"Do you have any symptoms such as night sweats, diarrhea, and nausea while sleeping?"
Li Jingsheng asked calmly.
"My appetite has never been very good. It's true that I've had diarrhea recently. Is this okay?"
she asked nonchalantly.
"Wait a moment." After Li Jingsheng said to the patient, he turned to look at the counter. "Sister Tang, please come over and check this female patient's lymph nodes."
"OK!"
She said something to the customer who was buying medicine, and then walked over quickly.
Maybe he was in a hurry to go back to the counter to sell medicine. After signaling to the young female patient, he reached out to touch her neck.
"Hey, wait! Put on your gloves, it's more hygienic!"
Li Jingsheng quickly stopped and handed her the transparent film gloves.
Patients usually wear rubber gloves when performing operations, which are very thin but still affect the touch of the hands.
Membrane gloves are thinner, have little effect on the feel of your fingers, and are very cheap.
The only drawback is that it is easy to break.
However, it is fully capable of performing medical examinations on the body surface.
Tang Ping nodded knowingly, put on gloves and checked the lymph nodes in the patient's neck. In fact, most warm-blooded animals with hairs have the most abundant cervical lymph nodes.
For example, this is the case for commonly eaten chickens and pigs.
If possible, try to eat less chicken neck skin and pig neck meat, also known as trough meat.
If you really want to eat it, you can clean it before cooking.
Because lymph is an important part of the immune system, lymph is the bravest fighter and the main battlefield against the invasion of various viruses, germs, and toxins. After long-term accumulation, the lymph becomes a accumulation station for toxins and harmful substances.
After eating, it will definitely be harmful to human health.
When Tang Ping checked the lymph nodes in the patient's neck, the patient complained of pain.
"There is bilateral cervical lymphadenopathy."
Tang Ping looked at Li Jingsheng.
"Check her armpit lymph nodes again."
Li Jingsheng's expression became much more serious.
When Tang Ping examined the patient's armpit, she laughed repeatedly, "Gurgling, ticklish, I'm ticklish..."
"Just be patient for a little bit, the inspection will be over soon."
After the inspection, Tang Ping's expression became much more solemn.
"Boss, I just checked her and found that the lymph nodes in her neck and armpits were swollen."
"Go and do your work!"
Li Jingsheng nodded.
"Girl, please register your name and contact number."
"Why do you need to register these when buying oral ulcer medicine? I don't need to register when I buy it at a pharmacy!"
The patient appeared very alert.
"You also said that it was a pharmacy, and ours here is a clinic, which is equivalent to the outpatient department of a hospital. The nature is definitely different. Don't worry, we are just asking patients to register routinely in accordance with the regulations of our superiors, and we will never reveal the patient's privacy. "
The ledger Li Jingsheng took out was densely packed with the names, contact information, and even addresses of many patients.
Clinics have some disadvantages compared to hospitals.
For example, when a patient registers, no matter what the disease is, the hospital can only treat patients if they register. As long as the patient registers, the patient's ID card information can be obtained.
It is very difficult for clinics to obtain patient ID information.
Especially a small clinic like this.
We are still struggling to have enough food and clothing. If a patient comes in to buy medicine for oral ulcers and you have to ask her to register her ID card information, she will probably turn around and leave.
All Li Jingsheng can do is try his best to persuade patients to cooperate.
The female patient finally filled in her name and phone number.
In order to prevent the information from being incorrect, Li Jingsheng took out his mobile phone and tried to dial the above number on the spot.
The phone rang on her.
The ringtone is also a very touching love song "There is a kind of love called letting go".
Young men and women often have beautiful visions for love, and naturally yearn for beautiful love.
"Please understand, I'm just verifying that the phone number is correct."
Naturally, Li Jingsheng would not say that some patients did not fill in their real numbers.
"Can you give me the medicine now? Also, what is the cause of my swollen lymph nodes?"
"I suspect your disease is not a simple oral ulcer. I suggest you go to the Centers for Disease Control and Prevention immediately for further examination. There are free medicines available there."
"What disease is that?"
The girl looked confused.
"We won't know until the disease center tests it. I initially suspect it is a bad viral infection."
"Do I have to go to the Centers for Disease Control and Prevention? Can community health stations treat it?"
"I guess no matter which hospital you go to, you will eventually go to the Centers for Disease Control and Prevention. They are better at treating this disease. It's best not to delay and go now, because this virus is contagious to a certain extent."
"Okay then! Thank you!"
The girl is gone.
After going out, I saw her standing on the side of the road, hailing a taxi, and headed towards the west end of the old street.
The west end leads to the city center, and the Municipal Center for Disease Control and Prevention is in this direction.
It seems that she took the advice and took a taxi to the CDC.
Li Jingsheng still called and reported the matter as required.
Because he was unable to obtain the patient's ID card and other information, the follow-up work could only be left to the CDC.
"Boss, what's wrong with that girl?"
Tang Ping knew that the girl's illness was certainly not simple.
Otherwise, the boss will not let her wear gloves for inspection.
"Maybe it's Xiao Ai."
Li Jingsheng's tone was quite serious.
'Xiao Ai' is a code word among medical staff, a code name for AIDS.
For example, syphilis is called 'Xiao Mei'.
If it's cancer, it's called CA, and sometimes it's also called mass. Very few doctors and nurses would say the word cancer in front of their patients.
This is done to avoid stressing the patient.
"It's such a pity that Xiao Ai was infected at such a young age. Many girls don't know how to protect themselves."
After hearing this, Tang Ping shook her head and sighed.
"I'm afraid she herself is completely unaware. When the test results of the disease control come out, she will probably collapse."
Li Jingsheng also sighed.
The disease is always so ruthless and will never show mercy because of the patient's age or gender.
"Boss Li, the signboard has been installed for you, please check it. If there is no problem, I will come over in the evening to settle the bill."
The advertising store owner came in and said to him.
Many business people are superstitious and only go in and out in the morning. The first business opened in the morning, even if it doesn't make any money, I am willing to close the deal as long as I can protect my capital.
The owner of the advertising store proposed to settle the bill in the evening because he was worried that he would upset the customer in the morning.
Li Jingsheng went out to take a look and found it was very good.
"The boss's craftsmanship is very good! I will pay you the balance now, there is no need for you to make another trip."
He settled the bill on the spot.
He doesn't believe this.
The owner of the advertising shop has just been sent away, and another patient has arrived.
A middle-aged woman in her late thirties entered the door, covering the right side of her face.
"Doctor, the right side of my face hurts so much. Can it be cured?"
She showed pain even when she spoke.
"How did it happen? Did it suddenly start hurting?"
Li Jingsheng found that the woman's right cheek was very red and swollen.
First of all, it was natural to suspect that she was beaten by her husband.
A girl is afraid of marrying the wrong man.
Some women are married to violent husbands who will grab the woman and beat her up if she doesn't do anything right. This kind of thing is not uncommon.
"I don't know what's going on. Four days ago, I felt a little pain here when I was eating. I thought it would be fine in two days, but I didn't expect it to get worse. Today I feel a rancid taste in my mouth. In the past two days When brushing your teeth, I don’t dare to touch this area.”
She pointed to the molars on her right lower jaw.
For this kind of disease, you should have seen a dentist.
But for Li Jingsheng, every surgical patient is extremely precious.
They have already come to your door. If you can eat it, you will definitely be welcome.
"Let me check you first."
He reached out and pressed the woman's right cheek and chin.
"Oh...it hurts, it hurts so much!"
The woman immediately cried out in pain.
"I feel a lump, let me look inside again! Open your mouth!"
Li Jingsheng took out a small flashlight.
The woman's mouth looked painful when she opened it, and she could only open her mouth to about two-thirds of its normal width.
Significant swelling can be seen between the buccinator muscle and mucosa.
There is caries on the lower right first molar.
Oral inflammation and redness and swelling like this are often related to root inflammation.
Considering that the red and swollen area is large in size and there is likely to be pus inside, the effect of antibiotic treatment may not be ideal.
Li Jingsheng now has an expert level of drug efficacy and drug metabolism. These two medical skills have brought him great convenience when formulating treatment plans for patients.
Just by looking at the situation, you can estimate the approximate treatment effect in your mind.
Proficient general surgical diagnosis is also of great use at this moment.
The best way to determine whether there is an abscess in the red and swollen area of the patient's right mandible is to perform a puncture.
The patient has felt a putrid smell in his mouth for the past two days, and it is very likely that there is pus overflow.
If an abscess is present, surgery will be required.
"Surgical drainage combined with antibiotics to control the inflammation should be able to resolve the abscess. If you have to extract the molar, it won't be able to deal with it."
He quickly made a prediction in his mind.
It may seem like just redness and swelling on the cheek, a minor problem, but treatment requires the attending doctor to have a variety of medical skills.
Medication, general surgical diagnosis, oral diagnosis, surgical incision, separation, hemostasis, suturing, etc.
It’s not difficult to meet people.
For specialists in large hospitals, handling this case is just a piece of cake.
Li Jingsheng needs to use all his strength.
The patient's first molar was incomplete due to dental caries.
The periodontal redness and swelling are extremely obvious, indicating that the cheek is red and swollen caused by this molar tooth.
Upon closer inspection, it does not look like molar apicalitis.
He found a wound next to the root of the tooth, as if it had been punctured by something.
Because the cheek was swollen, the wound was located around the molar and was almost ignored.
"Have you ever had your gums pierced by a bone or something when you were eating something a few days ago?"
"Yes. When I was eating chicken, I was pricked by bone fragments. It hurt a little at the time, so I thought it was nothing and ignored it. My face is swollen like this. Is it related to it?"
the patient asked.
"We are not sure for the moment, but it feels like there is a certain relationship with the gum being punctured. It just so happens that this tooth is also a carious tooth. After the injury, it caused infection and inflammation, resulting in molar apexitis."
Li Jingsheng could only make a rough inference.
I can't say for sure.
"What should I do now? Can you treat it here?"
The patient suddenly became anxious when he heard multiple disease names.
Who would have thought that eating a chicken could cause such a big problem.
"I suspect that there is suppuration inside, and I need to take an ultrasound. The cost is 100 yuan, can you do it?"
"Can you still disagree? Let's do it!"
Women are not stingy people.
The money that needs to be spent must be spent.
If you are sick, you must treat it!
After guiding the patient to pay the fee, Li Jingsheng took her to have a B-ultrasound to check the condition.
He is not good at diagnosing the oral cavity.
Suppurative mumps is also possible.
There is also an unknown abscess, which must be investigated.
The face is very rich in nerves and blood vessels, so the risks of surgery are quite high.
Fortunately, his stitching level has improved now.
If you need to make an incision to drain pus from the face, you must consider the issue of postoperative suturing scars.
Especially women who love beauty should pay more attention to it.
After ultrasound examination, Li Jingsheng found that the boundary of the lesion was not clear, the internal echo was uniform, and the area of the lesion was more than 5*7.
There are three stages of abscess.
Pre-abscess stage, abscess formation stage and abscess absorption stage.
It is currently between the early stage and the formative stage.
If left untreated, the area of the lesion will continue to expand, and eventually ulcers will appear inside the mouth or face, and pus will flow out. An abscess of this size already carries a serious risk of poisoning.
and the possibility of sepsis.
After the ultrasound examination, Li Jingsheng took her temperature with an infrared ear thermometer and found that she had a low fever.
37.4 degrees.
Measured again, 37.5 degrees.
Fluctuations in body temperature measurements are normal.
The patient developed low-grade fever.
A rise in body temperature also means the body's immune system is triggered to begin a full-scale fight against the abscessed lesion.
Ordinary small abscesses, such as the most common type of acne, do not cause a rise in body temperature.
The patient's body temperature rose by nearly one degree, the first sign of an all-out war by the body's immune system. If sepsis occurs, the body's immune system cannot resist it, and the patient will develop high fever, chills and other reactions.
"My situation is not serious, right?"
the patient asked.
"It's quite serious. There's an internal abscess, and it's quite large. You don't have any symptoms like chills now, do you?"
"No."
The patient denied it.
"I just gave you a comprehensive examination, and your situation will definitely not be solved by just injections. My suggestion is to incision and drainage of pus. You may need to do a larger operation to separate the pus lesions. Then cooperate with injections to reduce inflammation. , anti-infection, and the disease should be under control within three or four days."
Li Jingsheng hopes to win this business.
Not only to make money, but also to increase the diagnosis and treatment experience in this area, and to improve the surgical level at the same time, the life points earned should not be too little.
There are many benefits and he is naturally positive.
"I need an operation. Can you do it here?"
When the patient heard that he was going to have surgery, he was a little hesitant. It’s hard to believe how good a small clinic is.
"Can do it."
Li Jingsheng answered firmly and forcefully.
"Our boss's surgical skills are very good! Here, this young man suffered a big, long cut on his waist. Our boss gave him treatment and he has basically recovered now."
Tang Ping pointed to the young man who came for the review to help Li Jingsheng support his appearance.
The young man smiled honestly.
"Then... let me call my husband first and ask him how much this surgery will cost?"
"The total cost is estimated to be around 800. If the drainage effect is not good and the surgery needs to be expanded, the cost is estimated to be around 2,000." Li Jingsheng could only give a rough cost estimate.
In larger hospitals, it costs more than 700 just to suture a skin flap, purely for surgery.
This patient's surgery is definitely not easy, and the risks are also quite high. He still has to have intravenous injections for three to five days. Eight hundred yuan is really not much.
Li Jingsheng knows that the only advantage of a small clinic is that there is no queue, the cost is low, and it is convenient.
It's still in the initial stage, don't think about how much money you can make at once, take the business first before you have the chance to expand your reputation.
Many people don't even know that he can perform surgeries here.
The woman walked aside to make a phone call.
Li Jingsheng checked the wound of the young man with a scratch on his waist, and the healing reached the best level A.
No inflammation, no infection, no cracks, no pus.
It can be seen that the initial healing of the wound is basically completed.
"You should be able to come over and have the stitches removed in two days. You don't have to come over tomorrow."
Li Jingsheng gave him a tube of erythromycin ointment and asked him to go home and apply it on the wound.
The fact that such a long wound could heal so quickly gave Li Jingsheng greater confidence.
If he were allowed to return to work in the No. 1 Hospital now, he would be able to complete the skin suturing task no worse than the attending physician.
As for outstanding trainees and residents, their suturing skills are definitely not as good as his.
At this time, new patients came in.
"Doctor, I brought my mother-in-law here. Please take a look."
The man who opened the door that morning and inquired about whether he could have his bones straightened came over with a thin woman.
This woman was particularly thin, with dry and yellow hair, and she walked very slowly.
Her movements are not as agile as some old people.
"Did you break your right wrist in the fall?"
Li Jingsheng motioned for the woman to sit down.
"right."
She carefully rolled up the sleeve of her right hand. Her right wrist looked quite slender, like a fragile young lady in ancient times. It's really like being powerless.
The skin is duller.
Diagnosed with the naked eye, there was no obvious redness or swelling, only some abrasions on the underside of the wrist and the palm of the hand.
Wrestling is something that no one can avoid.
Needless to say, children are naughty, active, try some dangerous moves, and wrestling is commonplace.
Adults are generally more stable and will not fall easily.
However, after an unfortunate fall, the injuries are often much more serious than those for children.
This woman was too thin and seriously lacked the protection of the fat layer. When she fell, her bones were almost there to bear on her.
"Even if I can't use this hand hard, especially when carrying a basin or a bowl, it will be extremely painful."
She took the initiative to describe the symptoms to Li Jingsheng.
"Let me check it out for you."
Li Jingsheng used a junior-level bone-touching technique to touch her bones.
His expression is always serious.
Her husband was standing nearby, grabbing his wife's hand and stroking it here and there, so as not to cause any misunderstanding.
He is a pretty good male doctor in the hospital's nail and breast surgery department. It is dangerous when he encounters a female patient with breast lesions and performs palpation.
I saw that his movements were gentle but precise, and extremely stable.
Compared with the master-level bone-touching technique, it has obviously made great progress.
It has been able to achieve the three key points of stability, accuracy and lightness. The technical points of two light and one heavy points and three fixed points when touching the bones have also been basically integrated.
The judgment of bone elephants has also made great progress.
In the past, we could only judge the density of bones, but now we have a clearer tactile judgment of the toughness, density, and whether the bones are diseased.
You can even feel some of the vitality of the bones.
After touching it, he felt confident.
It's nothing serious, just a partial dislocation of the wrist bones and a slight fracture in one place.
"Can it be cured?"
"The problem is not that big. There seems to be a fracture. I need to take an X-ray to check."
Li Jingsheng must take a film for her before he dares to treat her.
If anything happens, taking a film can be used as the best evidence.
"It turns out the bone is broken, no wonder it hurts so much! Help me pat it!"
When the woman heard that she had broken bones, she had a clearly frightened expression on her face.
"There are many levels of fractures. Your bone is not completely broken. For example, if you bend a small stick hard, there will be cracks, but it will not break. That's probably what it means."
Li Jingsheng explained.
"How much does it cost to do a test?"
The woman's husband is more concerned about expenses.
"One hundred dollars."
"Can I not take pictures?"
"That's definitely not possible! This is just the most basic examination. If you go to a big hospital, you will probably be asked to take a CT scan, which is much more expensive."
Li Jingsheng discovered that it is really not easy for a small clinic to make money.
A checkup costs 100 yuan, and the patient still wants to bargain.
There is no such thing in large hospitals. Routine examinations are prescribed directly by doctors without consulting the patients at all.
(End of chapter)
