Chapter 914： Physical symptoms do not match

"Cui Lao is a warm boiled frog, first look for you to see the patient, and then as long as you can not wipe the face, it will give you the benefits, let you work in the emergency department." Su Yundao.

Thoughts inside, Zheng Ren also thought. However, there is a Nobel Prize in hand, who will go to the emergency department to work like a busy, tired and unprofitable place.

Zheng Ren just smiled and did not answer Su Yun’s words.

Both of them know that, like the director of the old Pan, Cui Lao is not reconciled.

There are no new people in the emergency department, but they must also exist. They just desperately burned their own little life and barely supported it.

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

But is the power of the individual useful?

It’s totally useless. Even if Cui Lao is old enough to teach at the age of 70 or 80, the harvest is also embarrassing.

It is necessary to improve the treatment of emergency doctors, etc. The problem will cause a chain reaction, which is not something that an academician of the Academy of Engineering can decide.

Sounds tall, is an academician, but just a signboard. Say useful, that is useful. It’s useless to say it’s useless.

Let the hospital and society adjust themselves? How much can it be improved after it has been paid?

A while ago, the fight against the bus driver was taken seriously, and now the driver of the driver has begun to judge the public security sentence.

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

Forget it, I am just a small doctor, and Zheng Ren smiles.

All the way to the emergency department, the hospitalization of Zhou Litao has long stood in the corridor waiting.

He has five short statures, his face is pockmarks, his dark face, and Su Yun stick together, forming a sharp contrast.

"Zheng Boss, there is a patient with symptoms that don't match. Cui Laozheng is going to see you today and look for you." Zhou Litao greeted him, very polite.

"Don't dare not." Zheng Ren immediately replied: "Cui Lao is wrong, this is not dare to be."

Zhou Litao smiled politely and took Zheng Ren to Cui Lao's clinic.

After entering the door, Zheng Ren saw an old man who had to be white in the clinic and was consulting.

"Cui Lao, hello." Zheng Ren was deeply embarrassed and first expressed his respect.

"Well, Xiao Zheng, you come to see this patient." Cui Laos headed, "Li Tao, tell Xiao Zheng about the patient's condition."

Zhou Litao immediately said: "The patient was treated with intermittent upper abdominal pain for 1 day, accompanied by nausea and vomiting. I have a history of smoking for more than 30 years, a history of hypertension for 12 years, and the treatment of collaterals is good. ""

"The patient's abdomen has no bulging, no intestinal type and peristaltic wave, no skin scar and abdominal varicose veins.

Deep tenderness in the upper abdomen, no rebound pain and muscle tension. The liver and spleen were not under the ribs, and the Murphy's sign was negative, and no obvious mass was touched. Abdominal percussion was drum sound, no pain in the liver and spleen area, no pain in the kidney area, negative mobile voiced sound, and bowel sounds about 3 times/min. No abnormal vascular murmurs were heard. ”

"B-return, mild fatty liver, and negative. But the patient complained of severe pain. Cui Lao judged that it may be aortic or mesenteric artery dissection, and is preparing for emergency treatment of 64-row vascular CTA."

Zheng Ren understands that there are still patients on the 64th row, waiting for the phone, so look for yourself during the interval.

This must be the meaning of Cui Lao.

While listening to Zhou Litao's narrative of the patient's medical history, while seeing the patient, Zheng Ren saw the system panel bright red.

Several diagnoses of isolated superior mesenteric artery type IIb and hypertension occur in front of the eyes.

A very troublesome illness, Zheng Ren thought of it.

Vascular interlayers are very troublesome. From the aortic dissection of Cui Heming to the patient in front of the eye, if the hospital is in a lower level, it will be treated with abdominal pain for admission to the hospital or clinic.

If the diagnosis cannot be confirmed in time, once the mezzanine is broken, waiting for the patient is death.

Especially for small and medium-sized hospitals, the rate of misdiagnosis is quite high when this disease is encountered.

And Cui Lao, the light is basically used to check the body to determine the diagnosis of the disease, this level, experience is not blowing.

Zheng Ren nodded and began to check the body.

As Zhou Litao said, the patient's abdominal tenderness is not obvious, there is a little deep tenderness, but it is not important.

The examination and tenderness is very light, but the patient's face is pale and the pain is sweating. This is a case of self-reported symptoms.

This is the case when the so-called body disease does not match.

Zheng Ren checked his body and looked at the emergency B-ultrasound and laboratory test. The patient can be said to be very healthy, and in addition to the severe pain, there are few other positive indicators.

"Cui Lao, I think it is more likely to be a mesenteric artery dissection." Zheng Rendao: "You can choose to do 64-slice CTA or interventional angiography and surgery."

"What about conservative treatment?"

"Well... conservative treatment depends on the opinions of the patients' families. I am a surgical person and I am not too much in favor of conservative treatment. Because whether it is isolated mesenteric artery dissection or concurrent aortic dissection, once conservative treatment, suppose nighttime burst The rupture of the interlayer will cause more damage to the patient." Zheng Rendao.

He also knows that his attitude is more radical.

Surgeons, generally more radical can solve problems with surgery, why should you leave a dark thunder?

Of course, in the superior mesenteric artery dissection, the cure rate of conservative treatment is also very high, Zheng Ren knows.

However, Cui Lao just asked his opinion, and Zheng Ren also said his inner thoughts.

Cui Lao looked at Zheng Ren and then said faintly: "Can the patient's surgery, can you do it?"

"I have no problem with the general surgery department." Zheng Rendao: "I will try to minimize the damage of the patient."

"Well, you and Li Tao took the patient to do the examination, and told me after the completion of the face." Cui Lao finished, waved his hand and motioned to push the patient to do 64-row vascular CTA.

The old man was full of momentum, and Zheng Ren recalled the picture of Cui Lao pointing to the nose of Director Kong yesterday, and then smiled.

For those who are in emergency, the temper cannot be urgent. Even if it is a chronic child, it will be ground soon in the emergency department.

The old Cui Lao, but very kind, pay attention to the patient's blood pressure, and personally watched the concentration and speed of antihypertensive drugs pumped by the micro pump, which put Zheng Ren to push the patient away.

"Zheng boss, do you think the patient is an isolated dissection or a concomitant aortic dissection?" Zhou Litao whispered as he walked.

The family members of the patients are all around, and everything is hypothetical without any objective basis. Can whisper, just whispered.

"I see the patient's signs, like isolated." Zheng Ren replied: "The point of pain is to swim, unlike the pain points of the aortic dissection fixed with radiation pain."

This is a reverse push, based on the reverse of the system panel.

Zheng Ren feels normal. The physical examination is consistent with the diagnosis of the system panel. It is estimated that the big pig's hoof is still correct.

He feels normal, but listening to others is another matter.