Chapter 371 There must be a road before the car reaches the mountain, and the road is wider than before
The so-called other methods are minimally invasive operations such as bronchoscopy to remove pathology.
After all, in the early years of major thoracotomy surgery, 1000ml of blood was opened and 1000ml of blood was closed, which left a very deep impression on people.
Although laparoscopic surgery has been fully rolled out in clinical practice, and even young doctors do not know how to perform "ordinary" operations, it will take some time for patients to accept this situation.
After all, the impression given by surgery is that it is open and closed, and ordinary people may not have a correct understanding of surgery.
"Okay, you stay and continue to communicate with the patient and the patient's family." Feng Zixuan glanced at Luo Hao, "Ronald, are you busy? Come with me to take a breather?"
"Not busy." Luo Hao smiled. .
After leaving the emergency room, the two of them did not take the hospital passage, but walked in the hospital courtyard.
Feng Zixuan kept making phone calls, mainly telling his people to keep an eye on online public opinion and be sure to discover and resolve it as soon as possible.
It can be said that the patient's suicide has nothing to do with the hospital, but he is afraid of being put on the line no matter what.
Say it doesn't matter?
Why should you help me if you didn’t hit me?
Why do patients commit suicide in hospitals? Is it because the hospital has no medical ethics and sense of responsibility, or is it because the medical insurance is not enough?
The medical insurance must be sufficient. It is the same for everyone. The pot belongs to the clinician. It is black and shiny, heavy, and bends the waist.
After finishing his work, Feng Zixuan let out a long breath.
"Mercury is really retrograde today."
"Huh? Director Feng, do you still know about Mercury retrograde?"
"Me? Why don't you know." Feng Zixuan was obviously much more relaxed, although his expression A little pale, but with a smile on his lips.
Luo Hao's diagnosis may not be correct, but Feng Zixuan is willing to believe it, and he believes it. (It seems to be a bad sentence, but I can't find a better description~)
"Ronaldiner, have you taken care of the quota yourself?"
"Hum, are you doing scientific research? As long as other departments are willing to learn, I can teach, no need to go to such trouble."
Feng Zixuan just smiled, but did not make any comments on Luo Hao's words.
Luo Hao didn't say anything and silently followed Feng Zixuan forward.
More than ten seconds later, Feng Zixuan asked, "I see you had a consultation before. The mother had kidney function problems, and she had a very unhappy time with Director Pei."
"But you and Chen The director, Director Yang, and even the directors of cardiothoracic surgery and orthopedics, who I have few dealings with, are all very accommodating.”
"Oh, this is indeed my fault." Luo Hao admitted directly, "Before coming to the first year of medicine, I learned about the technical level of various departments here through many channels, and the urology department was relatively poor."
"... ..."
Feng Zixuan has thought of countless reasons, but he has never thought of this reason.
Now that I think about it, let alone saying it, it really makes sense.
“My technical level is poor and I don’t listen to advice, so I will definitely be unhappy. In fact, after I contacted him, I found that Director Pei is quite good. At least he is not average but thinks he is super high.”
Feng Zixuan understood clearly.
Sometimes I see Ronaldinho doing things in an orderly manner, and sometimes I see him doing things in a messy way. In the end, co-writing still comes down to technique.
No matter how much he is trained by his bosses, Luo Hao is still a young man at heart and a person obsessed with technology.
Technology is close to technology.
For people with good skills, Luo Hao is willing to speak more and be gentler in his words; for people with poor skills, like Pei Yingjie, Luo Hao really doesn't tolerate them at all.
No wonder Pei Yingjie was beaten by Luo Hao's "essay"-like consultation records.
My skills are mediocre, and why he bites me to death has nothing to do with his urology department. Ronaldinho caught him, why don't he give him a lesson?
But these are all trivial matters. Feng Zixuan just asked about them and didn’t care.
Teaching Pei Yingjie a lesson only once, that old dog still dares to jump out and bite people.
“Can pathology be obtained from the patient’s right lung mass?”
This is the second time Feng Zixuan asks, and it should also be the last time.
"I can't take it, the location is too deep." Luo Hao gave a definite and unambiguous answer.
Since Professor Luo Haolo said that the pathology cannot be obtained, it means that it really cannot be obtained, and there is no need for others to try.
Once something unexpected happens while taking pathology, Feng Zixuan gets a headache just thinking about it.
Some time ago, a child in the hospital next door had an accident during minimally invasive tonsillar surgery. The fault has not yet been determined, and he is very worried.
If you can reduce one thing, there will be one less thing to do. There is no need to have to do minimally invasive procedures.
"Yes." Feng Zixuan nodded.
Since it is certain that pathology cannot be obtained, let’s go through the motions to convince the patient himself.
Don’t commit suicide, it’s scary.
If it is really a malignant tumor accompanied by systemic metastasis, then forget it. On the crucial days of the Lunar New Year and Lunar New Year every year, it is very common for late-stage cancer patients to commit suicide by jumping off a building.
After the New Year, after the fifteenth, you can die if you deserve it, and you won’t suffer this.
But the patient is most likely just suffering from inflammation!
If this person is really dead, the injustice will probably be worse than the eyes.
"This man is really right to live a breath of life. My parents' old colleagues still danced clap dance and sang Peking opera together after retirement."
"Clap dance ? Is it the kind of activity that disturbs the people? A few days ago, I saw that the rioters and square dances were on the main line, and the police went to take care of them, but they were kicked away by some uncles and aunts. " Luo Hao asked.
Feng Zixuan laughed.
Even the police are unwilling and unable to take care of this kind of bad thing. In some places, the police and hospital doctors are just as helpless.
“Six months ago, an old man suddenly fell ill with cancer. He was found very late and died soon after. Later, one of the people in the group played particularly well with the old man and thought he had cancer. He didn’t come to the hospital without eating or drinking, and ended up starving to death!”
Luo Hao was also surprised.
Similar cases are rare.
“There is another person who has been coughing all year round and began to suspect that he had lung cancer. No matter how he checked, he was fine. He died late, so he said he had lung cancer. He went to the imperial capital and was not diagnosed. Now he spends more than half of the month in the hospital. "
" Haha, that's quite extreme." Luo Hao laughed. laughed.
“In the past, those who worked at the train station for loading and unloading were all illiterate and had a lot of strength. But it seemed that their muscles were all grown in their brains, and they didn’t believe what others said.”
"I'll go to the Department of Respiratory Medicine later. You can take a look at the situation and check the situation. If you think it's okay, I won't care about it from now on."
Luo Hao smiled, this trust is indeed heavy. .
Xiehe is the last stop for medical treatment for patients across the country.
Are you the last stop for first-year medical students? Judging from Feng Zixuan's expression and tone, it should be like this.
Although it makes sense, Luo Hao feels a little stressed. But this was an inevitable experience, and Luo Hao didn't think about reducing the pressure on himself.
"There must be a road before the car reaches the mountain, and the road is wider than before."
"?" Feng Zixuan was stunned for a moment, but then he understood that this might be a new vocabulary on the Internet.
However, these words sounded auspicious, and Feng Zixuan smacked them a few times before remembering them.
The two came to the Department of Respiratory Medicine. Feng Zixuan found Director Tang of the Department of Respiratory Medicine and asked her to watch the film and make an evaluation.
Then he found the medical records of his father's patients and showed them to Luo Hao, and asked Luo Hao to make a diagnosis, then he went about his own business.
The medical records of the Department of Respiratory Medicine are quite well written, unlike the medical records of the Department of Surgery, which are impossible to read.
Many surgeons do not write medical records until the patient is discharged from the hospital, or even surgery records.
Most of the time they just copy and paste and get by with it.
Some patients with benign tumors were even copied and pasted with malignant medical records, which ended up causing a false alarm.
Although the medical records of the Department of Respiratory Medicine are not as good as those written by Meng Liangren, they are still pleasing to the eye.
Five years ago, the patient began to cough, chest tightness, and occasionally yellow sputum intermittently.
The patient had been to many hospitals for treatment and was once diagnosed with "upper airway cough syndrome" (UACS).
This is a disease similar to chronic bronchitis.
In Northeast China, due to the large temperature difference, especially in winter, the temperature difference between indoor and outdoor is at least 50 degrees Celsius, so respiratory diseases are common. Chronic bronchitis, emphysema, etc., almost all people over sixty will get it.
However, the patient still did not improve after being treated for upper airway cough syndrome for a period of time.
The chest X-ray showed that Uncle Huang had an 8mm nodule in the right middle lung field and bilateral hilar filling.
Further chest CT scan confirmed that there was a round non-calcified nodule with fat density in the upper segment of the right lower lobe; there were also peribronchial and vascular shadows in the bilateral lower lobes, right middle lobe and lingual lobe.
Small pulmonary nodules will not cause frequent coughing, and small nodules have fat shadows, so they are not considered malignant.
As for the presence of peribronchial and vascular shadows in the lower lobes, right middle lobes and lingual lobes of both lungs, Luo Hao considered it to be related to chronic inflammation.
Later, a bronchoscopy was performed.
The pathological results of the alveolar lavage fluid showed that although no signs of cancer or other serious diseases were found, a large number of lipid-containing macrophages appeared, which is a manifestation of lipoid pneumonia.
Lipoid pneumonia, generally... no, most of them are seen in infants and young children with congenital diseases.
For example, premature, weak or cleft palate babies may have interstitial pneumonia caused by inhalation into the lungs due to imperfect pharyngeal reflexes when fed milk, cod liver oil or paraffin oil dripped from the nostrils.
It was interesting. Luo Hao slid the mouse wheel and pulled the medical record to the top to confirm the content he had just scanned.
The patient has a history of hypertension for more than 20 years, with a maximum blood pressure of 200 mm Hg; no history of coronary heart disease; and a history of rhinitis for more than 30 years.
After reading the medical records and combining them with the contents of Xiehe Medical Records Database, Luo Hao made a guess.
Luo Hao is still not sure exactly how lipoid pneumonia is caused.
The other side was still busy. Director Tang of the Department of Respiratory Medicine also believed that the bronchoscope could not reach the patient's position. He suggested that he go to the Cardiothoracic Surgery Department for consultation with Director Xu, perform laparoscopic surgery, and obtain pathology for a clear diagnosis.
Luo Hao had nothing more to say about the patient. It was a fungal infection caused by raising pigeons.
As for how to make the patient believe and rekindle the hope of life, that is Director Feng Zixuan’s business and has nothing to do with him.
After reading the medical records, Luo Hao went to the ward to chat with the patient. With the blessing of affinity +3, Luo Hao chatted smoothly. After ten minutes, he found the cause of the disease and compared it with the medical records and the contents in the Xiehe Medical Records Database. With the help of AI assistance, he had a definite diagnosis.
Back in the office, Feng Zixuan was not there, probably busy.
Luo Hao thought for a while and felt that the case in front of him was special. He picked up his mobile phone and called Zhuang Yan.
“Senior Brother~~~”
"Zhuang Yan, come to the Department of Respiratory Medicine. There is a special patient. Take a look. It's an annual assessment. If you can draw the correct conclusion, you will pass this year's assessment."
"Gah!" Zhuang Yan He was startled, "Brother, our medical team still has an annual assessment?!"
"It's just for you, don't worry, Chen Yong, Lao Liu, and Lao Meng don't have it."
Through the phone , Luo Hao could hear Zhuang Yan crying and was heartbroken.
This is too direct and too specific.
After hanging up the phone, Zhuang Yan rushed over soon, but she didn't come by herself, and Meng Liangren was followed behind her.
It’s like a child who has been wronged and followed by an adult.
Meng Liangren had a gentle smile on his face, as if he didn't notice Luo Hao's sharp eyes.
"Take a look at this patient." Luo Hao glared at Meng Liangren. Seeing that he didn't respond, he changed "you" to "you."
Zhuang Yan sat down with a frown and began to look through the medical records. Meng Liangren stood behind Zhuang Yan with his hands behind his back and also looked at the medical records together.
Luo Hao snapped his fingers, and then realized that he was not in his own office. Erhei did not have such a strong artificial intelligence and could run across a building to ask him for help.
Old Meng Xiaozhuang read the medical records for a full 30 minutes. Zhuang Yan then "reported" the key points she saw to Meng Liangren, and Meng Liangren also followed suit to improve and add to them.
Then Meng Liangren accompanied Zhuang Yan to the ward to see the patient and ask about the medical history face to face.
Generally speaking, doctors don’t pay much attention to this last step because they don’t have time. Whatever the objective examination reveals is what you get, and asking for medical history will most likely yield little.
But Luo Hao was not surprised when Meng Liangren took Zhuang Yan to ask for medical history.
Sitting in the office, Luo Hao vaguely hoped that they would come up with the correct answer.
After a while, a familiar voice came faintly from outside the door.
Luo Hao pricked up his ears and listened carefully. He had a mysterious feeling like listening to the root of the wall. Luo Hao found it particularly funny.
"Lao Meng, the patient does not have a malignant tumor. This has been confirmed, but what does the senior brother test me mean?"
"If you think about it carefully, what habits does the patient have in his life? .”
"Habit? Don't smoke, but drink. Aspiration? But I asked, the patient has no history of esophageal reflux."
Yes, Luo Hao smiled, pneumonia patients can ask about esophageal reflux, Zhuang Yan has already Getting started. There's no harm in thinking about it.
"Indeed, there is none. Even if there is, it shouldn't be lipoid pneumonia. You have never seen patients with aspiration."
"I have seen large lung shadows."
"Yes, so this can be ruled out." Meng Liangren didn't seem to have found the correct answer either. He was not leading Zhuang Yan to draw the correct conclusion, but he was also guessing.
"What else is there? High blood pressure? Rhinitis? I think it is because the patient loaded and unloaded irritating items when he was a loader at a railway station when he was young. It is similar to silicosis and pneumoconiosis and is a disease caused by work."
< br>"It doesn't seem like it. It's been many years. If there is, it's old. That's not how it appears in the film." Meng Liangren murmured in a low voice, seeming to be thinking.
In Luo Hao's imagination, Meng Liangren had stretched out his sweat-stained hands and subconsciously touched Erhei's head.
"Edible oil, or non-edible oil, is volatile and can cause..."
"Have you noticed that the Department of Respiratory Medicine has written in the medical record - lipoid pneumonia? , the most important means of treatment is to stop further intake of lipid substances. ”
"But they can't find the source. But this can prove that in the judgment of specialists, the irritating oils consumed in earlier years will not travel through time and space and cause illness now."
"That's strange. , why?" Zhuang Yan murmured sadly.
If Luo Hao's facial features and senses hadn't been digitally transformed, he wouldn't have been able to hear what Zhuang Yan was saying.
"In this way, let's figure it out step by step." Meng Liangren pondered, "The patient has a respiratory disease. What are the factors that can cause it? Rhinitis must be one."
"But rhinitis It is inflammation of the nasal mucosa caused by viruses, bacteria, allergens, etc., and may originate from various physical and chemical factors or certain systemic diseases
Among the many types, the most common is allergic rhinitis, which is caused by allergens such as dust mites, molds, pets, and pollen, and has a genetic tendency. "
"Non-allergic rhinitis is caused by viruses, bacteria, pungent odors, temperature changes and other factors, including vasomotor rhinitis, atrophic rhinitis, hormonal rhinitis, etc. ”
Zhuang Yan is a graduate student from a prestigious university with solid basic skills. When it comes to rhinitis, she doesn’t even need to search online and will immediately give a standard answer.
Meng Liangren didn’t say anything, just listened quietly. .
“The main symptoms of rhinitis include nasal congestion, sneezing, runny nose and nasal itching, but the specific symptoms can vary according to the type of rhinitis.
Acute rhinitis often manifests as dryness, burning or itching in the nose at the early stage, and eventually develops into obliterative nasal sounds, hyposmia, etc.
The main symptoms of chronic rhinitis are nasal congestion and increased nasal discharge. Symptoms such as headache and discomfort at the root of the nose may also occur.
If the condition is severe, inflammation may also affect other parts of the upper and lower respiratory tract, causing complications such as pharyngitis, otitis media, tracheitis, bronchitis and pneumonia. "
"Lao Meng, this is what the book says. First of all, I have never seen pneumonia caused by rhinitis, and even if I have, it is estimated to be very mild; secondly, the patient's rhinitis is not very serious, not serious at all. "
"Okay, this is doubtful, what happens next? It is aspiration caused by reflux esophagitis, which has been ruled out by us. "Meng Liangren continued.
The two of them were studying outside the office.
One is from a major and has a solid theoretical foundation; the other is experienced in clinical practice and is as meticulous as hair.
Luo Hao listened with great interest.
They are only one layer of window paper away from the correct answer, but that layer of window paper is in the blind spot of vision, and they have not yet obtained a definite answer.
It looks simple, only separated by a layer of window paper, but sometimes this layer of paper is a natural chasm. Many people cannot make it through in their lifetime.
After a while, Feng Zixuan came back with a gentle expression.
"Xiao Luo, why are you still waiting for me here? I see Xiaoyan is discussing something outside."
"Director Feng, I see the condition of your elder. That's it, Zhuang Yan was asked a question as part of the year-end assessment. "What?" Feng Zixuan was surprised.
The Department of Respiratory Medicine had found a patient who had received no answer at least two hospital-wide consultations. Luo Hao actually asked Zhuang Yan to solve the problem.
It is also used as a year-end assessment.
Why is it so decent? Feng Zixuan was surprised and then smiled, "What is the reward for the assessment?"
"I haven't thought about the reward yet, I just want to know where Zhuang Yan is now. "
"What's the level?" Feng Zixuan didn't ask about the assessment without rewards, but asked Luo Hao curiously about Zhuang Yan's rating.
“It is true that medical students in other universities have poor foundation, but it is not important. The main reason is that they have seen too few clinical rare cases and their thinking is not divergent. But this is inevitable, after all, during the college entrance examination The scores are so different.”
"!!!"
Feng Zixuan listened quietly to Luo Hao's pretense.
However, Concordia is indeed the top in the country in this regard. More than ten years ago, during the summer vacation, Concorde’s expert team flew across the country, touring other colleges and universities to find geniuses and bring them back. Interview for graduate school at Xiehe University.
There are indeed some behind-the-scenes operations here, but the fact that Xiehe’s golden name has survived for so many years proves that most people still did the right thing.
Otherwise, even Concord, which has a profound foundation, will not be able to withstand the disaster.
"Xiaozhuang's basic knowledge is solid, but he lacks some clinical divergent thinking. He has already found the problem, but he doesn't take that step."
"Problem? Where is the problem?" Feng Zixuan asked .
Is this talking about Zhuang Yan? This is talking about the clinical experts from the First Hospital of Medical University!
The patient in front of me, Feng Zixuan, sought consultation from the relevant departments, and even Director Shen was taken over to take a look.
No one has the answer, no one knows where pneumonia comes from.
Because it doesn't involve malignant tumors, everyone doesn't care much about it. Just cough, it's not fatal.
Are chronic bronchitis and emphysema still rare in the Northeast? If you don’t become a migratory bird and don’t spend the winter in Hainan, chronic bronchitis is a disease that almost every Northeasterner over the age of 6 or 70 will suffer from.
But...
Feng Zixuan fell into deep thought.
"Director Feng, how is that patient?"
"First sent to the trauma department, some blood transfusion, and little psychological work. Then he was discharged from the hospital and admitted to the chest department. I called Director Xu and he performed the surgery."
Feng Zixuan had already put the matter in order. The arrangements are in place and there are no surprises for the time being.
And the incident happened in the women’s bathroom, and no video was released on the Internet.
Feng Zixuan expected the enemy to be lenient, but those surprises did not happen.
It can be said that this matter has been solved perfectly. All that is left is to appease the patient, undergo surgery, and wait for pathology.
Feng Zixuan was not worried at all about the pathology results. With Luo Hao's diagnosis, he was worried.
Now his attention is on this patient.
"I'm going to listen to what they discussed."
"Let's go together." Luo Hao also stood up, smiling as warm as a spring breeze and walked out of the office with Feng Zixuan.
"No, is it fat? Some people are too obese... No, the patient is not fat, and is a little thin." Zhuang Yan's hair was about to explode.
Meng Liangren's square face was expressionless, and he was thinking seriously.
It seems that he has regarded Zhuang Yan's "assessment" as his own assessment, and is pondering and investigating bit by bit.
"Senior brother, what's going on?" Zhuang Yan asked immediately when she saw Luo Hao walking out.
Luo Hao smiled and said nothing.
"I remembered!! I just said that I seemed to have forgotten something!" Meng Liangren suddenly shouted loudly.
The excitement was beyond words.
(End of this chapter)