Chapter 2331 【2331】Appropriate Means of Inspection

Before taking medical measures, it is necessary to make a clear diagnosis in non-rescue situations.

If you suspect intussusception and choose to do auxiliary examination, the previous textbooks usually talk about the use of barium meal.

This was because there was a shortage of B-ultrasound machines and CT machines at that time, but only X-ray machines had abundant resources.

The advancement of medical technology allows doctors to have more choices, and then eliminates those inappropriate examination methods.

For example, a barium meal is actually very inappropriate, because intussusception causes intestinal obstruction, and if you take a barium meal again, it will only aggravate the intestinal obstruction.

CT has radiation, the preferred b-ultrasound is fast and convenient.

There is a b-ultrasound room in the emergency department of Seoul. It is the fastest to take the child in the past.

Several people came to the B-ultrasound room with their children in their arms. Since the child's condition was urgent, I explained it to other children in line and their parents, and jumped to the front of the line for an examination.

Four typical symptoms of intussusception. One is paroxysmal abdominal pain manifested as a child crying and then quiet. The second is vomiting, which the child had. The third is jam-like stool, that is, bloody mucous membrane stool, which is not present in this child. The fourth is a sausage-like mass, yes.

There are only two of the four symptoms, which can only be called preliminary suspicion, and instrument-assisted examination is necessary. Lumps like vomiting and a sausage-like mass are signs of intestinal obstruction, not necessarily due to intussusception. For example, ascariasis, another common childhood disease, is clinically common. Roundworm clumps can also cause intestinal obstruction, but the age of onset is generally older, but it is true that this disease usually does not have blood in the stool. If the doctor's hand touches the lump, the surface of the ascarid mass is cord-like. That being said, depending on the feeling of the doctor's hand, each doctor's hand feels different. It's really like Schrödinger's cat that can't tell.

B-ultrasound examination is much more intuitive. According to the principle of intussusception, b-ultrasound can detect the phenomenon of a large ring enclosing a small ring, which is called concentric circle sign.

The clinicians stood around the B-ultrasound doctor and followed him. Two hypoechoic groups surrounded by a hyperechoic band appeared on the instrument screen.

"It should be intussusception." The B-ultrasound doctor in Shou'er has a lot of knowledge about this disease, and he is familiar with it, so he can judge it after a few glances.

Just in case, sweep the kid's appendix again. Acute appendicitis is also a very common and easily overlooked acute abdomen for infants and young children. The appendix is ​​connected to the cecum, so it is close to the location of the onset of the disease, so it needs to be distinguished.

There is no problem after sweeping the child's appendix. If you want to be more cautious, you can do ct again, ct is more time-consuming, and there is not much need to do ct if there are relatively clear inspection results.

A good doctor can save money for patients and their families.

The focus is now on the next medical strategy.

In the case of intussusception, if serious intestinal necrosis is caused, an operation is required immediately to cut off the dead intestine and perform intestinal anastomosis. Inform the emergency nurse to call up and ask the pediatric general surgeon from the inpatient department to come down to see the child so that he can make a decision.

It just so happens that today is the busiest time for the employees to return to the hospital for their first day of work. Many surgeries that were delayed by the holidays were scheduled to be done in a hurry, and the surgeries were fully booked the day before. It is said that all the general pediatric surgeons have gone to the operating room, and it will take some time to inform the doctors to come down from the operating room.

The doctor in charge continues to be the emergency doctor until the people from the inpatient department come down to pick up the patient.

Seeing that the child's condition was getting worse, Xie Wanying suggested, "Why don't we hurry up and try to reset the child, Doctor Duan."

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