(Thanks to friends for the encouragement of empty and lonely cold 671112, ziluo134, Zhifeng Love, Ty~ Wu monthly ticket)

For the eight newcomers who just reported today, the experience of the first day was quite happy. At least it's very relaxed, and I rubbed the chicken leg to eat. It makes other friends envious, because they started work directly after the first day of reporting.

The emergency department is also relatively peaceful, except for the technician incident under Qiao Qiao yesterday, there are no patients who need to be admitted.

first went to the anorectal department to change the dressing for Qiu Huaiyuan and Doudou, and then went to the ward on the second floor to patrol the ward, and the morning work was all done neatly.

"Brother Liu, Han Miao was discharged from the hospital today, I'll help you in a while. Qiu Mingyuan ran over.

"Go ahead, do as much as you can. Liu Banxia glanced at Xiao Yue, who was chatting with Xu Dan, and said.

Qiu Mingyuan is so depressed that he can't do it, Brother Liu is a very good Brother Liu, but he is a little improper.

"Even if you are officially on duty today, Dr. Wei and Dr. Wang are not here today, Liu Yiqing, Miao Rui, and Su Wenhao will follow me first. Liu Banxia said.

"Teacher Liu, after being in the emergency department, will you be on 24 days off and 24 off?" Liu Yiqing asked curiously.

"It's only temporary, and when we move to a new building, we can schedule shifts when we have more doctors. Now there are so many clinics, and there are too many doctors to separate. Liu Banxia said.

"You can also get used to the pace of work in the emergency department in advance, and I don't have any requirements for you to work night shifts for the time being. Anyone who wants to go to the school can apply for it, and if you want to work night shifts in the future, you will need to evaluate. ”

"Teacher Liu, what about us? Teacher Shi has surgery today. Xu Yinuo asked.

"Escrow, escrow, I'll take care of it all. If there's nothing going on in a moment, I'll take you around the operating room. Pay attention to the discipline of the operating room, if anyone makes a mistake, the next time you go in, you may not know when to go. Liu Banxia said.

I'm very excited about these people, and it's certainly good to be able to get into the operating room. I've been there in the past when I was an intern, but I just glanced at it from a distance.

"There's another thing, the nurse is in charge of the triage now. In the future, it will be handed over to you, and each person will come in turns one day. Liu Banxia continued.

"When you go back, you can discuss it yourself and put out the duty schedule. This is also an assessment item of your training, and if the triage accuracy rate is very high, there will be extra points. ”

Hearing this, these people were a little disappointed. If they do take the job, they will be confined to the triage table all day. Even if a patient needs first aid, they can't get involved.

"Eh, why are you here again?" Liu Banxia just wanted to lead them to the operating room for a walk, when he saw that the TV reporter who had interviewed him yesterday led someone in again.

"Hello, Dr. Liu. After discussion on our station, we decided to do a special program about emergency doctors, and from today we need to shoot here and collect materials. Qu Feng said with a smile.

Liu Banxia frowned, "Have you also finished consulting with our leaders?"

Qu Feng smiled and nodded.

"Then you can shoot, but I have a request, don't occupy the main route, and don't go into the emergency room and the clinic to shoot. Liu Banxia thought for a while and said.

"The emergency department is still a little different from other departments, usually it doesn't seem that there are so many patients, but some patients need to be rescued as soon as they come. ”

"Doctor Liu, don't worry, we will abide by these things, and they will not affect your work. Qu Feng assured.

Liu Banxia nodded, "That's fine, you can do whatever you want." ”

It's just that he still doesn't understand a little, if the TV station wants to collect materials, wouldn't it be better to go to an affiliated company or a city hospital to collect it? There are many patients over there, and there are many cases.

If you can't figure it out, don't think about it yet, and then he's like an old hen, squatting in the emergency room with a bunch of chicks.

"Dr. Liu, there is a patient with abdominal pain, and Dr. Qi is treating other patients. Xu Dan shouted.

"Cheer up, every patient with abdominal pain in the emergency department needs to be given a lot of attention. Liu Banxia said.

"There are many causes of abdominal pain, and if we don't think about it very well, it can make the patient's condition worse and even life-threatening. ”

The patient who came to the clinic was a woman in her forties. It should have hurt a lot, his face was pale, and he still had sweat on his head.

"How long has it been hurting, can you tell me where it hurts?" asked Liu Banxia.

"I had a stomachache after eating last night, and I thought I had a bad stomach. Then the pain became worse and worse, and it didn't work after taking painkiller tablets. But it doesn't hurt all the time, it hurts for a while. The patient said.

"You lie down first, let's check, is the position you are holding your hand the most painful now?" asked Liu Banxia.

"No, the right side hurts, I don't dare to cover it. The patient said.

Liu Banxia frowned, the pain on the left side is easy to do, if it hurts on the right side, it is not good that it is an acute abdominal pain caused by appendicitis. If it is really appendicitis, the patient's tolerance is also very strong, and many people can't help but come to the doctor after an hour or two.

"Chinkova takes her blood pressure and temperature. Liu Banxia commanded, and then reached out and pressed it on the patient's Mai point.

"Ugh. ”

As Liu Banxia's fingers pressed down, the patient shivered in pain, and his body curled up.

"Blood pressure 80/120 and body temperature 38.6 degrees Celsius. Qingkova said.

Liu Banxia nodded and touched the patient's abdomen again. He could feel that the patient's abdominal muscles were a little tense, but it was not very serious, which made him feel a little relieved.

If it is plate-abdomen, it is not possible to cause peritonitis caused by perforation of the appendix, which is too dangerous, which is also one of the reasons why acute abdomen is terrible. Now there is only a little tension, which just means that the inflammation in the abdominal cavity has spread to the abdominal wall or peritoneum.

"Let's take a blood draw for you first, and then do a B-ultrasound to see what is going on in your abdomen. If it is acute appendicitis, surgical intervention is required. Otherwise, after the appendix bursts, it will be very dangerous. Liu Banxia said.

Hearing Liu Banxia's words, the patient was obviously startled, "Doctor, can't you just take medicine? It costs a lot of money to do surgery, right?"

"Let's check it out and see the results later. Are you from Binhai City or where are you from? Do you have medical insurance?" asked Liu Banxia.

"I came to Binhai to work, to do cleaning, and I don't have medical insurance and agricultural cooperative services. The patient said.

"Nongms is also OK, and it can also be reimbursed on a pro-rata basis. You belong to the emergency department, as long as you are in the province, it is okay, let's take a look at the situation first. Liu Banxia said.

"Although conservative treatment can also be considered for appendicitis, it is very dangerous. If it is severe, it may cause perforation, necrosis, and some complications. ”

Hearing Liu Banxia say this, the patient's heart is somewhat solid, otherwise the salary of two or three months will not be enough to suffer from this knife.

Xu Dan collected the blood, the mobile ultrasound was also pushed over, and Liu Banxia also began to operate directly.

It's just that looking at the images on the screen, Liu Banxia was stunned. The appendix appears to be in good shape with no significant swelling. How is this possible?

The symptoms of appendicitis are too obvious, the pain in the right lower abdomen, the rebound tenderness of the McLean's point, it is not appendicitis. Could it be a gallbladder problem?

He applied some more couplant and swept it over the patient's right upper abdomen. Judging from the images, the gallbladder does have some inflammation and some gallstones.

However, he did not make a diagnosis right away, because the patient's clear location of pain was the right lower quadrant. If it is really acute cholecystitis or gallstones, it should be right upper quadrant pain.

Don't look at one on top and one on the bottom, the distance is not very happy, but in terms of medical judgment, this is a clear indication.

Ding!Mission Released: Strange abdominal pain

Open-ended task: Because of the contradictory indications of abdominal pain, it is difficult for the host to determine the condition. The host needs to apply the knowledge learned to provide appropriate medical treatment to the patient, and the task reward is related to the host diagnosis process and results

Looking at this task prompt, Liu Banxia frowned, and the system really changed. Now it's not just the final result that is assessed, it's the process that is required.

Just like answering a question, you don't just have to give the correct answer, you also need to give the steps and ideas to solve the problem. It is definitely that the more simplified, the higher the reward will be.

After a little hesitation, Liu Banxia did a percussion at the patient's gallbladder, but the patient did not have a strong reaction. If it is acute cholecystitis, if the gallbladder is touched during the percussion of the patient, the patient's reaction will be more intense than the tenderness at the McCelottes just now.

In order to be more cautious, Liu Banxia scanned the patient's kidneys and ureters again to see if it was due to abdominal pain caused by kidney stones.

Although there are stones in the kidneys, there is no stuckness, and the ureters are clean.

"With the ultrasound examination just now, there should be no problem with your appendix. However, there are some stones in your gallbladder that will require a CT scan for further diagnosis. Liu Banxia looked at the patient and said.

"Doctor, can't you give me any more useful painkillers to keep my pain from hurting? The patient said.

"Not really, if you were given analgesics, you might have missed a lot of the symptoms in the next tests. Let's do a CT scan, which can be more accurate. Liu Banxia said.

"And can you contact your family? If you really need surgery, we need to be accompanied by a family member, and you need someone to take care of you. ”

"My family is not in Binhai City, I came here to work. Doctor, am I seriously ill?" the patient asked.

Liu Banxia shook his head, "Don't be nervous, we just asked you this according to the process." Take a CT scan to see more clearly. ”

The patient may also be really tormented by abdominal pain, although he is also a little distressed about money, he still nodded and agreed.

Liu Banxia's mood was not so relaxed, and this complicated abdominal pain really stumped him.

If the cause cannot be found, it may delay the treatment of the patient, leading to more serious complications and life-threatening.