Diagnosis: General surgery proficiency 10.1/100.
Cool!
As long as the 'money' is in place, everything you wish for will really come true.
This diagnostic medical skill was instantly upgraded from entry level to proficient level.
He was pleasantly surprised to find that his vision for diagnosing general surgical diseases suddenly opened up. In fact, every medical student learns the same clinical theoretical knowledge. Why are there some strong and some weak?
In the diagnostic process, experience accumulation is one aspect, and diagnostic thinking is equally important.
With experience in diagnosing various similar diseases, we can conduct comprehensive analysis and syndrome differentiation based on patient symptoms, examination results, medical history, age, etc.
In the end, we can get rid of the false and seek the truth, and then we can get the correct diagnosis result.
It can significantly reduce the probability of misdiagnosis and missed diagnosis.
The improvement of diagnostic thinking requires accumulation over time and diligent thinking.
Opening your horizons is equivalent to improving your diagnostic thinking.
He felt that after the general surgical diagnosis was upgraded to the proficiency level, it seemed that he had reached a new high point when diagnosing diseases in this field.
In the past, when I stood at the foot of the mountain and looked at the scenery, I could only see a very small part.
Now that we have climbed halfway up the mountain, we stand at a different height. Our field of vision has opened up, and we can already see more things.
Doubts and diagnostic clues that were invisible before, and details that were easily overlooked before, are all now visible.
There are many reasons why pustules may develop on your back.
Common ones include folliculitis, diabetics, local injuries and infections, back compression due to long-term bed rest and lack of hygiene...
This old man got sick suddenly. He suddenly felt pain in his back more than a month ago. After a while, a large red and swollen lump developed, and then began to suppurate.
Causes such as folliculitis and local injury and infection can basically be ruled out.
The old man was well-dressed and clean, and he didn't look like someone who was unhygienic.
Li Jingsheng carefully searched for clues, trying to find out the real cause.
He looked at the pustule on the old man's back again, and now he could see pink liquefaction flowing out of the wound. There is a streak of yellow-white liquid mixed in the middle. If you are not particularly careful, it is easy to ignore it.
If he was still an entry-level general surgical diagnostician, even if he saw the yellowish-white liquid mixed in the pink liquid, he wouldn't care at all.
At this moment, he had proficient general surgical diagnostic skills, which immediately attracted his attention.
"The debridement was just completed at the community service station yesterday, and anti-inflammatory and antibacterial drugs were used in the abscess cavity. How could it suppurate so quickly?"
Because according to Li Jingsheng's medical knowledge, it takes at least three days for a pustule to mature and liquefy, that is, suppurate.
He immediately found a cotton swab and picked out a little yellow-white liquid.
Those pink liquids are blood and body fluids, and they are very light.
The yellow-white liquid he stirred up seemed quite viscous.
Like purulent nasal discharge, it can be stringy.
But it's not as sticky as purulent nasal discharge.
It can basically be concluded that this is mature pus.
What exactly is going on?
Could it be that the debridement in the abscess cavity was not complete and there are still infected lesions?
Li Jingsheng looked very excited after finding a clue.
As long as this old man is cured, his small clinic will become famous in the field of general surgery. In the future, we will attract a steady stream of patients with surgical diseases to come for treatment.
This was the type of patient he most desired.
Not just because he has spent a lot of life, time and energy to learn and improve many surgical skills. And it’s not just that surgery is very profitable.
Also because surgery is easy to learn and difficult to master, not to mention in clinics, but also in most primary medical institutions, including community health service centers, the development of surgical business is basically in a state of neglect.
Because training surgeons is too difficult.
The cycle is long, the threshold is high, the risks are high, and the investment is high.
The key is, after finally cultivating him, he immediately jumped to a larger hospital.
Water flows to lower places, and people go to higher places!
Who doesn’t want to live a good life?
If you have greater abilities and can enter a larger hospital, you will naturally choose to go to a larger hospital for development. Not only will there be greater room for development, but the working environment and learning environment will be better.
Income will also be higher.
At the same time, social status and medical status will rise accordingly.
There are very few surgical patients in primary hospitals, which is one reason why good doctors cannot be retained.
After all, small hospitals can only treat minor ailments such as colds and fevers, which is deeply rooted in the hearts of the people.
"Old man, I'm going to open your wound and look inside. It will hurt a little. Do you need some anesthetic?"
Li Jingsheng asked the old man.
"It's okay. This little pain is nothing. I can bear it."
In front of his wife, the old man showed his iron will.
"Just be brave! It'll hurt if you stay there! Don't scream!"
The old lady was taunting her husband.
In fact, it is also a disguised form of concern. She definitely still wants her husband to take anesthesia, but she doesn't want to damage her husband's dignity in front of outsiders.
That's why I gave such a cynical reminder.
"Who are you looking down on? Dr. Li, it's okay. Just open it and check it! I promise not to cry out about pain."
The old man spoke forcefully, but he closed his eyes, and then clenched his back molars, making his cheeks bulge.
Li Jingsheng held back his laughter and took the old man into the treatment room inside.
“Do you need a cork in your mouth?”
"What do you want that thing for? Get it quickly."
The old man said impatiently.
Li Jingsheng was mainly worried that he would break his teeth.
The old man turned his head and saw that the door to the treatment room was closed and his wife had not come in, and his expression suddenly relaxed a lot.
Take a deep breath, then close your eyes again and grit your teeth.
Li Jingsheng used a sterile cotton swab to open the incision and found that the abscess cavity was quite deep.
He shined a flashlight inside to look for the source of the yellow-white pus.
The old man's body was shaking slightly, obviously in great pain.
Cold sweat also broke out on his forehead.
But he didn't say a word.
The main reason is that he is afraid that his wife outside will hear him laugh at him.
After some hard work, Li Jingsheng accidentally found the source of pus outflow about 2cm superficial to the left side of the abscess cavity.
"Strange, why did the pus flow out from here?"
He was very excited about this discovery.
At the same time, I am also very puzzled. This position is a good place for surgical debridement, and the possibility of not cleaning it is very small.
It was debrided three times, and the second time was even performed by Ding Wangshou, a senior surgeon.
How is it possible to leave a small piece of infected and suppurating tissue without cleaning it?
When something goes wrong, there must be something fishy.
Li Jingsheng changed to a long cotton swab and tried to scratch the source of the pus.
"Well!"
The old man groaned.
Teeth clenched.
You can see that the tissue in that area is slightly white, and the pus has not continued to flow out.
"It hurts a little, just be patient! As long as the cause is found, your pustule will hopefully be cured."
Li Jingsheng observed the location of the source of pus that he had just identified.
After a while, light yellow pus came out again.
The amount is very small.
Only as thin as a hair.
If he hadn't made a diagnosis in advance and deliberately searched for the source of the pus discharge, he might not have made this discovery at all.
He simply checked the entire abscess cavity carefully several times.
Make sure only that location is where the pus continues to drain.
"Is this a hidden sinus passage?"
A flash of inspiration flashed in Li Jingsheng's mind, and he knew that there was a major breakthrough in diagnosis.
The real cause has probably been found.
Doctors at health service stations will definitely use alcohol or saline when debriding patients.
This causes the source of pus to disappear temporarily.
Because both alcohol and saline are highly irritating.
When cleaning the abscess cavity, the muscles will automatically contract due to pain.
The sinus tract is forced to temporarily close, and no more pus will flow out.
When the patient got sick a few days later and went to see a doctor, he found that the abscess cavity was already severely infected and filled with pus. It was even more difficult to find this tiny sinus tract.
This also led to the failure of all surgeons at the health service station to discover this hidden sinus tract.
Refractory pustules caused by sinus tracts are uncommon but can be encountered clinically.
However, usually, the sinus tracts are relatively large, forming a pus drainage port directly on the body surface. An experienced doctor can diagnose it at a glance.
This old man's sinus tract was in his back. In addition, it took a long time to seek medical treatment. The medical skills and examination equipment of the health service station were limited, so the real cause of the disease was never found.
He was treated again and again, but the disease just wasn't getting better.
It happens over and over again.
Now that the sinus tract has been discovered, this is a good thing.
But it’s not too early to be happy.
If the sinus tract is too deep, Li Jingsheng will definitely not be able to handle it.
In addition, his small clinic has no other examination equipment except an outdated X-ray machine and a B-ultrasound machine.
Fortunately, examining sinus tracts does not require high-precision instruments such as color Doppler ultrasound, CT, or MRI.
B-ultrasound combined with X-ray can completely detect it.
Large hospitals are more rigorous and often conduct examinations in conjunction with laboratory data.
If it is deep inside the body, such as the chest, abdomen, etc., in order to identify the sinus tracts, sinus angiography may even be performed.
Li Jingsheng suppressed his inner excitement and joy.
The opportunity to make a name for yourself is now.
But be sure to hold on steady.
You must stay calm, otherwise if the disease is not cured, and the person is disabled or killed, it will really become a state of extreme joy and sorrow.
"Sir, we have made a major diagnostic breakthrough for the cause of your disease. I found out that there is probably a sinus tract. Next, I need to do an ultrasound examination and X-ray examination for you. The cost of these two examinations is 200 yuan."
The old man doesn’t seem like someone who is short of money.
He should be able to afford the cost of these two tests.
Li Jingsheng's inspection equipment is always a bit old, but it has to be something different.
"Great. As expected, I came to the right place. As long as you cure me, it won't be a problem to give you an extra thousand yuan in red envelopes. No... one thousand yuan is still a little less. I will give you two extra red envelopes. Thousands of red envelopes.”
The old man was very generous.
Bang bang bang!
When the old lady heard her husband starting to spend money outside, she was so anxious that she banged on the door.
"Old man, let's cure the disease first. Other hospitals don't allow doctors to receive red envelopes now, so don't harm other doctors."
The old lady is somewhat quick-witted.
This excuse was high-sounding. It would not make Li Jingsheng unhappy, but it would also prevent her husband from giving Li Jingsheng an extra red envelope of two thousand yuan.
Men are generous and women are stingy. This is almost natural.
