Gao Yan is still receiving emergency treatment in the operating room. But this does not prevent Sun Lien from taking his examination results to Director Liu for help. In fact, it is not uncommon for lower-level doctors to be unable to solve the case. After all, not all patients have the same problem.
The symptoms are very typical and obvious. At this time, a more experienced superior doctor often needs to re-diagnose the patient.
Liu Tangchun often went to the emergency room when he had nothing to do, but this was the first time he saw Sun Lien asking for help. He took the test results handed over by Sun Lien with some curiosity, "What kind of case is this? Director Sun, you can't figure it out.
Dr. Xu can’t handle it either?”
After being teased by Liu Tangchun for two consecutive days, Sun Lien was already a little numb. He just said helplessly, "You can see and then talk."
The content of Gao Yan's case was written by Sun Li'en. It was summarized based on the communication with Gao Yan's parents on the phone and the preliminary diagnosis and treatment plan for Gao Yan in lower-level community hospitals. Writing medical records is a technical job, and it is also hard work. Calculation.
During his internship, Sun Lien had been writing case content for seven or eight months. He was now able to make the content detailed, objective and true, without any guesswork.
"Let me take a look." Director Liu motioned to Sun Lien to put the cases and other things on the table in front of him. He was still eating, and from time to time he would drink black coffee to feed his food. But his eyes were already reading the contents of the cases.
Since the implementation of electronic medical records, Comrade Liu finally no longer has to look at other doctors' ghost drawings to guess the content. This great good news has even made his originally sparse hair grow back a lot of the previous ghost drawings. Sometimes Director Liu
You still have to find a nurse to identify it.
"It does look like an infection." After reading the records, Director Liu had almost finished his bowl of rice. Wiping his mouth with a tissue, Liu Tangchun clicked on the case and asked, "What do you think is wrong?"
"I can't tell." Sun Lien just felt something was wrong in his heart, but he didn't understand what was wrong. "If there is anything abnormal, it may be that when the patient was admitted in the morning, the family member who sent the patient here took the opportunity to run away.
."
"Run away?" Liu Tangchun was also stunned, "What happened?"
Sun Lien recounted what happened in the morning from beginning to end. "The police were called at that time mainly because the patient's stab wound was unusual."
Under normal circumstances, if a patient engages in self-mutilation, the inner side of the lower arm, which is the side of the wrist, will usually be affected. However, the area where Gao Yan was chopped to pieces of flesh and blood and exposed bones was the outer side of the lower arm, the dorsal side of the hand.
If someone intends to chop his arm with a kitchen knife, then based on conventional movements, it is assumed that the location where the knife will be cut will definitely be the inside of his arm. Generally speaking, if the outside of the arm is cut to a bloody state, it is basically after an attack.
The scars left by using his arms to protect his head and face.
In addition to the unusual nature of the arm injury, there are also some questions about the patient's disease process.
His disease worsened too slowly.
When he went to the community hospital for treatment, Gao Yan had severe high fever. His body temperature was as high as 40.2c. He complained of headache, high fever, and chills for more than four days. However, after two days of treatment, the high fever still existed. In addition, he came to the Fourth Central Hospital for treatment.
Nearly a week has passed since Gao Yan became ill.
Viral meningitis starts very quickly, but it is also relatively easy to treat. Generally, including the time of onset, one week is enough to cure or transform into a more serious disease.
Gao Yan was even able to walk into the emergency room on his own with the support of the accompanying woman. This situation conflicted with the diagnosis of viral encephalitis.
If it is bacterial meningitis, although it can be treated as the disease progresses, the combined therapy of antibiotic intravenous drip + oral antibiotics provided by the community hospital should be able to directly eliminate the bacteria that invade the meninges.
After listening to Sun Lien's explanation, Liu Tangchun nodded, "There is indeed something wrong." He stood up and took his white coat off the hanger, "Let's go see the patient."
In the operating room, Gao Yan's upper arm repair is coming to an end. Strong and tall orthopedic carpenters are trimming the skin flaps of his lower arms. Although the skin flaps cut by sharp tools are much easier to repair than tears,
In order to better align the wound and promote the healing of the sutured wound, the carpenters are still cutting the highly strict skin and flesh carefully. They must not only ensure that the wound is well-fitted, but also ensure that the wound tension is not increased by cutting too much. In short,
This is meticulous work.
Liu Tangchun and Sun Lien were observing the progress of the operation downstairs in the observation room on the second floor.
"The vital signs are not stable." Liu Tangchun looked at the busy anesthesiologist downstairs and suddenly muttered to himself. He pressed the intercom fixed on the side of the observation window and asked, "What are the patient's vital signs?"
What's going on?"
The one who was busy downstairs was the doctor with zebra glasses who had placed a jugular vein cannula on Zhao Weihong. He didn’t bother to answer Liu Tangchun’s questions. He pushed up his glasses and adjusted the dosage of the medicine for a long time before staring at the monitor.
, while groping on the wall with his hands for a long time, he found the intercom, put it to his ear and said, "Director Liu, right? The patient sent from your department has a very poor reaction to anesthesia. It's fine under normal doses of anesthesia.
The reaction is that as soon as the dose is slightly increased, the blood pressure will drop."
"Has the blood volume been replenished?" Liu Tangchun raised his eyebrows. For anesthesiologists, it is common for patients to occasionally become insensitive to anesthetics. However, the anesthetic tolerance threshold is not high, and it is relatively rare for patients to be insensitive to anesthetics at the same time.
His first reaction was that the patient's blood volume was insufficient.
"I have received 4 units of AB type rh negative blood transfusion." The doctor with zebra glasses patted his thigh, "The heart rate is also normal. It should not be a blood volume problem."
"Is there a problem in maintaining anesthesia?" Liu Tangchun also became curious. "Last year, the First Central Hospital reported that there seemed to be a problem with the calibration of the propofol received in their hospital."
The doctor with zebra glasses shook his head and said, "We dare to use milk for patients with high intracranial pressure. We give them ammoflurane and procaine. If the concentration of ammoflurane is less than 2%, the blood pressure will increase."
If the blood pressure is higher than 3.5%, it will drop. This patient is in trouble anyway, and I am sweating all over."
At this moment, Sun Lien suddenly saw a strange green color in front of his eyes.
"Wait a minute." Sun Lien, who noticed something was wrong, quickly tugged on Liu Tangchun's sleeve, "Director Liu, let them take a look at the patient's urine bag."
"Urine bag?" Liu Tangchun repeated in confusion, and suddenly realized something, "Xiao Wang, go to the patient's side and check the condition of the urine bag."
Dr. Zebra scratched his head, looked back at the monitor step by step, and walked towards the operating bed. He lowered his head and suddenly looked back in surprise at Liu Tangchun who was standing on the second floor. Then he bent down and picked up the product from the bedside.
He picked up the urine bag and showed it to the two of them.