Damage to blood vessels during surgery, leading to blood clots?
This is possible, but it is obviously inconsistent with symptoms such as high fever.
The patient's surgical site is on the lower limbs, and there are not many reasons that can cause high fever in a short period of time.
It takes at least several days, or even longer, for wound infection and suppuration to cause sepsis.
While Li Jingsheng was thinking hard, he felt that his knowledge and experience were still too little.
"By the way, there are ecchymoses under the conjunctiva, is it just an accidental phenomenon?"
Subconjunctival ecchymosis is a good breaking point.
The most common causes of subconjunctival ecchymosis are sepsis, gonococcal conjunctivitis, and subacute infective endocarditis, and these causes can basically be ruled out.
Li Jingsheng's cardiovascular medicine diagnosis level is not high, but he has some experience in diagnosing infective endocarditis.
At this time, Director Hua and others had already discussed a result.
"Considering that there is a certain purulent lesion at the connection between the patient's tibial head and joint, although debridement has been performed, sepsis is still suspected."
Many of the patient's current symptoms are indeed highly consistent with sepsis.
Now that there are pathogenic factors, Director Hua and others almost unanimously support this diagnostic conclusion.
Li Jingsheng just happened to master the Department of Dermatology Immunology not long ago, and he has some deeper insights and understanding of immunology medicine.
In addition, the diagnosis of cardiovascular medicine also has a certain level.
General surgical diagnosis also has a good foundation.
These are closely related to the Department of Infectious Diseases.
He thought it was very unlikely that the patient had sepsis.
The time shouldn't be that short.
Of course, it cannot be ruled out that the patient has developed sepsis before surgery.
But this possibility can also be ruled out.
No preoperative examinations?
Unless the second hospital is a sham and there are major problems in management.
If it was really that bad, it wouldn't be alive now.
Therefore, the possibility of sepsis is basically ruled out.
"Beauty, can you check the patient's armpits to see if there are any ecchymoses?"
Li Jingsheng looked at the nurse in charge of the bed.
Originally, it would be better to call her Teacher XX, but Li Jingsheng was not familiar with her and didn't even know her name, so he decided to call her Beauty instead.
Nowadays, beauty has basically become a universal term for young women.
"Can."
She nodded in agreement.
But judging from her disapproving expression, she also felt that Li Jingsheng had a lot going on.
The chief physicians have discussed the diagnosis. Why are you, a resident doctor, messing around here?
Can you show off?
After examining the patient, she couldn't help but exclaim, "The patient has a lot of ecchymoses in the left armpit." Then she examined the right side.
"What about the right side?"
Director Hua asked impatiently.
Obviously, this is a major discovery.
Considering the patient was a lesbian, no one thought to check her armpits.
"There is also extensive ecchymosis in the right armpit."
This result made everyone look at Li Jingsheng with admiration.
Director Hua, Professor Wu and others could not help but rethink the possible causes of the patient's disease.
After Li Jingsheng learned that the patient also had a large number of ecchymoses in his armpits, he immediately thought of a possibility.
"It's a fat embolism, that's probably it!"
Although the diagnosis is obtained, what is the cause of fat embolism?
The pathological mechanism has not been sorted out, and Li Jingsheng did not dare to draw a conclusion rashly.
"Director Hua, I suggest that the patient do a urine test and blood routine immediately, focusing on checking whether there are fat particles. It is best to push the ventilator over and prepare it. The patient's lungs should have severe edema, and the condition is progressing. It’s so fast, I’m afraid that when the time comes… I’ll be in a hurry.”
Li Jingsheng said it more tactfully this time.
"Xiao Li actually gave me this suggestion once, but I didn't think it was adopted before it got to that point."
Professor Wu might be worried about losing face, so he explained.
After all, even a fool can see now that Li Jingsheng, the new doctor, is very unusual.
Although they haven't given a diagnosis yet, they checked the fat particles in the urine and blood, which obviously gave a diagnosis.
And it’s definitely not sepsis.
Also, whether Li Jingsheng asked the patient whether the urine output had decreased or whether there were ecchymosis under the armpit, he always gave the right answer.
This ability of analysis and judgment is enough to instantly kill Dr. Ruan Xiaoqin and others present.
Even Professor Wu feels ashamed.
At this time, almost everyone in the orthopedic surgeon's office came, as long as they had no clinical duties for the time being.
Director Hua was directing the rescue at the scene, so he wanted to show off and at least learn some rescue experience.
After all, there are very few critical and severe cases that require rescue in orthopedic surgery.
Ou Qinglan was already fair-skinned and beautiful, but after putting on a white coat, she looked even fairer. Standing there, it is like a beautiful scenery.
Looking at Li Jingsheng on his first day at work, he was as powerful as a veteran on the battlefield, even faintly overshadowing the two chief doctors present. When she looked at Li Jingsheng, she couldn't help but be filled with excitement.
This is the man she admires.
Don't back down when facing gangsters. When faced with critical and severe cases, he was brave, resourceful and possessed strong medical knowledge, and performed extremely well.
It's really excellent.
Xiao Jing's eyes were a little sour, but more of a shock. He also didn't expect that the new Dr. Li was not only good at bone setting, he was also so good at diagnosis.
The most depressing person is Dr. Qin.
He has publicly declared that he will compete with Li Jingsheng to steal the beauty Ou Qinglan.
In terms of wealth and family status, he is confident that he can kill Li Jingsheng instantly.
At work, he previously thought he had great advantages. Now that he was actually on the battlefield, he realized how big the gap was with Li Jingsheng.
And it's not that he is stronger, but that Li Jingsheng is much stronger than him.
"Check the urine and blood immediately, and borrow the ventilator. Doctor Qin, go borrow the ventilator and be quick."
Director Hua's eyes were directly locked on the young doctors standing behind.
In the end, Dr. Qin became the unlucky guy who ran errands.
"Which department should I borrow from?"
Doctor Qin was very depressed. He was the chief resident after all, so why didn't he ask Xiao Jing to do errands?
"Go to the respiratory medicine department! Hurry."
Director Hua looked impatient.
When Li Jingsheng talked about preparing a ventilator, his expression and tone were very serious, which made Director Hua feel a little bit stressed.
Precisely because Li Jingsheng's performance in all aspects was excellent, Director Hua realized that Li Jingsheng would definitely not talk randomly.
Now I am afraid that something will really happen to the patient.
"Okay! I'll go right away."
Doctor Qin did not dare to neglect and immediately ran to the Department of Respiratory Medicine.
"Director Hua, if possible, I suggest you prepare some emergency medicine for fat embolism immediately. The patient's breathing rate accelerated three times per minute in this short period of time. And even after inhaling oxygen, the blood oxygen data did not change significantly. . I’m worried that the time left for us to rescue is getting less and less.”
Li Jingsheng once again gave a more pertinent suggestion.
Nearly a year of clinic experience has made him calm and wise.
Always do things carefully and never fight unprepared battles.
With these abilities, let alone a young doctor in his twenties. Even a forty-year-old doctor may not have it.
"Dr. Ruan, you go get ready immediately. Do you know the emergency medicine for fat embolism?"
"clear!"
If Ruan Xiaoqin can't even do this well, his job as an attending physician will really be in vain.
"Dr. Li, tell me why you suspect the patient has fat embolism or your diagnostic ideas."
"The reason is quite sufficient. I haven't figured out the diagnostic idea yet. Can you let me think about it again?"
Li Jingsheng felt a little uncomfortable when he faced the gazes of two chief doctors, many young doctors, two nurses, and family members.
"No problem, just think about it slowly and tell me and Professor Wu when you have decided."
Director Hua handed him the patient's examination information directly.
“To view the patient’s medical records and treatment plans, you can go directly to the office computer to view them.”
"Ok, thank you."
Li Jingsheng could feel that Director Hua valued him very much.
"Old Wu, which one do you think is more likely to be fat embolism or sepsis?"
Director Hua ignored him and started a new discussion with Professor Wu directly in the ward.
Director Hua did not dare to leave until the patient was out of danger.
"Ahem... Well, the probability of fat embolism is indeed higher."
Professor Wu's old face felt a little feverish.
It was undeniable that he was taught a hard lesson by this young doctor today.
Li Jingsheng's performance was so dazzling.
"Fat embolism is more likely to occur with long-term fractures. If this patient does develop fat embolism, the pathology must be clearly investigated to prevent similar cases from occurring in the future."
…
After seven or eight minutes, before the ventilator was borrowed, the patient suddenly suffered from limb twitching.
Blood pressure drops rapidly again.
His face, fingers, and lips became cyanotic at a speed visible to the naked eye.
Professor Wu quickly increased the oxygen concentration, but the effect was not good.
He wanted to increase the oxygen concentration again, but Li Jingsheng quickly advised, "You can't increase it any higher, otherwise it will be counterproductive. At this time, putting on a ventilator is the only way to save life."
The higher the oxygen concentration, the better.
If it is too high, oxygen toxicity can occur.
Moreover, if the concentration of oxygen inhalation is too high, it will have the opposite effect of inhibiting breathing. It can also lead to atelectasis.
Now that the patient has already developed pulmonary edema and has difficulty breathing, giving him high-concentration oxygen is equivalent to a last-ditch operation.
Send the patient directly to the road.
Professor Wu certainly understands these medical common sense, but in clinical rescue practice, the oxygen concentration needs to be adjusted flexibly. He probably lacked practical experience in this area, and seeing that the patient was about to die, he frantically increased the oxygen concentration.
After being reminded by Li Jingsheng, Professor Wu's old face felt feverish again.
"I didn't think well. Why hasn't Xiao Qin borrowed the ventilator? This is really terrible!"
Professor Wu stamped his feet anxiously.
If he had adopted Li Jingsheng's opinion from the beginning, he wouldn't be in a hurry now.
Fortunately, Dr. Qin is awesome.
The ventilator was borrowed at a critical moment.
"The doctors in Hunei are very generous. When they heard that we had a critically ill patient, they were worried that we rarely use the ventilator, so they specially came over to help debug it."
Doctor Qin also brought back a male doctor.
But it was Li Jingsheng's acquaintance, Dr. Tang Weilin from the Department of Respiratory Medicine.
He is also an outstanding young doctor under Director Mu.
"Dr. Li, I heard that you have now joined our second hospital. Congratulations! Welcome to our Department of Internal Medicine!"
When Tang Weilin saw Li Jingsheng, he immediately smiled and said hello.
"Thank you, thank you! The patient just had convulsions and the symptoms of hypoxia have worsened. Please rescue the patient first!"
"good!"
Tang Weilin turned to look at the two chief doctors.
"Director Hua, Director Wu, then I will do it directly. If I had known that Dr. Li was here, I wouldn't have had to come over. Dr. Li's skills are very good."
He also praised Li Jingsheng by the way.
"Do it!"
Director Hua has long been extremely anxious.
Professor Wu regretted not listening to Li Jingsheng's advice, and now hopes that the patient can survive this test.
The two of them deeply agreed with Tang Weilin's praise that Li Jingsheng was very good.
Just now I saw Li Jingsheng's cleverness.
After the patient was put on a ventilator, the hypoxemia was significantly improved.
You know, bronchoscopy and ventilator are the 'magic weapons' of respiratory medicine.
Each department has some 'magic weapons' that are different from each other.
The orthopedic surgery department didn't even have a ventilator and had to borrow one. This also showed that the second hospital was 'poorer' than imagined.
Because orthopedic surgery is a department that generates relatively good income.
Of course, this also depends on the hospital. Although some hospitals are large in scale, their orthopedic surgery business is not well developed, and their ability to generate revenue will naturally be much weaker.
"Director Hua, I can't help you much here. I'm going back to the outpatient department to work first."
Li Jingsheng looked at the time and saw that it was past one o'clock. The patients at the outpatient clinic must have been waiting very anxiously.
"Go! It seems like this decision to recruit you here is the right one."
Director Hua looked at him with extremely soft eyes.
"Qinglan, I'm leaving! I'll see you again at noon tomorrow!"
Li Jingsheng still enjoyed the admiring look Ou Qinglan was looking at him at this moment.
That's hero worship.
The hero is saddened by the beauty.
Beauty is easy to fall in front of heroes.
"Um!"
Ou Qinglan watched him leave, then looked back.
This scene was seen by Director Hua.
He couldn't help but secretly exclaim, Dr. Li is not only great in medical skills, but also great in dating.
When did we win the most beautiful doctor in orthopedic surgery?
…
When Li Jingsheng returned to the outpatient clinic, there was indeed a long queue of patients.
As long as manual treatment is available, many patients are willing to wait in line even for two or three days.
Low cost, less suffering, and better recovery results than surgical treatment are all advantages.
The injuries caused by steel nails and splints are not just as simple as surgical incision of skin and flesh. It causes almost lifelong damage to bones.
Drill N holes into a good bone. If there is no other way, the doctor will not let the patient undergo this kind of surgery.
Some patients have steel nails and steel plates. After treatment, patients can move freely with little discomfort.
But there are also some patients who recovered after surgery.
After one or two years, or even longer, the bone will develop inflammatory necrosis, infection, and suppuration, etc.
Therefore, compared with manual treatment, surgical treatment has great disadvantages.
Especially surgeries requiring internal fixation.
In order to solve this problem, orthopedic surgeons have also thought of some methods. For example, after a patient recovers from surgery, the patient will be notified for a second surgery in about half a year.
What are you doing?
Remove the steel nails and plates driven into the body.
The patient's bones are then allowed to heal further.
The risk of foreign objects remaining in the body is also eliminated.
It is not difficult to see from here that surgical treatment and manual treatment are actually the same in principle.
It's all about reconnecting broken bones and making them grow back.
It’s just that the surgical treatment process is more complicated, and it needs to be repeated several times to achieve the effect of manual treatment.
This is also why traditional Chinese medicine has declined and been suppressed by Western medicine, but bone-setting techniques have always had a very good market in many places.
Very popular with patients.
"Why did you come here? It's time for the patient to complain to us again."
Dr. Xu asked him with a dark face.
"I went to help rescue a critical case. It's okay. At worst, I will work overtime to treat all the registered patients."
Li Jingsheng treated one more case at noon because he worked overtime. Other patients felt that one was favoring one over the other, so they complained to him.
Now, he's asking to work overtime again.
"Are you still working overtime?"
Doctor Chen said with a grimace beside him.
Li Jingsheng is not afraid of being complained, and Dr. Xu is not afraid of being complained, but Dr. Chen is.
This is the difference between having real ability and not having real ability.
Dr. Chen has no confidence to fight against the medical department.
If you give him any punishment, he won't be able to bear it.
"It is not easy for patients to come here with their illnesses. For me, what I sacrifice is just a little personal time. For them, what I have to solve is a big problem. So I will work overtime according to the situation. If the medical department is really unkind, then... Let Director Hua solve it."
Li Jingsheng explained.
"What's the matter with overtime? We should have the final say on our surgical reset clinic. Don't worry, the matter at noon has been explained clearly. But you must pay attention to the method in the future."
Dr. Xu very much supports his apprentice’s kindness as a doctor.
The master and apprentice were each more aggressive than the other, and neither of them cared about the punishment from the medical department.
"Well, I will resolutely obey the decision of the two superior doctors."
Dr. Chen has put the position right.
As soon as Li Jingsheng joined the company, he automatically fell below Li Jingsheng.
"Hurry up and treat the patient as soon as possible!"
Dr. Xu asked Li Li to call the number.
Li Jingsheng was about ten minutes late. Judging from the situation, they should have already treated a patient.
The patient came in with a cane.
It was none other than the couple who had an argument with Li Jingsheng at noon.
The husband's words were quite polite, but the main reason was that the patient's wife was a bit unreasonable.
When the two of them saw Li Jingsheng, their expressions were a little unnatural.
"What's wrong?"
Li Jingsheng was generous and had no intention of making things difficult for these two people.
Of course, there must be some discomfort in my heart.
"I broke my foot while riding a scooter. Please see if it can be cured!" the patient replied cautiously.
The patient's wife lowered her head and said nothing.
People are all like this.
You must feel guilty if you do something bad! It would be somewhat embarrassing.
"Ouch, this hurts badly!"
Li Jingsheng frowned after watching the movie.
When the patient and his wife heard this, they thought Li Jingsheng was deliberately not treating them.
"Um...can you please help me treat it?"
The patient's wife looked at the elderly Dr. Xu pleadingly.
"I've been ill these past few days and I'm not feeling well. I need Dr. Li to treat you." Dr. Xu refused.
The patient's wife turned a little pale after hearing this.
Only at this moment did she realize how stupid her willfulness and impulsiveness were. If it couldn't be cured here, they would have to do surgery.
"Dr. Li, I'm sorry at noon. I spoke a little too harshly. Please forgive me."
In order for her husband to be treated here, she could only bow her head and admit her mistake to Li Jingsheng.
"The harsh words are acceptable, but the constant complaints make me afraid to treat you."
Li Jingsheng replied to her slightly coldly.
(End of chapter)
