Deep abdominal tenderness, no rebound tenderness and muscle tension. The liver and spleen were not found under the ribs, Murphy's sign was negative, and no obvious mass was palpable. Abdominal percussion revealed drum sounds, no percussion pain in the liver and spleen area, no percussion pain in the kidney area, shifting dullness was negative, bowel sounds about 3 times/min, and no abnormal vascular murmur was heard. "

"The B-ultrasound report showed mild fatty liver, and the rest was negative. But the patient complained of severe pain. Mr. Cui judged that it might be aortic or mesenteric artery dissection, and he was preparing for emergency 64-row CTA."

Zheng Ren understood that there were probably patients on the other side of row 64, waiting for a call, so he asked himself to take a look during the interval.

This must be what Cui Lao meant.

While listening to Zhou Litao's narration of the patient's medical history and looking at the patient, Zheng Ren saw that the system panel was bright red.

Several diagnoses such as isolated superior mesenteric artery dissection type IIb and hypertension came to the fore.

It's a troublesome disease, Zheng Ren thought to himself.

Vascular dissection is very troublesome. From Cui Heming's aortic dissection to the patient in front of him, if the level of the hospital is lower, he will be admitted to the hospital or outpatient for observation because of abdominal pain.

If the diagnosis cannot be confirmed in time, once the dissection ruptures, what awaits the patient is death.

Especially in small and medium-sized hospitals, the misdiagnosis rate is quite high when encountering this disease.

As for Mr. Cui, the diagnosis of the disease was basically confirmed just by the physical examination. This level and experience are not exaggerated.

Zheng Ren nodded and began to check the body.

Just like what Zhou Litao said, the patient's abdominal tenderness was not obvious, and there was some deep tenderness, but it was not important.

The physical examination showed mild tenderness, but the patient's face was pale and he was sweating profusely from the pain. This belonged to the situation of severe self-reported symptoms.

This is the case of the so-called incompatibility of physical symptoms.

After Zheng Ren finished his physical examination, he took another look at the emergency B-ultrasound and laboratory tests. The patient can be said to be healthy, except for the severe pain, there are few other positive indicators.

"Mr. Cui, I think the possibility of mesenteric artery dissection is relatively high." Zheng Ren said: "You can choose to do 64-slice CTA examination or interventional angiography for diagnosis and surgical treatment."

"What about conservative treatment?"

"Well... Conservative treatment depends on the opinions of the patient's family members. I am a surgeon, and I am not very in favor of conservative treatment. Because whether it is isolated mesenteric artery dissection or complicated aortic dissection, once conservative treatment, assuming nocturnal sudden onset The rupture of the dissection will cause greater damage to the patient." Zheng Ren said.

He also knew that his attitude was of the more radical kind.

Surgeons, generally more aggressive. The problem that can be solved by surgery, why keep a hidden thunder by your side?

Of course, for isolated superior mesenteric artery dissection, the recovery rate of conservative treatment is also very high, which Zheng Ren knows.

However, Elder Cui was only asking for his own opinion, and Zheng Ren also expressed his inner thoughts.

Elder Cui looked at Zheng Ren, and then said calmly, "Can you do the patient's surgery?"

"I have no problem with the general surgery department." Zheng Ren said: "I will try my best to minimize the patient's injury."

"Okay, you and Li Tao take the patient for an examination, and let me know when you're done." Mr. Cui finished speaking, waved his hand, and signaled them to push the patient to do a 64-row CTA.

The old man was very imposing. Zheng Ren recalled yesterday's scene of Cui Lao pointing at Director Kong's nose, and then smiled wryly.

It is impossible for people who engage in emergency treatment not to be in a hurry. Even a slow person will soon be worn out in the emergency department.

But Mr. Cui in front of him was very kind, told to pay attention to the patient's blood pressure, and personally checked the concentration and speed of the antihypertensive drug pumped in by the micropump, and then let Zheng Ren and the others push the patient away.

"Boss Zheng, do you think the patient had isolated dissection or complicated aortic dissection?" Zhou Litao asked in a low voice while walking.

The patient's family members are all around, and without objective basis, everything is a hypothesis. If you can keep your voice down, just keep your voice down.

"I see the patient's signs, which seem to be isolated." Zheng Ren replied: "The pain point is moving, not like the pain point of aortic dissection with fixed pain point and radiating pain."

This is the reverse push, according to the reverse push of the system panel.

Zheng Ren felt that it was normal, and the physical examination matched the diagnosis on the system panel. It is estimated that the big pig's hoof was right this time.

He thought it was normal, but hearing it in other people's ears was another matter.