Chapter 15 Appendicitis that still hurts after the incision
Luo Hao didn’t even ask what happened. He didn’t brush his teeth or wash his face, so he ran out of the house and put on the sign 307.
Drove to the hospital.
"Luo Hao, there is a complaint from the general surgery department. Please take a look at the medical records."
After entering Lin Yuming's office, Lin Yuming went straight to the topic without any wordiness.
"The patient was diagnosed with acute appendicitis and had constant pain in the right lower abdomen after appendectomy. Director Wen said that the patient was pretentious and the pain threshold was too low. But after half a month, the situation had not improved. When I went to Director Wen, he ignored the patient. Finally, The patient’s family complained to the medical office.”
Lin Yuming stood up and handed the computer to Luo Hao while briefly introducing what happened.
Pain after appendectomy?
Luo Hao's first feeling was that there shouldn't be any problem.
But if it hurts for a few days, it won’t be a problem, but if it hurts for half a month, it will become a big problem.
Before Lin Yuming finished speaking, Luo Hao heard the sound of system tasks dinging in his ears.
[Urgent mission: It’s not just appendicitis.
Task content: Find the cause of the patient's pain after appendectomy and cure it.
Task time: 3 days.
Task reward: 10,000 experience points, acting level +1. 】
"..."
Luo Hao looked at the rewards of the system tasks and was speechless.
I don’t want to be in the entertainment industry, and my acting skills are of no use to me.
It would be great if the skill level +1 was added to surgery.
The gray surgical techniques in the system technology tree can all light up, and there are a lot more things that I can do.
Even if it is not added to the surgical skills, it would be good to be able to give a diagnosis aid AI fragment.
"Luo Hao, are you having trouble?" Lin Yuming saw Luo Hao was slightly stunned, frowned and asked coldly.
“Huh?”
“Afraid of that guy Wen Youren?” Lin Yuming said disdainfully, “He wanted to tell the patient’s family about hiring experts. At that time, I suppressed Come down, do you think I'm scared?"
Luo Hao smiled and shook his head.
"Uncle, I'm not afraid."
"Well, let's take a look at the medical records first. It's best to solve the problem without leaving any future troubles. If it can be solved smoothly, I will find an opportunity to send you to the General Hospital before the end of the year. Surgery. Wen Youren, he wants to have a good year?"
Luo Hao's eyes were filled with flying fish suits and embroidered spring knives.
Depending on what uncle Lin Yuming meant, Director Wen must be taught a lesson this time to prevent this bad guy from always making little moves behind his back.
Luo Hao's smile was bright and sunny. He sat in front of the computer and looked at the medical records first.
The patient is male, 42 years old. He went to the emergency department mainly because of abdominal pain and diarrhea for 3 days. (Half a month ago)
The patient's abdominal pain started in the periumbilical area and moved to the right lower abdomen and gradually worsened.
The nature of the pain is tingling, and exercise and diet can aggravate the pain. Oral analgesics such as paracetamol can partially relieve the pain. The pain is associated with low fever and loss of appetite.
The abdomen is soft to palpation, accompanied by diffuse tenderness. The tenderness is most obvious in the right iliac fossa and is accompanied by rebound tenderness. The colon aeration test was positive.
Initial laboratory tests revealed elevated white blood cell counts and levels of inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein. Liver and kidney functions were normal.
The initial diagnosis was acute appendicitis, and the patient underwent laparoscopic appendectomy under general anesthesia that night.
The patient's postoperative recovery was unsatisfactory and he was still suffering from pain in the right lower abdomen.
Looking at the description in the medical records, it was a typical case of acute appendicitis. The surgical records were also written according to the standard template. Luo Hao could not see any problems.
But the clinical history is difficult to describe in a word. If you want to confirm the diagnosis, you have to go for a physical examination and consultation in person.
And in the system panel in the upper right corner of the field of view, the diagnostic assistant AI did not give a correct diagnosis because of insufficient conditions.
Luo Hao pondered.
After a few minutes, Lin Yuming asked, "Xiaoluohao, what do you think?"
"Uncle, the conditions are not sufficient, I have no opinion for the time being. I will be sick soon." District, I have to do a physical examination and ask about the medical history personally to see if there is any breakthrough." Luo Hao said.
Lin Yuming nodded.
He also knew that Zichou Yinmao could not be seen simply by looking at the medical records.
The medical records are all copied and pasted according to the panel, which can be said to be the same.
Look at the medical record first, mainly looking at the patient’s special laboratory indicators and some details. It is extremely difficult to determine what happened through this kind of Class C medical records.
"Let's go." Lin Yuming greeted Luo Hao to leave the hospital building and come to the General Surgery Department.
It was already dark, and the nurse was busy collecting blood while pushing a cart. In the doctor's office, a doctor wearing a thick mask sat blankly.
Seeing the iconic mask, Luo Hao knew he was Chen Yong without looking carefully.
"Doctor Chen, you are on duty." Luo Hao greeted.
"Uh...ah?" Chen Yong suddenly saw Luo Hao and was stunned for a moment, "Why are you here?"
Then Chen Yong saw Lin Yuming appearing behind Luo Hao.
He stood up suddenly and said as if he was guilty of a crime, "Lin...Director Lin."
"There is a complaint. I'm going to see the patients after appendectomy." Director Lin said calmly.
At this time, Chen Yong noticed that both Lin Yuming and Luo Hao were wearing white clothes, and he seemed to understand something.
"Are the patient's family members emotionally stable?" Lin Yuming asked.
"It's okay, they just want to find the problem and make the patient less painful." Chen Yong made a grammatical remark.
Lin Yuming nodded and followed Chen Yong to the ward.
It was still early and the patient’s attendant was still snoring on the bed. The patient was lying on his side with a painful expression on his face.
"Are you feeling better?" Chen Yong asked.
The patient shook his head gently.
"This is..." Chen Yong was about to introduce Director Lin, but when he saw Director Lin shook his head slightly, he immediately shut up.
Under the mask, Chen Yong pursed his lips slightly, trying hard to guess why Director Lin came in person.
"Please lie down while I check your private parts." Luo Hao came to the patient and said with a smile.
A ray of morning sun shot in from Luo Hao's ear, and it was red, making his smile become warmer and brighter.
Luo Hao rubbed his hands as he said, "It's a bit cold outside, but it's fine in the house."
The patient was not surprised when he saw two doctors, one old and one young, coming over. He just complained, "Other people were discharged from the hospital in two or three days after appendicitis surgery, but I haven't recovered even after half a month."
"Let me take a look." Luo Hao smiled to reassure the patient.
At this time, his hands were already warmed by rubbing them together. Luo Hao was still worried and put it on his neck to test the temperature.
On physical examination, the patient had obvious pain in the right lower abdomen, tenderness, and no rebound tenderness or muscle tension.
The diagnostic assistant AI finally collected all the relevant information, and a line of words popped up - it was recommended to check the 64-slice CT scan of the abdomen.
Luo Hao was a little puzzled, but he didn't show it. Instead, he gave Lin Yuming a look.
In front of the patient, there are many things that cannot be said.
Lin Yuming said nothing and returned to the doctor's office with a sullen face.
"Director Lin, I recommend a 64-slice CT scan of the abdomen."
"Huh? Why do we do this examination?"
"Perfect auxiliary examination of the intestines to rule out related diseases."
"Hepatobiliary and pancreatic disease? It's impossible. The B-ultrasound before the operation showed that the patient only had mild fatty liver." Chen Yong asked in a loud voice.
Wearing a mask properly, Chen Yong gives people a weird illusion.
Lin Yuming glanced at him, and without questioning Luo Hao's decision, he decided directly, "Yes, I'll say hello to the director of the CT room and go there early in the morning. Before dinner, Dr. Chen, go and explain to the patient's family."
Chen Yong’s delicate eyebrows twitched three times.
The face outside the mask was filled with sadness, "Director Lin, what should I say."
"Why do you still need me to teach you? Do you want me to be on duty for you?" Lin. Yuming stared at Chen Yong and said coldly.
Everyone in the general surgery department was disliked by Lin Yuming. Even the floor tiles in the general surgery department had an evil look to them. Lin Yuming wished he could step on them more often.
What Director Wen did before was unethical, which made Lin Yuming full of prejudice against them.
Lin Yuming also knew it was prejudice, but he didn't care.
Would a medical director care about the opinion of a junior clinician?
Not at all.
Let alone a junior doctor, even Wen Youren, a famous provincial doctor, is just that in Lin Yuming's eyes.
Chen Yong scratched his neck, and he was getting nervous. Just when he was about to refute, Luo Hao suddenly said, "Just say that it is the need of expert consultation for the first-year medical university in the provincial capital. This is an easy explanation."
"!! !”
Chen Yong looked at Luo Hao, who was lying without blinking, and was inexplicably surprised.
This is too much nonsense.
"Director Lin, let's go back. I'll go to the CT room and take a look at the machine first." Luo Hao glanced at the time and said to Chen Yong, "Do the examination at 7:30, don't be too late. Save other patients from being unhappy ”
...
An hour later, Chen Yong communicated with the patient and his family.
He first made a report to Director Wen, then bravely communicated with the patient's family, and tried his best to narrowly pass the test.
As time goes by, all the patience of patients and their families has been worn away. Their complaints and complaints are like a hornet's nest, which may explode at some point. .
The medical office knew it was nonsense. Except for a few solid organs in the upper abdomen, the 64-series CT was basically useless.
The same goes for Director Lin, who is so doting on Luo Hao.
Especially the patients and their families are on the verge of an outbreak. Just a small lead is enough to make the flames accumulated during this period spurt out and burn everything.
When I reported to Director Wen, he seemed to be indifferent to it.
Chen Yong was a little confused. He looked at the time and saw that there were still 20 minutes left. He was not in a hurry to take the patient to the CT room, so he hid in the duty room and called Jiang Wenming.
"Master." Chen Yong briefly told what happened in the morning.
"What do you think is going on?"
"Oh, that's it."
On the other side of the phone, Jiang Wenming seemed to be brushing his teeth and talking loudly.
"Master, I don't understand. Director Wen doesn't care at all. Director Lin took Luo Hao to see the patient in the morning, but he listened to Luo Hao's unreliable suggestions. Really, is it possible now? No one cares about the patients anymore?”
Chen Yong complained angrily.
"Hula la la~~~"
Jiang Wenming spit out all the water in his mouth and spoke much more clearly.
“How many times have I told you, you can’t be so angry youth in everything. Yes, you may have never understood the word “angry youth”. Now almost no one uses it. In the past, this word was very popular. Don’t look down on everything. Analyze calmly," Jiang Wenming scolded.
“But...”
“Do you remember the patient with liver cyst?”
"Remember."
"For such a big thing, Director Lin did not have an attack. As far as I know, he is not the kind of person with a good temper." Jiang Wenming explained, "Is the patient yours? "No."
"That's good. Please write down all the treatments and the course of your illness last night and this morning. Be sure to be thorough."
As he spoke, Jiang Wenming increased his tone.
"Shifting the blame is a given, but the important thing is that you don't take the blame. Chen Yong, you must write down who asked for instructions on every decision. Don't write about Luo Hao, he is too young and can't handle things. Just Write the medical advice given by Director Lin and ask Director Wen Youren for instructions."
Chen Yong was startled.
It’s not necessary to write it so clearly.
"After the examination is completed, you go back and make up the disease history record first. Remember what I said, be detailed! Even if it is long-winded, don't leave anything out. Not only this time, but also in the past few months, all Patients and all handling must be careful.”
“Why?” Chen Yong was puzzled.
"Be careful not to spill blood all over you."
"Uh, okay, Master."
"Come to the clinic and see me when you're done, and I'll explain it to you. It's so early in the morning, I haven't done it yet Have breakfast."
Hearing what Jiang Wenming said, Chen Yong sighed, "Master, please come back. I think you are the only serious doctor in the department."
"My novel recently. I have to go to the channel and promote Douyin. The editor asked me to post updates. How can I go back and take care of the patients? Besides, the world will not go around without me? Come to me after you are busy and I will tell you what is going on." br>
After Jiang Wenming finished speaking, he hung up the phone.
Chen Yong held his mobile phone and stayed there for a long time, listening to the "didi-di" sound coming from it.
It seems different from what I imagined.
Is this a confrontation between Director Lin and Director Wen? Chen Yong thought about it doubtfully.
When the time is up, Chen Yong takes the patient to the CT room.
When I came to the CT room, I saw Director Lin and Luo Hao standing in the operation room from a distance.
Director Lin seemed to take this matter very seriously, and Chen Yong kept everything in mind.
"Xiaoluohao, what do you think the patient's problem is?"
"Intestinal problems, the initial diagnosis is correct or not, it is wrong."
"What? What do you mean?" Lin Yuming asked.
Luo Hao's words seemed like he was playing a riddle.
"Let's do a checkup first." Luo Hao did not answer immediately.
Everything was Luo Hao's guess, and the diagnostic assistant AI suggested it. Luo Hao continued to think along this line of thinking, and got a little clue.
But Luo Hao was not sure.
Leave the needle in the patient, do a skin test, and inject medicine after 15 minutes.
64-slice CT images appear on the screen frame by frame.
Soon, Lin Yuming saw the "problem"!
After all, he is an undergraduate student who graduated from the imaging major. Undergraduate students at that time were still considered the most favored students, unlike the college students after the expansion of enrollment.
The patient has abnormal images of the colon!
"Director Lin, this is here." Luo Hao pointed at the screen with his hand and said, "I don't think it's a tumor, it should be a colon lipoma."
"Colon? Lipoma?!" Lin Yuming asked in confusion.
“Here, a 6cm intraluminal lesion was found in the cecum. The lesion had a clear border and was considered to be a uniform fat density without solid components. The mass of the lesion caused partial colon obstruction, and I diagnosed it as a cecal lipoma.”
Luo Hao glanced at the system panel in the upper right corner of his field of view, and the diagnostic assistant AI had given a clear diagnosis.
“The thickening of the colon wall accompanied by fold edema indicates pseudomembranous colitis.”
Luo Hao added.
"Is the intraluminal lipoma in the ileocecal region causing incomplete intestinal obstruction and inducing inflammation, so the appendix is a problem?" Lin Yuming asked tentatively.
At this moment, he already subconsciously knew that his clinical level was much worse than that of his nephew.
"Yes." Luo Hao smiled, "So whether the diagnosis of acute appendicitis is correct or not is wrong."
It turns out that this is the case, Lin Yuming's thinking suddenly opened up.
He also had his own ideas on how to solve the problem next.
Chen Yong stared at the abnormal "lump" on the screen in a daze. He never expected that Luo Hao would have to do a 64-slice CT scan and suddenly see the problem.
Normally, 64-slice CT will not be performed for acute appendicitis. Even if such patients come back for treatment, they will probably be misdiagnosed.
Rare diseases have never been within the diagnostic scope of prefecture-level hospitals, and encountering them can only be described as "unlucky".
If every patient undergoes a detailed examination, it is estimated that the doctor will be complained out of his job before a similar patient is screened out.
Luo Hao is very powerful, Chen Yong looked at Luo Hao deeply.
But Luo Hao had no idea. He looked at the screen and didn't know what he was doing.
"Luo Hao, what should we do next?" Lin Yuming asked.
"There are several solutions. First, laparoscopic exploration, limited staged resection of the cecum and appendectomy."
Lin Yuming frowned and pondered.
“Because the patient had an appendectomy half a month ago, I do not recommend a second surgery.”
"Keep it simple." Lin Yuming whispered.
"Second, I suggest using colonoscopy for resection."
"Is there anything else?"
"It's gone for the time being."
Lin Yu Ming was thoughtful and did not continue to ask.
Chen Yong sent the patient back alone and was just in time for ward rounds. Director Wen only glanced at him and passed by as if he hadn't seen him.
Chen Yong, who wanted to report his condition to Director Wen, didn't have time to ask a word.
Something is wrong, something must be wrong!
After Chen Yong made a handover with the doctor in charge of the bed, he began to make up the course of the disease as Jiang Wenming said.
He wrote in great detail, even a bit verbose.
After I finished writing, I read it carefully twice before going to the outpatient clinic to see Jiang Wenming.
There were many outpatients, and Jiang Wenming was busy all the time. He didn’t take a sip of water until he got off work at noon.
Chen Yong closed the door, "Master, I'm here."
"I saw you." Jiang Wenming had already opened the hospitalization workstation, found the patient's medical record, and explained it to Chen Yong word for word.
“Master, if you don’t want to be so meticulous, it’s all in vain.”
"Yes." Jiang Wenming said calmly and calmly, "Don't you feel that the rain is coming?"
"Ha, Master, you are thinking too much."
"No. "More, just do as I say." Jiang Wenming said, "Stay aside and watch this. Be careful not to get blood all over you."
"! "
"By the way, you just said it was Luo Hao who gave the diagnosis?"
"Yeah."
"This young man is pretty good. If not, he is better than the doctors who graduated from Xiehe University with a bachelor's degree, a master's degree and a Ph.D. in 8 years. I admire him." Jiang Wenming sighed in a low voice.
"This... is not difficult, right? If you can do the inspection at will, I can do it."
Chen Yong whispered unconvinced.
“Can you?” Jiang Wenming asked jokingly, but it seemed that he was not laughing at Chen Yong, but talking to himself.
"Here's what happened."
Jiang Wenming picked up the pen, took out a piece of A4 paper from the printer, and began to straighten out the timeline, explaining to Chen Yong the past, present, and his guesses about the future.
......
"Director Lin, what should we do about this matter?" Luo Hao asked, following Lin Yuming.
"I'll handle the rest." Lin Yuming finished speaking slowly, then suddenly stopped and looked back at Luo Hao.
Facing Lin Yuming's gaze, Luo Hao knew that there must be something serious.
"Xiaoluohao, you know what Director Wen's attitude is when we ask experts to perform surgery."
"I know, he doesn't agree, and even secretly causes trouble and instructs the patient's family members to complain."< br>
“What do you think we should do?”
Lin Yuming’s question made Luo Hao fall into deep thought.
The intrigues in the hospital were far away from him, and the system had no knowledge in this area.
Luo Hao knew very well that his uncle Lin Yuming was sharpening his knife and was preparing to teach Wen Youren a "lesson".
But how to do it specifically... No teacher taught him when he was a student at Union Medical College, so Luo Hao's mind went blank.
"That's it."
Back in the office, Lin Yuming picked up a pen, pulled out a piece of A4 paper from the printer, and began to mark several important points along the timeline. point.
"There is a lot of pressure on medical insurance now. If many surgeries are performed in the old way, the hospital will be unable to make ends meet. There is only one solution!"
"Uncle." Luo Hao tentatively called uncle, and when he saw Lin Yu Ming didn't respond, knowing that he was speaking to her as a family elder, not as the medical director.
“If we want to completely solve this problem, shouldn’t the country increase investment?” Luo Hao asked.
"Haha." Lin Yuming smiled.
“No one pays attention to the medical industry. But others don’t pay attention to it. Those of us who are doctors should pay attention to it, because we are facing human lives. So we can’t blame others. If we have the conditions to treat diseases and save people, then there is no need to do so. The conditions will not be fulfilled?”
"Uh..."
Luo Hao never expected that his uncle would sing a high-profile song to him, and he didn't know how to answer it.
"Do you think I have a demonic barrier in the meeting?" Lin Yuming looked at Luo Hao and asked jokingly.
"No, no, no, uncle, you are right!" Luo Hao replied with a smile.
"The general environment is the general environment. We are doctors, and we must be worthy of the white clothes we wear. What should we do when the general environment is like this? Times have changed, and of course we must evolve."
"To treat the same disease, for example, the patient in front of me, even if Director Wen did not misdiagnose it, how much does it cost to perform a localized staged resection of the cecum and an appendectomy?"
"What if we do a gastroenteroscope for polyps?" How much does the removal surgery cost?”
“Uncle, that’s not a polyp,” Luo Hao emphasized.
"I just finished asking, and the director of the gastrointestinal endoscopy room of the first medical university said that he can do it as if it is a large polyp. The risk is indeed a bit, but it is worth the risk."
Luo Hao read it You can do it yourself just by looking at the system panel.
Although it is extremely difficult to perform a colonoscopy on a lipoma with a diameter of 6cm, and the location of the lesion is in the ileocecal area, making the operation extremely difficult, it is still within the scope of my "ability".
“It will cost up to 8,000 yuan to perform such an operation, provided that the best titanium clips are used.”
“I want to beat Wen Youren, not because of personal hatred, but because of personal hatred. Let him know that times have changed."
As he spoke, Lin Yuming looked at Luo Hao and asked seriously, "Can you bring down Wen Youren's arrogance by bringing people to the general surgery department?"< br>
Luo Hao looked at Lin Yuming seriously, trying to find out what Lin Yuming was thinking in his expression.
(End of this chapter)