Dr. Lin asked tentatively, "Excuse me, are you a Monday student?"
Zhou Sheng was stunned for a moment and asked strangely: "Do we know each other?"
He is indeed born on Monday.
Dr. Lin smiled and said, "It's our first time meeting you, but I've heard others talk about you. When I saw you today, you turned out to be young and promising."
Faced with Dr. Lin's praise, Zhou Sheng was a little confused.
He thought for a while, he was outside his chest and it seemed like he had no acquaintances.
I don’t know where Dr. Lin heard of him.
There was a serious illness in front of him that required consultation, and Zhou Sheng did not have time to delve into the matter.
Zhou Shengsheng had no choice but to smile and stop answering these words.
There is not much time for small talk during the consultation.
The consultation time will soon officially begin.
First, of course, Zhou Yisheng introduced the patient’s condition.
At the same time, Bai Mingming placed the patient's chest X-ray on the reading light.
In the consultation room, the eyes of several people from outside the chest were immediately attracted.
Zhou Sheng began to introduce the patient's condition and analyze the chest X-ray.
Typical mediastinal emphysema.
Dr. Lin understood it as soon as he saw it.
He was more concerned about how Zhou Sheng discovered the patient's condition.
Zhou Sheng also briefly explained the diagnosis process.
Dr. Lin listened and nodded frequently in agreement.
At the same time, he was also slightly surprised.
From Zhou Sheng's description, it only took two hours from the time the patient was admitted to the hospital to the time he was diagnosed with spontaneous esophageal rupture.
This can be said to be extremely fast for the diagnosis of a very rare disease.
Dr. Lin vaguely recalled a consultation he participated in for esophageal rupture three or four years ago.
The emergency center at that time was still an emergency department.
It took more than ten hours to confirm the condition in the emergency room.
Dr. Lin sighed in his heart, these young people who come to the emergency room are not simple!
Wait for Zhou Sheng to finish explaining the situation concisely.
The next step is to evaluate the patient's current condition.
The prerequisite for judgment is, of course, an examination report on the esophagus.
Dr. Lin asked: "Has the patient's esophageal radiography been done?"
Zhou Sheng said: "It has been prepared for a long time. Teacher Bai, the radiography film."
Bai Mingming immediately stepped forward to change the film on the reader.
Dr. Lin secretly praised in his heart that he was well prepared for this week's life. Even before the consultation, the esophageal radiography had already been done.
It seems that they are quite confident in their judgment of the condition!
The esophageal radiograph is hung up.
Zhou Sheng continued to analyze his condition through this photo.
"There is radioactive leakage, radiographic material appears in the chest, mediastinal emphysema, and currently there is no septic shock. The location of the esophageal break is in the lower segment, and the length is about 3 cm when viewed from the radiograph. This situation is typical.
For esophagothoracic fistula..."
According to the type, esophageal rupture is divided into esophagothoracic fistula and esophagomediastinal fistula.
Fistula, pronounced as "leak" in Chinese, refers to a tube in the body formed by a lesion that ruptures outward, through which secretions from the lesion flow out.
This word is used to express the very image of esophageal rupture.
As for thoracic fistula and mediastinal fistula, it can be seen literally that if a fistula affects the chest, it is a thoracic fistula. If a fistula affects the mediastinum, it is a mediastinal fistula.
It can be clearly seen that thoracic fistula has a larger area than mediastinal fistula and affects a wider range of areas and organs.
Zhou Sheng finished describing his condition.
It stands to reason that the next step should be for Dr. Lin, an expert in this field, to give supplementary and therapeutic opinions.
But calves born on Monday are not afraid of tigers.
In other words, I have not been in the hospital for a long time and have not yet become tainted by the atmosphere in the workplace.
The wolf on the operating table was unknowingly brought to the consultation by Zhou Sheng.
Zhou Sheng couldn't stop at this moment: "In this case, we should fast, gastrointestinal decompression, anti-infection, replenish blood volume and albumin, correct water, electrolyte and acid-base balance, and provide nutritional support at the same time..."
Zhou Sheng was talking eloquently, and several interns, including Cao Xin, had their brains running at high speed and trying to remember. This was a rare clinical learning opportunity.
Even Bai Mingming and the two thoracic residents listened carefully and secretly memorized the response given by Yisheng next week.
Dr. Lin was not angry because Zhou Sheng stole his line.
On the contrary, he listened quietly. The treatment measures given by Zhou Yisheng were all very pertinent.
If your esophagus is broken, you must fast. If you fast, you need nutritional supplements.
Food in the esophagus, bacteria entering the chest, poisoning and infection must be considered. Anti-infection, replenishing blood volume and albumin, correcting water, electrolyte and acid-base balance are also necessary operations.
Up to this moment, Dr. Lin did not feel that the treatment given by Zhou Sheng was outstanding. It was just a satisfactory and basic clinical treatment method for esophageal rupture.
But I never expected that Zhou Yisheng hadn't finished speaking yet.
He continued: "The patient's wound is not particularly large, and it was discovered in time. However, considering that food, digestive juices, and bacteria have entered the chest, closed chest drainage and endoscopic retrievable stent placement should be performed as soon as possible to seal the fistula.
mouth."
Dr. Lin was a little surprised when he heard this.
In the past, treatment of this type of esophageal rupture, regardless of the size of the wound, generally required standard surgical procedures. Esophageal repair, drainage, or even esophageal resection.
However, with the continuous development of endoscopic technology, thoracic surgery is increasingly using esophageal covered stent implantation to close small gaps.
But these are cutting-edge technologies.
And because there are not many patients with esophageal rupture.
This kind of surgery may not be performed even once a year.
Therefore, not many people know about advanced endoscopic surgery.
Zhou Sheng is young and works in the emergency department. He is a little surprised that he knows something about endoscopic treatment.
Zhou Sheng said this in one breath.
There's a feeling of pleasure.
There is something in the belly, and if I don’t say it, I will still suffer internal injuries.
But after speaking it out completely.
Zhou Sheng also felt that he had said a bit too much.
"Dr. Lin, I'm done, please give me your professional opinion."
Dr. Lin smiled, that was enough. What else could he say?
I can only add one point, let the "students" I brought here continue to gain more clinical experience with this disease.
"Dr. Zhou's analysis is very accurate, especially regarding treatment, and he has given a general direction. I agree that the patient's onset time did not exceed 24 hours, and the photo shows that the wound is about 3 cm, which is suitable for endoscopic treatment. It is not appropriate.
Chi, this case is admitted to our department and we will arrange surgical treatment this morning."
The consultation ends here.
People outside the chest left one after another.
The rest of the transfer of departments was arranged by Bai Mingming.
Zhou Sheng and Cao Xin returned to the lounge and changed their clothes.
The two of them left the emergency center before Bai Mingming.
The two walked side by side.
Zhou Shengsheng asked: "How do you feel about the first day of emergency work? Do you feel particularly tired after working overtime on the first day?"
Cao Xin smiled and said, "It's okay. It's very fulfilling."
"Can you hold on? Are you thinking of leaving?"
"It's impossible, unless it's Team Leader Zhou and you don't want me anymore."
"It's impossible not to want you. Dean Cheng introduced you. How could I drive you away? Start following Su Quan from tomorrow. If you have any questions, you can come to me at any time."
"receive!"
The two walked and chatted until they separated near the hospital parking lot.