Chapter 915： Low-key connotation

Zhou Litao still had questions to ask, but when he saw the eyes of the patient's family, he refused to continue.

When I came to the cT room, I waited for a little while. The doctor at cT and the patient at the back explained the situation and added it to the emergency patient.

Other patients also understand that when the patient is lying on the flat car, there are three doctors and one nurse nearby. As for this, everyone who thinks that this patient will not work.

People who are unreasonable and not considered by others are also, but not common.

Just in front of this window of the emergency department, the contact is much more common.

The patient was sent to the cT room and several people came to the operation.

Zheng Ren did not get started. It’s always better, it’s not good. He stood quietly behind the doctor in the cT room and looked at the film.

"Zheng boss, the patient has no blood, I think if the diagnosis of isolated superior mesenteric artery dissection, or conservative treatment is better." At this time no family members, Zhou Litao immediately said his own ideas.

Su Yun's eyebrows were vertical and just wanted to go back. Zheng Ren's elbow touched him gently and smiled. "If there is no blood clot in the cavity, there is no problem with conservativeness. After all, the mesenteric artery has a low sandwich pressure, and The aorta is incomparable."

Zhou Litao also has some doubts. Just Zheng boss did not say that it is recommended for surgery? How did you change your mouth so quickly?

"It's just a possibility, Cui Laowen, I will say it." Zheng Ren said with a smile: "There are various benefits, surgery, can avoid monitoring, patients with large intestinal necrosis and other complications may occur. If it is conservative, it can reduce the damage of the operation and save the patient and the family of the patient."

This is really sleek, Zhou Litao does not know how to answer.

"Look at the diagnosis first, how to do it, or listen to the patient's family." Zheng Rendao.

The 64-row cT time is very long, and the patient's abdominal pain and agitation are obvious, so it took half an hour to introduce the patient.

Then Zheng Ren said: "Zhou Zong, you should push the patient back first, I will look at the reconstruction results."

Looking at Zhou Litao's departure, Su Yun asked inexplicably: "The boss, this is too much."

Zheng Ren thinks that Su Yun just said that it is not the opposite of Zhou Litao, but that he has more words. Smiled and said: "What people say is true."

"Cut." Su Yun swears, "The pain of the mezzanine is not something that most people can bear. I have encountered a patient and asked him after the operation. He said that it hurts like a knife stuck in his chest. At that time, he didn't want to live. If you can die directly, or die more simply."

"Well, I can do surgery, I still have to do it, and I don't agree with conservative treatment." Zheng Rendao.

"Then why don't you marry him." Su Yun expressed disdain for Zheng Ren's attitude as a good old man.

"It doesn't make sense. This kind of patient can't receive our department. It should be more experienced." Zheng Rendao: "If we need to go to power, we will do it. If not, the vascular department can do it. In the cT room, you are in the emergency department, and you are not free."

"You are a man with a tail." Su Yun looked at Zheng Ren with a smile and said: "Is it so low-key?"

"This is a low-key connotation. And you are not saying that you don't want to go to the emergency department? Why are you so arrogant?" Zheng Ren asked.

"..." Su Yun is speechless.

This is really a dilemma. He thinks carefully, Zheng Ren said that it makes sense, but he does not agree.

It’s very embarrassing.

"There are two viewpoints in the academic world, surgery and conservative. But I still prefer surgery. The specific situation is analyzed. If there is conservative treatment, there is a risk of recurrence." Zheng Rendao: "This point, we have to wait for 64 rows of blood vessels cTa It will be fixed after it comes out."

Su Yun nodded, quietly watching the doctor in the cT room to do the examination, the black hair in front of the forehead floating.

Because it is an emergency, the 64-row cT three-way reconstruction is done very quickly.

The superior mesenteric artery can be seen in both true and false double lumens. There is no thrombus in the true cavity, and thrombosis can be seen in the pseudocavity.

The false lumen is not large enough to compress the blood vessels, causing the superior mesenteric artery to occlusion.

The superior mesenteric artery supplies all the small intestine and 2/3 of the large intestine for blood supply. Once ischemia, it causes ischemic pain in the small intestine.

In Haicheng Zhengren who had a case of intestinal bleeding, embolization of part of the superior mesenteric artery, and actively let the small intestine necrosis and resection, is the reason.

However, patients who used to want intestinal necrosis and found bleeding points were removed. The current patient is to avoid this situation.

The patient's condition is judged, and the operation is between two.

If in the emergency department of Haicheng City, Zheng Ren certainly did not hesitate to explain to his family and went to surgery. But here is 912, ambiguous, Zheng Ren only comments, not responsible for making decisions.

Sending the film back, Zhou Litao has sent the patient to the general surgery, and is not there. Cui Lao inserted the film into the reader, put on the reading glasses, and looked at it frame by frame.

After more than ten minutes, Cui Laocai said: "Xiao Zheng, what do you think?"

"Can be conservative, you can..."

"I asked your opinion, it is not for you to play the ball." Cui Lao was not happy, looked at Zheng Ren.

White hair is like snow, and his eyes are like a knife.

"I recommend surgery." Zheng Ren immediately returned to the road, "I observed on the way, the patient's pain threshold is relatively low, blood pressure control is not good. This patient although there is no thrombus in the true mesenteric artery, but conservative treatment, the more The possibility of good afterwards will be further reduced."

Cui Lao did not speak, sat down and quietly looked at Zheng Ren.

"The operation is also relatively simple, the next stent can be. The superior mesenteric artery angiography + PTa + stenting. If the patient's home economy is no problem, after three days of surgery can be discharged."

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

"..." Zheng Ren was the first time to hear someone commenting on himself.

Cui Lao, it is really different But he practiced medicine in that era, the difficulty is not comparable to the present. The contradiction between doctors and patients has become more and more acute as medical care has been pushed to the market.

"The patient has a history of smoking, a history of hypertension, and poor blood pressure control. In my experience, patients with a history of smoking are basically unable to survive. Now given low molecular weight heparin anticoagulation, alprostadil dilatation of blood vessels, papaverine solution You go to general surgery and prepare for surgery." Cui Lao said.

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

It is difficult to maintain a successful history of smoking, and for Zheng Ren, it is worth a million dollars. If you are so sure, it is not like a doctor said it.

But Cui Lao 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 the journal.

This is just a summary of Cui Lao’s life experience. Other places can’t learn.

Zheng Ren’s heart stunned and nodded deeply.