Before taking medical measures, a clear diagnosis must be made quickly in non-rescue situations.
If you choose to undergo auxiliary examination if you suspect intussusception, previous textbooks usually talked about using a barium meal.
This was because at that time, there was a shortage of B-ultrasound machines and CT machines, and only X-ray machines had abundant resources.
The advancement of medical technology allows doctors to have more choices, thereby eliminating inappropriate examination methods.
A barium meal, for example, is actually very inappropriate because intussusception causes intestinal obstruction. If you take a barium meal again, it will only aggravate the intestinal obstruction.
CT has radiation, so B-ultrasound is quick and convenient.
There is a B-ultrasound room in the emergency department of Seoer. It is fastest to take the child over and do an ultrasound.
Several people carried the child to the B-ultrasound room. Since the child's condition was quite urgent, they explained to the other children and parents in line and jumped in line directly to the front for the examination.
There are four typical symptoms of intussusception. One is paroxysmal abdominal pain, with the child crying and then becoming quiet. The second is vomiting, which this child has. The third is jam-like stool, that is, bloody mucosal stool, which this child does not have.
The fourth one is a sausage-like mass with...
Only two of the four symptoms can only be called preliminary suspicions, and instrument-assisted examination is necessary. Vomiting and sausage-like masses are signs of intestinal obstruction, not necessarily caused by intussusception. For example, another common clinical disease in children is roundworm.
Disease. Roundworm clumps can also cause intestinal obstruction, but the age of onset is usually in older children, but it is true that this disease usually does not have bloody stools. When the doctor touches the lump, the surface of the roundworm clump will be like a cord. It is said like this
, depending on the feeling of the doctor's hand, each doctor's hand feels different, it's really like Schrödinger's cat, I can't explain it.
B-ultrasound examination is much more intuitive. According to the principle of intussusception, B-ultrasound can detect the phenomenon of a large ring within a small ring, which is called the concentric circle sign.
Clinicians stood around behind the B-ultrasound doctor and watched. Two low-echoic clusters appeared on the screen of the instrument, with a high-echoic band in the middle.
"It should be intussusception." Shoe'er's B-ultrasound doctor is very knowledgeable about this disease and is very familiar with it. He can tell it after a few scans.
Just in case, scan the child's appendix again. Acute appendicitis is also a very common and easily ignored acute abdomen disease in infants and young children. The appendix is connected to the cecum, so it is close to the location where the disease occurs.
Differentiate and identify.
After scanning the child's appendix, there is no problem. If you want to be more cautious, you can do a CT. CT is more time-consuming, and there is no need to do additional CT if there are clearer examination results.
A great doctor can save patients and their families money.
The focus now is on the next medical strategy.
In the case of intussusception, if severe intestinal necrosis occurs, an operation must be performed immediately to cut off the dead part of the intestine and perform an enteroenterostomy. Inform the emergency nurse to call the inpatient general pediatric surgeon to come down and see the child so that he can make a decision.
It just so happens that today is the first day of work for all the employees back to the hospital. It is the busiest time for everyone. Many surgeries that were delayed by the holidays have been scheduled and rushed, and the surgeries on the first day were fully booked. It is said that all pediatric general surgeons went to the operating room.
Yes, it will take some time to notify the doctor before he comes down from the operating room.
Until someone from the inpatient department comes down to pick up the patient, the doctor in charge will continue to be the emergency doctor.
Seeing that the child's condition was getting worse, Xie Wanying suggested: "We should seize this time and try to reset the child, Doctor Duan."
