Chapter 914 Connotative Low-Key

Zhou Litao wanted to ask more questions, but seeing the eyes of the patient's family members, he held back and did not continue.

When I came to the CT room, I still waited for a while. The CT doctor explained the situation to the patients behind, and added the emergency patients.

The other patients also understood, seeing that the patient came lying on a flat car, accompanied by three doctors and a nurse, just this battle, anyone who saw it felt that the patient was going to die.

There are people who are unreasonable and inconsiderate of other people, but they are not common.

It's just that in front of this window of the emergency department, there are many contacts, and it has become the norm.

The patient was sent to the CT room, and several people came to the operating room.

Zheng Ren didn't get started either. It's not good to always overstep the bounds. He stood quietly behind the doctor in the CT room, watching the film.

"Boss Zheng, the patient has no bloody stool. I think that if the diagnosis is isolated superior mesenteric artery dissection, conservative treatment is better." At this time, there is no family member of the patient, so Zhou Litao immediately expressed his thoughts.

Su Yun raised his eyebrows, and just about to turn back, Zheng Ren touched him lightly with his elbow, and said with a smile: "If there is no thrombus in the cavity, there is no problem in being conservative. After all, the dissection pressure of the superior mesenteric artery is relatively low, and The aorta is no match."

Zhou Litao was also a little puzzled, didn't Boss Zheng just say that he suggested surgery? Why did you change your mind so quickly?

"It's just a possibility. Cui Lao asked, so I said it." Zheng Ren said with a smile: "Each has its own advantages. As for the operation, it can avoid the possibility of large-section necrosis of the patient's intestinal tract and other complications. If it is conservative, it can reduce the damage of the operation and save costs for the patient and the patient's family."

What he said was so tactful that Zhou Litao didn't know how to answer it.

"Let's look at the diagnosis first. What to do is to listen to the patient's family." Zheng Ren said.

The 64-slice CT took a long time, and the patient had abdominal pain and obvious agitation, so it took half an hour before the patient was pushed out.

Then Zheng Ren said: "Mr. Zhou, you can push the patient back first. I'll take a look at the reconstruction results."

Seeing Zhou Litao leave, Su Yun asked in puzzlement: "Boss, this guy talks too much."

Zheng Ren felt that Su Yun had just said the wrong thing. It wasn't that Zhou Litao talked too much, but that he talked too much. He smiled and said, "What they said is true."

"Cut." Su Yun sneered, "The pain of dissection is not something ordinary people can bear. I met a patient and asked him after the operation. He said that the pain felt like a knife was stirred in his chest. At that time, he didn't want to live. If you can die directly, it would be easier to die."

"Well, surgery is still possible, and I don't agree with conservative treatment," Zheng Ren said.

"Then why don't you hate him." Su Yun expressed contempt for the attitude of a good old man like Zheng Ren.

"It doesn't make sense. This kind of patients can't be accepted by our department. They should be more experienced in general surgery." Zheng Ren said: "If we need to be on stage, we can do it. If not, the Department of Vascular Medicine can also do it. CT room, the inpatient of the emergency department, are you free?"

"You are a man with your tail between your legs." Su Yun looked at Zheng Ren with a half-smile, and said, "Is there any need to be so low-key?"

"This is low-key with connotations. And didn't you say you didn't want to go to the emergency department? Why are you so arrogant?" Zheng Ren asked back.

"..." Su Yun was speechless.

This was really a difficult choice. After thinking about it carefully, what Zheng Ren said made sense, but he disagreed with it.

It's really suffocating.

"There are two views in the academic world, surgery and conservative. But I still prefer surgery, and I will analyze the specific situation. If conservative treatment, there is a risk of recurrence." Zheng Ren said: "For this, we have to wait for 64 rows of vascular CTA It will be decided after you come out."

Su Yun nodded, quietly watching the doctor in the CT room doing the examination, with black hair floating weakly on his forehead.

Because it was an emergency department, the three-dimensional reconstruction of 64-slice CT was done quickly.

True and false double lumens can be seen in the superior mesenteric artery, there is no thrombus in the true lumen, and thrombus formation can be seen in the false lumen.

The false lumen is not large enough and compresses the vessel, resulting in occlusion of the superior mesenteric artery.

The superior mesenteric artery supplies all of the small intestine and 2/3 of the large intestine. Once ischemic, it will cause ischemic pain in the small intestine.

Zheng Ren in Haicheng had done a case of intestinal bleeding in a patient, embolized part of the superior mesenteric artery, actively let the small intestine be necrotic and resected, this is the reason.

But the previous patients wanted intestinal necrosis and found the bleeding point to remove it. Today's patients are avoiding this situation.

Judging by the patient's condition, whether to perform surgery or not is in between.

If it was in the emergency department of Haicheng No. 1 Hospital, Zheng Ren would not hesitate to explain to his family members and perform the surgery. But here is 912, ambiguous matters, Zheng Ren only offers opinions, not responsible for making decisions.

After sending the film back, Zhou Litao had already sent the patient to the general surgery department, but he was not there. Mr. Cui inserted the film into the film reader, put on the glasses, and watched carefully frame by frame.

More than ten minutes later, Old Cui said, "Xiao Zheng, what's your opinion?"

"You can be conservative, or you can..."

"I'm asking for your opinion, not to let you play football." Old Cui was displeased, and glanced at Zheng Ren.

White hair like snow, eyes like knives.

"I suggest surgery." Zheng Ren immediately returned, "I observed on the way that the patient's pain threshold is relatively low, and blood pressure is not well controlled. Although this type of patient has no thrombus in the true lumen of the superior mesenteric artery, conservative treatment will heal The possibility of a good future will be further reduced.”

Cui Lao didn't speak, sat down and looked at Zheng Ren quietly.

"The operation is also relatively simple, and the next stent is enough. Superior mesenteric angiography + PTA + stenting. If the patient's family has no financial problems, he can be discharged from the hospital after three days of observation."

"Well, is this right?" Cui Lao said: "Young people, be energetic, don't be old-fashioned and pretend to be deep."

"..." This was the first time Zheng Ren heard someone comment on him like that.

Mr. Cui is really different.

However, the difficulty of practicing medicine in his time was not comparable to that of now. The contradiction between doctors and patients has become more and more acute as medical care is introduced to the market.

"The patient has a history of smoking and hypertension, and his blood pressure is not well controlled. In my experience, patients with a history of smoking are basically unable to keep it. Now they are given low molecular weight heparin anticoagulant, alprostadil to dilate blood vessels, and papaverine to relieve spasm , you go to the general surgery department and prepare for the operation." Cui Lao said.

He not only gave a diagnosis, but also determined the next treatment.

With a history of smoking, it is difficult to hold back the word of success. To Zheng Ren, it is worth ten thousand gold. It doesn't sound like a doctor is saying it with such certainty.

But Mr. Cui said so.

This is a summary of experience. Although this sentence is not rigorous, it is precisely because of this that it cannot appear in journal articles.

This is just a summary of Mr. Cui's life experience, which cannot be learned elsewhere.

Zheng Ren's heart shuddered, he nodded and bowed deeply.