The child was only five years old, conscious, with a frown on his face, showing an expression of pain, and could not speak a word.
This is a bit different from what I learned before.
Following the car was his mother, a very young Tibetan woman. Although her expression was a little anxious, more importantly, she still had trust in the doctor.
Through simple communication, everyone understood that she actually did not see the child swallowing the foreign object, and she did not know whether it was a nail.
But the reason why the county hospital reported it like this is naturally based on evidence.
They took a CT scan and brought it with them in the car.
CT tip: Metal foreign body in the esophagus, located at the level of the 5th cervical vertebra to the 1st thoracic vertebra.
This tip is clear. Neck 5 is the most prominent part of the flat thyroid cartilage, where the Adam's apple is located. The body of the thoracic 1 thoracic vertebra is approximately 4cm above the jugular notch.
The distance between the two is about 3 centimeters, which is similar to the length of an iron nail, so the county hospital made this guess.
Just a guess, not really sure.
Fortunately, except for the stuck foreign body, all the patient's indicators are relatively stable for the time being, which leaves time for consultation and discussion.
The emergency department, emergency surgery department, gastrointestinal endoscopy department and anesthesiology department all participated in tonight's consultation.
The one who came down from the gastrointestinal endoscopy department was Director Kong himself.
He had already changed his clothes and was getting ready to get off work, but after hearing this, he felt a little uneasy. He had to see it with his own eyes.
He took the CT film and watched it for a long time, and then passed it on to others to watch one by one.
"It's difficult to tell the shape of the foreign body from the CT film alone." He said, "What do you think?"
As the representative of the emergency surgery department, Ye Chen immediately shook his head: "I can't tell. It doesn't look like an iron nail from the cross-section, and it neither punctured the esophagus nor fell into the stomach."
"Your analysis makes sense." Director Kong nodded, his eyes falling on Tao Le who was standing aside.
He had noticed this little girl just now. She spoke Tibetan fluently, which was completely different from someone like him who relied on Bluetooth headphones.
There have been too many new things in the hospital recently, and an old man like him is a little overwhelmed, so he hasn't had time to experience any virtual teaching, and naturally he doesn't recognize Tao Le's identity.
Even so, when he saw that she was so young and had the name of a resident doctor, she was probably a local doctor - his habit of being a teacher came back to him.
There is no other way. Passing on, helping, and leading are the main tasks of aiding Tibet this time.
It is not only necessary to provide good treatment services during the time, but more importantly, what is left behind after the person leaves.
In this kind of situation, he, Kong Qingmin, has never been left behind.
"Tell me about it." Director Kong pointed at Tao Le and said, with a hint of taking a test in his tone.
"I agree with the director and Teacher Ye's opinions." Tao Le replied calmly: "I have a suggestion. Since the shape of the object cannot be seen clearly in the CT scan, just take a plain chest X-ray."
"That's right." Director Kong nodded with satisfaction: "Image detection is a method. When choosing, it depends more on where it is used. CT is indeed clearer than plain films in many cases, but only plain films can be accurate. The ground reflects the overall shape of the foreign object.”
The flat film was soon taken. The location of the foreign body was similar to what was seen on CT, but the shape was very different from what was expected.
It's not a nail, but a ring-shaped metal piece stuck right under the entrance to the esophagus.
It was this thing that tortured the child for more than 6 hours.
Judging from its size and location, it is still difficult to remove it by conventional means.
"To be on the safe side, let's do a surgical incision." Director Kong thought about it and was not very sure.
"No problem." Ye Chen has a background in gastrointestinal surgery and has experience in this kind of surgery.
The conditions for surgery today were pretty good. Needless to say, he had prepared the blood source in advance. He originally wanted to try the acupuncture pulse control and hemostasis technique he had just learned.
What's even more unique is that Teacher Tao Letao is also here, so even if there are any problems, he can remedy them in time.
Seeing that the proposal for surgery had been unanimously approved and the discussion of the anesthesia plan was about to begin, Tao Le quickly spoke up.
"Wait a minute." Her voice was clear and focused everyone's attention.
"I think we can try to remove the object directly. If it doesn't work, we can do another operation."
Director Kong was a little surprised and a little impatient when he heard this. How many years has it been since his judgment and decisions were interrupted and questioned?
The emergency anesthesiologist was Le Zeng, the attending physician at Beijing No. 2 Hospital. He sat on top of Tao Le. Hearing this, he quietly pulled her hand and murmured in a very small voice:
"Teacher Tao, Director Kong is authoritative in this regard."
"I know." Tao Le said openly, "That's why I said I wanted to give it a try and let Director Kong see if it's feasible."
Kong Qingmin's good impression of this young doctor has basically been cleared. He has always been willing to give advice to his disciples who are sensitive and eager to learn, but only if they understand the rules.
"Why can't it be done? I have thought about it all." He said with a serious face: "I don't have time to explain it to you one by one now. In the future, you can study more and think more, and you will naturally understand."
"The main reason is that there is no assistance from an endoscope, right?" Tao Le not only did not stop there, but continued to ask.
Kong Qingmin kept a straight face and did not answer. He turned directly to Le Zeng and asked: "Are there any problems with anesthesia?"
"The child is a bit young. Consider using intravenous anesthesia. There should be no problem." Le Zeng replied quickly, while giving Tao Le a wink.
Unfortunately, not only did she not want to answer, she stood up directly and said loudly:
"The location of the foreign body is not deep, so it can be taken out directly with the intubation forceps. I can do it blindly without an endoscope."
Kong Qingmin felt like there was a fire rushing up to him.
Blind take? who do you think You Are? I have been doing endoscopy for so many years and know the structure of the human esophagus and stomach very well, so why don’t I do a blind scan?
Not because the metal piece stuck under the esophagus is indeed a bit large, and blind removal is very likely to push it deeper, scratch or even split the esophagus.
Rather than having to undergo surgery in the end, or even face more serious problems - esophageal fistula, or even suppurative mediastinitis or pleurisy, it is better to use this treatment plan directly.
He was about to say something more when he heard Tao Le say: "I'll try it once. If it doesn't work, I'll use your plan for surgery, director, okay?"
Kong Qingmin suddenly felt helpless.
