Chapter 1109

"A patient with high-altitude falling injury jumped from the fourth floor and didn't want to be hospitalized at home." Yuan Lihan explained vaguely.

Zheng Ren's heart moved. He jumped from a building and didn't want to be hospitalized. The two keywords were linked, and he thought of several possibilities.

"Because of insurance?" Zheng Ren asked in a low voice.

President Wang was filled with emotion and admiration.

Medical technology is medical technology, and what Dr. yuan just said is another aspect.

He is in the imperial capital and seldom touches insurance. Living in 912 hospital, the deposit paid in advance is 50000. In other words, if you don't pay 50000 yuan, you can't even live in the hospital.

As for whether the patient can be reimbursed, it is not within the scope of President Wang's consideration.

But the situation in Haicheng is completely different.

Whether to see a doctor here can be reimbursed is definitely a major consideration for the patient's family members to choose where to be hospitalized and what kind of treatment.

But boss Zheng knew it was because of insurance. What the hell is this? President Wang is also aware of the problem.

Yuan Li Leng nodded.

Zheng Ren smiled, "you talk."

Then he and President Wang continued to move forward.

"Boss Zheng, what's the matter?" President Wang asked.

"Jumping from a building belongs to suicide, and the insurance will not be reimbursed." Zheng Rendao said, "without insurance, many orthopedic steel plates can't be used. If domestic cheap steel plates are used, most of the injured are in the lower limbs. In the future, the steel plates may be broken."

“……”

"This is a medical risk in the future. Therefore, if the emergency department accepts such patients, it will not be very urgent and can not be reimbursed. The orthopedic doctor will be very unhappy. If it is particularly urgent, it will not be.

But didn't Dr. yuan say that he jumped down from the fourth floor. It's estimated that the injury is not very serious. There may be calf fracture, intertrochanteric fracture and femoral shaft fracture. "

"These, as long as they are not open, are not a big deal. So change a hospital and tell the doctor that they fell accidentally, so they fooled it."

"Well... Is that really good?" President Wang has been working as a doctor in the top large-scale third-class hospital in China. He has been in Haicheng for several months. He has not done less surgery, but he has not mastered this kind of vague caution.

"I don't know whether it's good or not. Even if it's serious, it belongs to insurance fraud." Zheng Ren said blandly: "but after all, it's better to treat people than those small community hospitals. It's better to realize hedging every day. Haicheng community small hospital doesn't spend money on hospitalization and pays money every day."

"Send money? So powerful?"

"Yes." Zheng Ren nodded as he walked. "I've heard people say that it's about 100 a day, about this price. Hang up the bed to prescribe medicine, and the hospital will take it to sell it. This is a form of hedge insurance. There are many ways to do it. The large deficit of medical insurance does not lie in the third class hospital, but in the community."

"This is not..." President Wang was filled with righteous indignation.

"Calm down, the grass-roots level, it's all like this. If you are strict, you should converge. If you are loose, you should seize the time to prescribe medicine." Zheng Ren smiled, "everyone has good things, and no one will do much. In fact, it is said that everyone has good things, and in the end everyone has no good. But who knows what to do."

Zheng Ren assumes an attitude that he is only a doctor and is only responsible for seeing a doctor and surgery. This kind of thing is not in his charge, and he can't control it.

Wang always sighed. There are so many loopholes below. He didn't know before.

Walking to the door of the emergency room, Zheng Ren looked around.

The body was slightly stiff and immediately walked into the emergency room.

There are nurses busy in the rescue room. The patient is lying on the rescue bed. The number displayed by ECG monitoring is still very stable.

Zheng Ren walked in quickly and attracted the nurse's attention.

She turned her head and said in surprise, "President Zheng, you're back."

But the surprise was just a moment. When the little nurse looked behind Zheng Ren, she fell into boundless disappointment.

Zheng Ren knows that Su Yun is the one who can really surprise the little nurse. I don't know that I haven't finished drinking with Chang Yue now.

Nodded, Zheng Ren came to the patient, stretched out his hand and said, "stethoscope."

Wang always had some doubts. He took out the diving stethoscope from his white pocket and handed it to Zheng Ren. The patient had blood pressure of 150 / 100 mmHg, heart rate of 102 beats / min, respiration of 28 beats / min and blood oxygen saturation of 98%.

ECG showed sinus rhythm, which was an emergency patient, but not a severe patient.

The patient's injury was the same as Zheng Ren's judgment. In the lower leg, President Wang estimated that it was a tibiofibular fracture. But the fracture is a little serious, the left leg is congested and edematous, and the skin is a little shiny.

Osteofascial compartment syndrome is obvious and easy to recognize.

If President Wang handled this patient, he would neither talk about medical insurance with the patient's family like Yuan Li, nor listen to the abdominal cavity with a stethoscope like Zheng Ren

Boss Zheng, why don't you do some knitting? Isn't that bullshit?

Vital signs are stable. It is estimated that the abdominal organs are all right. Otherwise, Yuan Li would not leisurely talk about medical insurance with the patient's family members.

Back to 10000 steps, even if it's something, you shouldn't auscultate.

"Bedside B-ultrasound, call now!" Zheng Renshen said that in an instant, he had returned to the general role of hospitalization in the emergency department of Haicheng first hospital, "sodium nitroprusside, hypotension and high pressure remained below 120."

The little nurse was stunned. Although Zheng Ren had been away for half a year, his prestige was still there. His physical instinct was obedience, not questioning.

She hurriedly called someone to make a phone call, while she took the time to add medicine herself.

"Boss Zheng?"

"It is suspected that the main thoracic and abdominal aorta are torn." Zheng Ren gave the diagnosis directly, "go and ask Yuan Li to come in."

Zheng Rengang just took a look at the rescue room. The bright red background color of the system panel attracted him in. The system diagnosis seriously made Zheng Ren dare not delay time.

Auscultation is just a way, which is rarely used. Because the patient is thin, press the stethoscope hard, and you can hear the blood flow sound of the aorta. But there are many murmurs, which is not the real diagnosis.

This is just a way of Zheng Ren's retrograde inference, which others can't learn.

"..." President Wang looked at Zheng Ren in surprise and looked at the patient again. He was speechless. Where is this?

However, the diagnosis and treatment experience of patients with P-J syndrome tells president Wang that they must obey.

He hurried to the door and called Yuan Li in.

Yuan Li was a little unhappy. He had just finished the matter with the patient's family implicitly, and did not say it himself, but let the patient's family know what to do.

The next step is to sign a letter of responsibility for all the consequences, and then send the 120 ambulance to another hospital in the city for diagnosis and treatment.

In Yuan Li's opinion, it's just a fracture. Which hospital isn't for treatment?

Zheng Ren, did you come back to trouble yourself?! He was a little angry.

……

……

Note: This is a patient in 10 years. My level is not high. When I look at chest CT, I can't find the interlayer. To explain, the initial dissecting aneurysm is also difficult to distinguish. I just had doubts. I had to go home. I forced myself to wait until dawn the next day and contact the emergency vascular CT reconstruction.

Finally, I went directly to the ICU. The latter thing is also true. People live, but they spend a lot of money, and the family quarrels in a mess. When he was discharged from the hospital, his wife looked at me in the wrong way, the kind of vicious.

But that's it, smile.

Another gossip, my constitution is more attractive to dissecting aneurysms. For patients with rib fracture and aortic dissection, I have been on duty for 8 departments in the past ten years.

This is very speechless.