"Siying, if you think about this case carefully, it should be of great help in improving your clinical diagnostic thinking."
Li Jingsheng turned to look at Han Siying next to him.
"Uh-huh!"
She has already begun to think about dialectics.
Li Jingsheng began to do some necessary physical examinations for the child.
The body temperature is 38.7 degrees, moderately hot.
The child had no diarrhea, but had vomiting due to severe coughing, which was retching.
Lifting up the child's clothes, you can see the collapsed abdomen and clear ribs. The child is very thin.
"Too thin, I need to give my child more nutritious food!"
Li Jingsheng said to his family members.
"OK."
The middle-aged woman nodded in agreement, but her words didn't match her words.
I can understand how difficult it is for this family.
She just called this child the fourth child, indicating that there are probably more than four children in her family.
For families with good economic conditions, it is not easy to support four children. It will only be harder for a family with difficulties like hers.
It is good to be able to let children read and have enough to eat.
How is that possible if the children drink milk every day and have plenty of meat and fish every day?
Li Jingsheng auscultated the child's heart and lung sounds.
The crackling sound of bursting blisters can be clearly heard.
After checking this step, Li Jingsheng already felt a little confident.
"Siying, come and listen to his lung sounds."
She took the stethoscope and was very unfamiliar with it. She looked clumsy in every aspect and felt a little confused.
Even because I was too nervous, my auscultation position was wrong and I didn't hear the lung sounds, which made me laugh.
Under Li Jingsheng's guidance, she mastered the basics.
"I heard it, a very rough sound."
she said.
"Listen carefully. Are there any other sounds? Or remember the child's lung sounds. In addition, many patients have obvious differences between the left lung sounds and the right lung sounds. You have to distinguish them carefully."
Li Jingsheng is not a good teacher.
But for this motivated and simple female medical student, he was willing to try his best to cultivate her.
A doctor's energy and time are limited and he cannot treat several patients.
Only by cultivating more doctors can we meet the domestic demand for medical treatment.
The current medical situation in the country is that people die from droughts and people die from floods.
Small hospitals are hard pressed to find patients, large hospitals have long queues all night long, and in many large hospitals it is hard to find a bed.
Even patients with very serious conditions meet the admission criteria, but there are no beds and they have to wait.
With Han Siying's medical skills and motivation, as well as her demonstrated learning ability, I believe that she will definitely do well as long as she enters a large hospital in the future.
When she needed help and guidance the most, it was a fate that Li Jingsheng helped her like this.
As long as she is not a white-eyed wolf, she will definitely remember this master-disciple relationship.
When Li Jingsheng needs help in the future, she will do her best to help.
"I seem to hear a strange sound, like a friction sound, or... a sound of bubbles bursting!"
Her talent is really very good.
It's amazing how quickly you can discover so many things.
"Do you remember that sound?"
"Um!"
She nodded.
"The abnormal sounds you hear in the lungs are crackles. Pay attention to distinguish their subtle differences. The crackles like this child's are relatively thick and are the sound of large vesicles bursting. Those that are lighter are medium-humid. There is also a softer rale that requires careful attention to hear, which is a thin wet rale. There is also a sound similar to a twisting hair, which is also a wet rale.
Finally, you should pay attention to distinguishing the parts and differences of sounds. Novices can easily confuse it with cardiophrenic friction..."
Li Jingsheng carefully taught her these clinical techniques.
You can't learn it from textbooks because theoretical knowledge is explained in words. Only in this real practice, after listening to it several times, can you easily tell which sound is a wet rale, which is a dry rale, and which has both dry and wet rales.
It can also be seen from here that Li Jingsheng's level is N times higher than hers.
After all, Li Jingsheng himself worked as a resident doctor in the hospital for several years, and later relied on the attribute panel to improve the diagnosis of in-breath to a minor level.
Under normal circumstances, she may need more than ten years of clinical accumulation to reach Li Jingsheng's current level.
This is because she has great talent.
"I initially suspect that your child has a lung problem and needs a chest X-ray. The fee is one hundred yuan, just for the examination. Can you think of it?"
Li Jingsheng asked the family members.
"Okay! If I come here, I believe you. Going to a big hospital will only require more examinations."
A woman with four children must have been to a large hospital.
She feels that clinics are much more affordable than hospitals.
It took Li Jingsheng more than 20 minutes to make the film, and he wanted to smash the grandpa's phone.
Now that I have some money left in my hand, and as a doctor of the Second Hospital, I have the opportunity to build a good relationship with the hospital's logistics department, and maybe I will have the opportunity to buy a retired X-ray testing equipment.
Based on my feeling, the hardware facilities of the second hospital should be pretty good.
The clarity of the X-rays taken by patients undergoing orthopedic surgery is really great.
This grandpa's machine can be disposed of cheaply when the time comes.
After taking the X-ray of the child, he already had a relatively clear diagnosis in his mind.
There are small patchy density-enhanced shadows in the cardiophrenic angle area and inner zone of both lungs, with blurred borders, darker density in the middle and shallower edges. And the density is uneven.
The density is uneven and flaky, which is caused by the doping of air-filled alveoli.
From the above X-ray manifestations, it can be judged that the patient is likely to have pneumonia.
The lung texture was obviously thickened and the edges were blurred.
This suggests that there is extensive alveolar inflammation that masks some of the thickened lung markings.
Then it can be seen from the film that there are two lobes of the lungs atelectasis.
Combined with the patient's multiple symptoms, Li Jingsheng's final diagnosis was lobular pneumonia.
When I first had a physical examination, I thought it might be lobar pneumonia. Now that I have X-rays for auxiliary diagnosis, the results are clearer.
It is undoubtedly lobular pneumonia.
Because in lobar pneumonia, bacteria often invade from the airways and stay directly in the alveoli, with a single alveolar as the center, and then spread widely to adjacent alveoli through the foramen of Connell, eventually forming lobar segment inflammation.
Lobular pneumonia occurs when bacteria invade the bronchi and trachea from the upper respiratory tract, causing inflammation, and then spread to the alveoli.
To put it bluntly, it’s bronchopneumonia.
Li Jingsheng's treatment for the patient mainly focused on anti-infective treatment, cooling down and eliminating phlegm.
"Does the child have a history of penicillin allergy?"
Before prescribing the medicine, he asked the family members.
"I do not know!"
How could the family know this?
There is no other way but to do a skin test.
Lactam and macrolide antibiotics are the drugs of choice for Li Jingsheng.
If the pathogen cannot be detected, we can only use probability theory to test drugs.
In fact, even if the pathogen can be detected, large hospitals will still make adjustments and replace other drugs if they find that the effect is not good after using the drugs.
"For the time being, I will prescribe medicine for the child for three days. It is best to come in the morning for infusion every day. It is recommended to get some nutritious food for the child to eat after returning home."
After Li Jingsheng prescribed the medicine, he once again mentioned strengthening nutrition for the child.
…
It was busy until about 11 o'clock when two staff members from the Food and Drug Administration came.
After coming in with a sullen face, he began to check the medicines on the counter of the clinic. No problem was found, and then he asked for the procedures for refilling the medicines.
Li Jingsheng has no loopholes at all now and is not afraid of investigation.
"Damn it, it must be the owners of those seven pharmacies who reported me."
I don’t know if seven people reported it together, or if one family reported it alone?
The two staff members from the Food and Drug Administration conducted a detailed investigation, obviously trying to find something wrong.
Li Jingsheng was very calm.
If there is a real problem, it is Modu Youyao who comes out to clean up the mess.
For such a large company, the strength is definitely not bad, and there should be strict quality control in terms of quality, evolution channels, etc.
Watching two Food and Drug Administration staff checking this and that at the counter really affected the customer's perception.
Customers and patients were unaware and thought something was wrong with the clinic.
At this time, Li Jingsheng's cell phone rang.
It was Director Hua who called.
"Dr. Li, is it convenient to answer the phone now?"
"Convenient and convenient! Please tell me!"
What Li Jingsheng is most worried about is that something will happen at the clinic and something will happen at the hospital.
"That's right. Yesterday's rescue case was successfully rescued and the department avoided a disaster. You made a great contribution. The department now needs excellent doctors like you who are responsible, knowledgeable and capable. Our department has noon There is an important consultation on difficult cases, would it be convenient for you to come and attend? It should be of great help to improve your clinical diagnosis ability in orthopedic surgery and learn treatment plans."
Director Hua is trying to show his goodwill.
Li Jingsheng made a great contribution yesterday, and he cannot do without a little expression!
Cultivating Li Jingsheng as a key talent in the department is the best reward.
It’s also a win-win for the department.
It not only cultivates outstanding talents, but also enhances the strength of the department.
"I'm afraid I can't get away now! Two staff from the Food and Drug Administration came and checked my clinic for almost forty minutes. I have to stay in the clinic to deal with it."
Li Jingsheng told the truth.
He was very happy to have the opportunity to participate in consultation on difficult cases.
But I can’t leave!
"People from the Food and Drug Administration are inspecting your clinic? Is it a routine inspection or just yours?"
Director Hua listened with concern in his tone.
There is also a hint of anger.
"It doesn't seem like a routine inspection. The car was parked at the door and I checked right in. Maybe my clinic sold more health medicines than usual these days, which made my colleagues dissatisfied and reported me."
My colleagues with pinkeye are really annoying.
"Let me help you settle this matter. You are now a doctor in our second hospital. You have to look at the owner when beating a dog. Your clinic does not sell expired drugs or illegal drugs, right?"
Director Hua directly stated that he would help him settle the matter.
And his tone was quite firm.
The department head is awesome!
Li Jingsheng couldn't help but think of the weirdness of this area in the south of the city again.
There is only the Second Hospital and a tertiary hospital. Lao Zhao warned Li Jingsheng not to try to grow bigger.
Analyzed from another perspective, the influence of the Second Hospital in the medical field seems to be beyond imagination. It should also have extraordinary influence in the administration.
Li Jingsheng didn't understand these upper-level things.
Just be a little fish silently.
"I promise to operate legally and not do anything illegal."
Li Jingsheng secretly rejoiced. Fortunately, after he first appeared in the newspaper, he noticed the potential crisis, conducted self-examination and self-correction, and had already fixed some loopholes.
"Just wait!"
Director Hua hung up the phone immediately after speaking.
Less than ten minutes later, two staff members from the Food and Drug Administration seemed to have received the notice and left in a hurry.
After checking for a long time, no problem was found.
Li Jingsheng ordered a lunch box and ate with three employees.
While we were eating, stationmaster Qiao drove up in a BMW. I parked at the door and hurried in without fear of fines.
Stationmaster Qiao could be seen looking serious and unhappy.
"Hey, Stationmaster Qiao, you're here! Please take a seat!"
Li Jingsheng thought to himself, could it be that he didn't listen to Stationmaster Qiao's instructions and kept selling health medicines, which annoyed Stationmaster Qiao?
As soon as the people from the drug supervision department left, stationmaster Qiao came over with a sullen face. Was he unhappy because he hadn't found anything against Li Jingsheng?
"Did someone from the Drug Administration come to check on you just now?"
Stationmaster Qiao didn't say a word of politeness, his face was dark.
"right!"
Li Jingsheng was also not sure what Station Master Qiao meant.
"These bastards clearly want to give me eye drops. Don't worry, I will give you an explanation for this matter. Also, I didn't know about this matter beforehand. Give me some time and I will find out. Who If it's not good for you, it means you can't get along with me, Qiao, and I'll ruin his job."
After Stationmaster Qiao finished speaking, he drove away in his car.
It’s very different from the calm and dignified webmaster Qiao in daily life!
Today's webmaster Qiao looks more like a frustrated and angry person.
After Li Jingsheng thought about it for a while, he understood a little bit.
It is possible that Director Hua found someone to handle the matter, and then the Second Hospital blamed Station Chief Qiao.
Webmaster Qiao may have really not known anything, but it was useless to talk about it, so he staged this "hurried Zhang Fei" image.
Less than an hour later, Station Manager Qiao called.
"It has been found out that it was Boss Cheng from Huimin Drug Store who reported you. But don't worry, we will give you a satisfactory explanation about this matter soon. How dare the drugstore take charge of the affairs of our medical institution? It's really counter-intuitive. Got them."
Stationmaster Qiao was obviously still angry.
"thank you!"
Li Jingsheng really didn't know what to say.
It's not a surprise that Boss Cheng from Huimin Drug Store reported him.
After all, that idiot was a little desperate at the Sunshine Clinic yesterday.
At about four o'clock, Boss Zhao came in person.
Today, Lao Zhao is different from usual. He is sweating profusely, the front and back of his collared T-shirt are soaked with sweat, and his face is a little red.
It seems that I have traveled a lot!
"Brother Li, come out and see something."
He stood outside and waved to Li Jingsheng, looking at Li Jingsheng with a rare hint of fear.
It's the kind of tremor that comes from the depths of the soul.
"What are you looking at?"
Li Jingsheng had no patients on hand at the moment, so he walked out and stared at Boss Zhao.
"Have you seen Huimin Pharmacy? Three vehicles from the Municipal Supervision Bureau surrounded him. The man named Cheng is finished."
Li Jingsheng subconsciously looked at the location of Huimin Pharmacy. It was more than 150 meters away and he couldn't see clearly.
You can vaguely see a few city supervisor's cars parked in front of the door.
What a quick move.
Li Jingsheng couldn't help but tremble. It would be better to keep quiet in the old streets in the south of the city!
It turns out that it is so easy to destroy a pharmacy or clinic.
This cannot be done by pure power.
It is a powerful force that is invisible and intangible, but actually exists.
When Li Jingsheng joined the Second Hospital, he became a member of this interest camp.
In other words, the entire medical industry in the south of the city is in the same interest camp.
Whoever dares to break the rules will be destroyed.
"That man surnamed Cheng went through many twists and turns. He wrote reports and called reports saying that your clinic sells illegal and expired drugs. He also said that someone had an accident after taking them a while ago. The city supervisor will not listen to him. I didn’t expect that the drug supervisor somehow fell into his trap. Well, it’s a good thing that he has been running a pharmacy here for almost four years, and he can’t even figure out who is in charge.”
A sharp light flashed in Boss Zhao's eyes.
"There is one more thing. I am also entrusted by someone to say a few words. Boss Liu, who is opposite me, came to your pharmacy yesterday and had a little conflict with you. She asked me to tell you that she can swear to God that she She was absolutely not involved in reporting the Sunshine Clinic. After a while, she is going to treat you to a meal and apologize in person."
Boss Zhao is a person who can't move even when he sees a beautiful woman.
Now I'm helping Boss Liu talk and act as a peacemaker, and I won't believe it if I say I didn't get any benefits.
"You, Lao Zhao, have spoken out about this, and I believe it. Please tell Station Master Qiao that I am very satisfied with the result, and thank him for upholding justice."
Li Jingsheng finally saw the power of the Second Hospital.
With the identity of a doctor at the Second Hospital, it turns out that he can be so 'horrible'.
Of course, he is not an ordinary doctor of the Second Hospital, but a special talent who is appreciated by Director Hua and specially recruited by the Second Hospital.
It cannot be judged by common sense.
After seeing off Lao Zhao, Li Jingsheng sent a message to Director Hua.
"Thank you, the matter has been resolved satisfactorily."
"You're welcome. Remember to come to the hospital to work tomorrow."
Director Hua looks quite young, but he replies to text messages faster than young people.
"haha ok!"
When Li Jingsheng replied to the message, a knowing smile appeared on his lips.
It’s so cool to eat based on your ability.
Patients came one after another for treatment, and Li Jingsheng was busy until about 6:40 in the evening, when he finally finished.
Today's diagnosis and treatment income is pretty good. I received one orthopedic surgery, one trauma suture, and several other cases.
Zero and zero total, gross income close to 2,700 yuan.
This is because Li Jingsheng is too kind and prescribes as little medicine as possible.
If he followed the routine of Kuai Kang Clinic, his gross income in a single day would probably reach 7,000 to 8,000 yuan.
Selling a piece of health medicine still went up, selling for more than 24,000 yuan. This was after nearly an hour of investigation by two staff members from the Food and Drug Administration, which had some impact.
Otherwise, it should probably sell more.
Some customers saw drug regulatory staff checking their products and feared there would be problems, so they postponed buying medicines or simply went to other pharmacies and clinics to buy them.
As long as no problems are detected, the impact will be minimal.
"Tidy up and get off work! Siying, you must carefully summarize the clinical knowledge you learned today when you go back. Every mature doctor accumulates and grows step by step in this way."
Li Jingsheng will go to work at the Second Hospital again tomorrow.
Although he had already prescribed medicines for several follow-up patients, he was still worried about changes in the patients' conditions.
If the condition changes, the medication must be adjusted.
You still have to find a way to recruit a certified doctor to get relief.
The glass door was pushed open, and Fatty Zhang from the People's Pharmacy brought the two of them in personally, carrying four cardboard boxes.
It says high-end imported fruits.
Fatty Zhang had a smile on his face, "Boss Li, I was a little too impatient when I came to negotiate with you about selling medicine yesterday. Please bear with me if I find anything wrong. These are a few boxes of durians. Please don't dislike them. They are my little possessions." Mind."
Thank you reader 1674597666915164160 for your support. Thank you very much.
(End of chapter)
