The hospital's hierarchical system is strict, and there is probably no young doctor in the department who dares to walk on equal footing with Lian Tao.
It is an attitude of the chief physician that the chief physicians are affable, but it does not mean that any young doctor can be arrogant and impolite in front of the chief physician.
If a young doctor is really that ignorant, he will most likely be marginalized, his career will get worse and worse, and he will gradually lose popularity.
The doctors and nurses in the Department of Respiratory Medicine noticed that Director Lian seemed to be very polite to this strange young man.
This also adds to everyone's speculation about the identity of this young man.
"Jingsheng, should you go to my office first to check the patient's information or go to the ward to check the patient's condition first?"
"Let's go to the office to read the information first! Drink some water to get rid of the alcohol. Otherwise, the patient and family members will think we went to see her because she was drunk!"
"Haha, Jingsheng is so funny when he talks! Do you know what your kind is called?"
"what is it call?"
"Mensao! Haha..."
Lian Tao smiled inconspicuously, and he was obviously in his forties.
The two seemed to have no age difference and established a very close friendship.
Entering the office, it is Lian Tao's exclusive office.
Being able to have his own separate office in the People's Hospital is not a treatment that ordinary chief physicians can have.
It is also enough to illustrate Lian Tao's status in the People's Hospital.
Lian Tao turned on his computer, logged in directly to his personal doctor account, and retrieved the patient's medical records, examination reports, etc.
"This is all the information about the patient. Last year, she was diagnosed with nasal polyps due to purulent discharge in both nasal cavities. She also had an operation to remove the nasal polyps in an external hospital."
Being sick is a great misfortune in itself.
What I fear most is meeting a quack doctor.
If you just prescribe some medicine, it would be better if there is no effect after treatment.
In this case, there are only two possibilities for directly performing surgery to remove nasal polyps. Either the doctor is doing it to complete the department's assigned tasks, or the doctor is really a quack.
Li Jingsheng checked the patient's detailed information and found that the physical examination temperature that day was 36.9 degrees, which was normal.
Blood pressure 114/65mmhg.
Pretty normal blood pressure.
The blood routine results showed that white blood cells were 9.2 times 10 raised to the 9th power per liter. Hemoglobin 150g/L, platelets 320 times 10 to the 9th power per liter...
Routine urine test and urine sediment were negative.
The 24-hour urine protein quantification ranges from 0.1 to 0.25 g.
Liver and kidney function, ALT68U/L, AST44U/L, ALB47g/L……
The examinations done by big hospitals are really detailed.
The advantage is that misdiagnosis and missed diagnosis can be prevented to the greatest extent.
The bad thing is that patients need to line up here and there, tossing around, and the high cost of examinations is also a drawback.
"Her sinus imaging examination is completely normal! This is not rhinitis at all!"
Li Jingsheng was speechless after watching the movie.
Why did I just have my nasal polyps removed?
And he had two surgeries.
"It is indeed not rhinitis. The result of consultation with the otolaryngologist in our hospital is bilateral nasal polyps. It will be fine without surgery. Of course, it will be better if it is removed. But nasal polyps are not the real cause of the patient at all."
Lian Tao said next to him.
The "master style" of doctors from the courtyard is worth learning.
Lian Tao didn't have any words to belittle the doctors from other hospitals, and he didn't even mean it.
"Tuberculosis can also be ruled out."
Li Jingsheng checked all the way down and the tuberculosis test was negative.
There are many other tests that can rule out the possibility of tuberculosis.
"The fungal cultures of the patient's blood, urine, and sputum are all negative. It's really hard to pinpoint the cause!"
Before Li Jingsheng came, considering the need to use thoracic diagnostic skills, he also spent 100 health points to upgrade thoracic diagnosis to a proficient level.
Currently, there are not many places where thoracic diagnosis is used.
But it’s also good to look at the patient’s chest X-ray.
It is accessible both internally and externally, and the advantages in diagnosis are very obvious.
"Brother Lian Tao, what is your diagnosis?"
After Li Jingsheng read all the inspection information, he asked the other party.
"It is somewhat suspected to be an inflammatory granulomatous lesion."
Lian Tao gave a diagnostic opinion.
From the examination results, granuloma should be supportive.
"Pulmonary Wegener's granulomatosis?"
Li Jingsheng also suspected that it was this disease, but the degree of agreement was not very high.
"Yes, I just suspect that the patient has this disease. However, this patient only has fever, purulent discharge, and cavitary nodules, so there is no way to diagnose it!"
When Lian Tao encountered such a difficult case, even though he had rich medical knowledge, he was still frowning at the moment.
"How about we go to the ward and see the patients! Maybe we can find some breakthroughs."
Li Jingsheng suggested.
The two went to the ward one by one to check on the patient's condition.
Li Jingsheng carefully performed a physical examination on the patient and asked some questions.
"Is she being treated with prednisone now?"
Li Jingsheng asked when he happened to see the nurse coming to take medicine.
"Yes, she was initially given 40 mg of medication per day, but now it has been reduced to 35 mg per day."
Lian Tao answered for the nurse.
Obviously, he personally prescribed the doctor's orders, and he also determined the dosage of the medicine.
This medicine is used for systemic lupus erythematosus, rheumatoid arthritis, rheumatic fever, nephrotic syndrome, chronic active hepatitis, ulcerative colitis, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura and other diseases.
Usually administered orally.
After checking on the patient's condition, the two returned to the office to continue their discussion.
Li Jingsheng came up with a bold idea at this time.
"Do you think we can start from the problem of space occupation in the right lung, which will make it easier to achieve a breakthrough?"
The hospital from another hospital started with the patient's purulent discharge and found out that the patient had polyps on both sides of his nose. He was stuck in this endless loop and could not get out.
If we want to make a major breakthrough in this case, it is very necessary to change the entry point.
"I started with this problem, but made no progress."
How could Lian Tao not think of this problem?
"What I mean is to stop the prednisone first, and then make a diagnostic breakthrough in the direction of granuloma."
After listening to Li Jingsheng's suggestion, Lian Tao's eyes brightened slightly.
"This proposal is a bit bold, but the idea is very special and a bit eclectic. It means jumping out of the fog to find out the truth. You can try it."
"Okay, let's try it first."
Li Jingsheng could only wait until the medication was stopped and conduct further examinations on the patient before making a diagnosis.
…
The next day, Li Jingsheng opened the door for normal business.
There are quite a lot of patients.
After the door opened, they rushed to the clinic to see the doctor first.
Li Jingsheng asked everyone to line up in a civilized manner and then issued number plates to prevent queue jumping.
"Dr. Li, please take a look at my father's right hand. It seems that he broke his right hand. Can it be treated?"
The person who grabbed the first position was a young and strong young man in his mid-twenties.
He took his seat, and then a family member helped the patient in.
The old man seemed to have a severely hunched back and a thin body. But there were four family members accompanying me, and together with the young man occupying the seat, there were five family members in total.
Needless to say, it must be a family with many children.
Having many children makes raising them very difficult, but as long as the children are filial, there will be many people to take care of them no matter what illness they have when they grow old.
"Hel him sit down, let me check first."
Li Jingsheng said to his family members.
When the family members helped the patient sit down, he saw the patient's expression of pain the moment he sat down. Also, the patient just moved slowly when walking.
Osteoporosis is common in the elderly, and fractures are easily caused by falls.
If you can break your right hand, it must be a heavy fall.
Could the hip joint have been fractured or injured?
"Where do you feel pain now?"
Li Jingsheng asked the old man.
"Hands, and here!"
Sure enough, the old man pointed to his right hand and his buttocks.
Li Jingsheng felt his bones and found that his right elbow joint was displaced, but there was no fracture.
Moreover, this old man's bones are much stronger than those of the average old man.
Raising so many children must be very hard work, doing a lot of work, and getting good physical exercise, so even when you get old, your bones are still much stronger than those of ordinary people.
This is the conclusion Li Jingsheng secretly made in his heart.
"Let me check your butt."
The old man's buttocks were felt again, and no fractures, joint capsule cracks or other problems were found. There was soft tissue contusion.
"Go inside and take a X-ray. If the fracture is not particularly serious, I can treat it here. The X-ray is 100 yuan."
"Can!"
The family readily agreed.
The consumption concept of young people is not like that of the older generation. Spending money is really almost like being made of paper.
Of course, Li Jingsheng likes such family members.
I helped the old man into the medical technical room and took an X-ray, but no fracture was found. The hip joint examination results were consistent with his bone palpation, and no bone cracks were found.
The old man's luck is quite good.
After being helped outside, let the old man sit down.
"Siying, bring the plaster and get ready to help."
"OK!"
She had just arrived and was originally planning to help Dr. Gao sell health medicines. Now that her help is needed for diagnosis and treatment, she is naturally happy.
You can take the opportunity to learn a lot of knowledge.
Moreover, she was very curious about bone-setting techniques and took the opportunity to gain more knowledge.
Li Jingsheng negotiated with his family about the cost of treatment, and one of his daughters, who was doing well, scanned the QR code and paid without saying a word.
Treatment can begin.
Ask family members to hold the elderly person to prevent them from falling.
I didn't dare to take anesthesia.
There are certain risks in brachial plexus block. For such an old man and a fall, it will be very bad if something goes wrong.
Fortunately, Li Jingsheng's current bone-setting skills are quite good.
He grabbed the old man's arm and gently swung it a few times, then put it down and pulled it.
Along with the old man's cry of pain, he successfully reset the displaced elbow joint.
Carefully apply a plaster to fix it, and let your children sit and watch for half an hour to make sure that the blood supply to the hand is not blocked because the plaster bandage is too tight, and then the patient can be allowed to leave.
If the plaster is tied too tightly, the blood vessels will be compressed, causing ischemia at the end of the hand.
As long as it lasts longer than half an hour, necrosis can easily occur.
That would be a big accident.
When everyone saw that Li Jingsheng easily fixed the old man's broken right hand, everyone naturally looked at his medical skills several times, and their level of trust rose to a new level.
After taking care of the old man who broke his hand, he continued to treat other patients.
Han Siying watched and studied and acted as an assistant.
When a new patient joins the queue, she will go over and issue a number plate to the patient.
A total of twenty-one patients were diagnosed throughout the morning.
No difficult cases were encountered.
It was already close to twelve noon.
After dealing with the patients in his hands, Li Jingsheng could finally get up and go to the toilet.
Tang Ping was busy infusing the patient.
Xiao Gao is working hard to sell medicine.
"Siying, I have read the medical records you wrote yesterday and made comments. You can take a look at it when you are free. Also, it is best for your female classmate to go to a big hospital for a check-up. I'm afraid What a serious illness it is.”
Li Jingsheng said to Han Siying.
"She refuses to go! And she is planning to come to you today. You can help her take a look then, okay?"
Han Siying pleaded.
"Of course this is no problem."
Li Jingsheng readily agreed.
At around 10 o'clock in the morning, while he was diagnosing a patient, his mobile phone rang several times.
I was busy at the time and didn't have time to watch it.
After opening it, I discovered that it was a message from Lian Tao.
It is the result of further examination of the patient.
After Li Jingsheng checked it, he fell into thinking.
That patient's condition seems complicated, but if it is divided into several blocks to diagnose and analyze one by one, it will not be so complicated.
The first block is the upper respiratory tract.
There is no abnormality in the sinus image, the nasal mucosa is also normal, and the nasal polyps have been surgically removed. Therefore, the upper respiratory tract should be normal and not changed due to disease.
The second block, the lungs.
No signs of nodules were found in imaging examinations, and there was no infection in multiple sputum specimen examinations. The evidence of tumor was insufficient.
Therefore, lung cancer can basically be ruled out.
The third block, kidney.
There were no abnormalities of hematuria, proteinuria, or impaired renal function.
In the fourth block, anti-neutrophil cytoplasmic antibodies are negative, and immune function diseases can basically be ruled out.
After checking this step, the possibility of pulmonary Wegener's granulomatosis can basically be overturned.
So what disease does this patient have?
Li Jingsheng used to think that his intraocular diagnosis had reached a small level and was already very powerful.
Now that I try to challenge this extremely difficult and difficult case, I feel that my level is far from enough.
The cause of the disease that causes headaches for top respiratory medicine experts like Director Yang and Lian Tao is naturally not easy to detect.
Li Jingsheng's current level of proficiency in thoracic diagnosis is at the attending level, so he has some diagnostic experience.
When he was thinking hard, he couldn't help but think of a possibility. Could the patient's disease be caused by infection?
The lungs are an organ that is relatively invaded by viruses, fungi, and bacteria.
For example, tuberculosis bacteria can cause changes in the lungs. The early images of tuberculosis are no different from lung cancer.
This patient had been tested multiple times for fungal infections, all of which were negative.
During the ward rounds last night, the patient once mentioned a symptom that was ignored by everyone.
She had forehead pain when she had fever and purulent discharge.
It's not serious and doesn't last long.
Headache, fever, and runny nose, aren’t these symptoms of a cold?
Of course, this patient definitely does not have a cold.
I have never heard of a patient whose cold symptoms lasted for as long as three months.
What causes a cold? Virus!
Li Jingsheng felt that the patient's lung biopsy specimen should be checked.
"Brother Lian Tao, can you take samples from the patient's lungs to check for viral and bacterial infections?"
"Specimens from lung lesions?"
Lian Tao replied to his message almost instantly.
It seems that Lian Tao has gone crazy in order to solve this case.
"Judging from the films, there should be nodules in the lungs, and taking specimens from these areas should be more accurate. I think the disease of sarcoid can now be ruled out."
Tumors and granulomas were ruled out.
This should be a pretty big blow to Lian Tao.
"Okay, I'll send you a message when the results are available."
There was no movement after Lian Tao replied the message.
Arrangements should be made to take biopsy samples from the patient's lung lesions.
At this time, the fast food ordered by the clinic was delivered.
Li Jingsheng took advantage of the moment when he was not busy and hurriedly ate.
Even while eating, he was still deducing the cause of this patient's illness.
CT shows a cavitary mass in the right lower lung. It is not granuloma, lung cancer, or tuberculosis. What disease could it be?
Now the disease is clearly visible, but there is no way to find out what the disease is.
Medicine is so confusing.
After eating, Li Jingsheng guided Han Siying to correct some problematic areas in the medical record.
At this time, a young girl opened the door and walked in.
She is even more plainly dressed than Han Siying.
And there was a sickly look on his face.
The spirit also seems a little bad. Very haggard looking.
"Siying, I'm here again!"
She forced a smile and waved hello.
"This is my boss, Dr. Li Jingsheng." Han Siying quickly introduced her. "Boss, this is the female classmate I mentioned yesterday."
"Hello!"
The girl greeted Li Jingsheng.
"Hello! Since we are Siying's classmates, we are acquaintances. No need to be restrained. Please sit down."
Li Jingsheng poured her a glass of water himself.
After she stood up and took it, she said thank you, but she still looked a little restrained.
"I basically understand your situation. It's mainly diarrhea, right?"
"Yes, right now I have diarrhea and a little fever, a low-grade fever."
She nodded.
"Come, lie down on the bed inside, and I'll check your abdomen."
Li Jingsheng said to her.
The best way is palpation and instrumentation.
"Siying, come here and help."
When Li Jingsheng examines a female patient, he must ask a female doctor or nurse to be by his side.
After the girl lay down, Li Jingsheng examined her abdomen.
A scar from the surgery was seen on her lower abdomen.
"Is this a scar from childbirth?"
"No. I had stones when I was a child. At that time, the medical conditions in my hometown were not good, so I had to undergo an operation."
"Urine stones?"
"right!"
Li Jingsheng must ask clearly.
Because it's about diagnosis.
History is very important in clinical diagnosis. Just like some thieves who were caught and sentenced to prison for stealing, they have a criminal record.
Even if they are released after renovation, they may still return to their old jobs.
When a theft occurs in the surrounding area, the police will first investigate these persons with criminal records.
The same goes for doctors. When looking for the cause of the disease, they need to check the medical history first.
Some diseases are prone to recurring attacks.
Some diseases may leave some complications and sequelae after they are cured.
"Does it hurt?"
"No pain!"
Li Jingsheng continued to press her abdomen.
"Ouch, it hurts, it hurts!"
There was an obvious tenderness reaction at the location where I pressed this time.
(End of chapter)
