(Thanks to my friend Benzoin Fennel, Man Line, Lazy Confused Bug Monthly Pass Encouragement)

"Mr. Liu, the MRI results of that patient just now came out, and the situation is not very good. Liu Banxia had just walked outside, and Su Wenhao greeted him.

"The inflammation of the gallbladder is very severe, and there are almost all stones in the entire gallbladder. Although there are no cases of stones falling into the common bile duct yet, I expect it to be sooner or later. ”

"Now I'm waiting for the latest blood test results to see if his blood sugar numbers have changed. If surgery is met, I would recommend gallbladder removal. ”

Liu Banxia nodded, "Okay, the blood test results will come out and show me, if you can go to surgery, you can go to the stage." Also, get in touch with the patient's family as soon as possible, after all, it is gallbladder removal, and there is a difference between appendix removal. ”

Su Wenhao nodded happily, and then ran to the laboratory, this is the urging result.

It can be regarded as a new problem that has emerged in the emergency center now, and as the number of patients visiting the hospital increases, the results of the examination come out much slower than usual.

Unless it's something that can really expedite processing, otherwise no one in this team can be inserted. After all, the rights of patients are the same, and you can't enjoy unique rights just because he is your patient, Liu Banxia is not good.

"Sister Li, we still have to do a good job of disinfection in the waiting hall, there seem to be more patients with colds recently. After looking at it for a while, Liu Banxia found Zhou Li.

"I'll arrange it in a while, and there are a lot of patients now. Zhou Li said.

"Thank you for your hard work, Sister Li. Liu Banxia said with a smile.

"Hey...... When can you suggest to the director, if only you could add three or five more nurses? Recently, the number of patient visits has increased so much that we are a little too busy. Zhou Li said.

"I'll try my best, but it's also a transition period. Only with a stable number of visits can the plan be reported to the hospital. Liu Banxia said.

Zhou Li nodded, and went back to work.

"Mr. Liu, the blood test results are out. Blood sugar has decreased a lot, but the calcium index is low, and the index of starch lipase and white blood cells is abnormally high, which can confirm the diagnosis of gallstone pancreatitis, and I am afraid that surgery will not be possible. At this time, Su Wenhao ran over again.

"How to give a doctor's order. Liu Banxia asked.

Su Wenhao's judgment is very accurate, this starch lipase is an important indicator of biliary acute pancreatitis. Combined with the patient's current condition, the diagnosis can already be confirmed.

It is also a very serious acute disease, and its clinical incidence is second only to acute appendicitis, acute intestinal obstruction and other common diseases.

The cause of the disease is the pancreatic lesion caused by gallstones or inflammation, forming pancreatitis, otherwise the blood sugar level of this patient when he was admitted to the hospital would not have been higher than the sky.

"Increase the infusion flow, give some nutrient solution, and admit to the hospital. That might buy us a few days? Wait for the pancreas to stabilize before removing the gallbladder. Su Wenhao said.

"Okay? Let's just do it, it's good. It seems that the patient's family members have also come over? Do a good job of explaining? I'm listening. Liu Banxia said.

Hearing him say this, Su Wenhao became a little nervous, and he was also a little stunned when communicating with the patient's family.

"Doctor? What's going on with Xiaowen?" Seeing them coming, the patient's father asked.

"From what we are currently diagnosing about? It is acute pancreatitis caused by gallstones. Su Wenhao said.

"Do you look at this is an MRI? The patient's gallbladder is already full of stones. What we can do now is to alleviate the patient's condition, and only after the physical indicators have recovered, can we do gallbladder removal. ”

"Can't you do it now?" asked the patient's father.

"Because the inflammation of the pancreas is more serious now, if we do surgery now, it will be too harmful to the patient? It is likely to cause more complications. Su Wenhao said.

The patient's parents glanced at each other? Looking at his son lying on the hospital bed, he was also a little worried.

Liu Banxia didn't stay here for long, and Su Wenhao had already finished explaining. Although this explanation is somewhat formulaic, it is also qualified.

Although he is also working, he is not involved in too much of the actual diagnosis and treatment process? Just observing. He also needs to make an accurate assessment of these interns before he can determine who has the ability to take care of patients independently.

Is this a very important thing? It's equivalent to delegating power to the interns, but power represents responsibility. He gave this power? He had to take the blame.

"Brother Wang, how is your patient?" Liu Banxia wandered to the internal medicine clinic again.

"I've been transferred to the ICU in the emergency department. Wang Huan said with a wry smile.

"Shortness of breath, chest tightness, muscle weakness when taking a chest x-ray? After a simple examination, it was found that the blood oxygen dropped to 92? After oxygen administration, he was sent directly to the ICU. ”

"Is it so serious?" asked Liu Banxia with a frown.

"yes? In the ICU, I was able to take care of it more carefully, and now the blood oxygen has risen, but the cause has not yet been identified. Wang Huan said.

"There is a high flow of humidification ventilation, diuresis, physical cooling, and the body temperature has now climbed to 39 degrees, and it will continue to rise. ”

"I'm going to stay tonight, I'm going to have to keep you informed about this patient. Otherwise, even if I go home, I won't be able to rest well, and I always feel that there is something I haven't considered. ”

"Oh, by the way, I've already asked him to contact his family, and he hasn't come here yet. Maybe his illness has something to do with the current season?"

Liu Banxia shook his head, "I don't dare to guess, it's not so busy here in a while, let's go over and have a look." ”

He was a little worried, he didn't expect to encounter such a difficult case just after resuming work. Even if this is not a patient he seems, it is a patient from the emergency center.

"Teacher Liu, just now the patient was struggling to breathe and listened to the lung sounds normally, and I also increased the oxygen dose and still did not improve. At this time, Su Wenhao ran over again.

"Let's go together. Liu Banxia said and walked out.

There was a critically ill patient with an unknown cause here, and a patient with an unknown cause but also a dangerous one, which made his heart a little anxious.

"Have you had another blood test?" asked Liu Banxia on the way out.

"Yes, the glycemic index has returned to normal, and the starchlipase and white blood cell levels have decreased a lot. It turned out that the initial treatment worked, only now the patient is suffering from breathing and the blood oxygen is decreasing. By the way, blood pressure is also dropping. ”

"The next time you encounter such a situation, you can use a bedside emergency caller to save rescue time. Liu Banxia said.

Su Wenhao was stunned for a moment and nodded.

This is indeed a mistake on their part, and the current emergency center has its own process for responding to the deterioration of the patient's condition. Today's mistake was to delay the time and not make the call at the first time.

Before coming to the hospital bed, Liu Banxia directly conducted a auscultation of the patient, frowning.

"Did you auscultate your heart just now?" asked Liu Banxia.

"After auscultation, the heart and lung sounds are normal. Su Wenhao hurriedly said.

"Just now I heard a friction rub, did a bedside chest X-ray and a cardiac ultrasound, called the cardiologist, and prepared a defibrillator. Liu Banxia said.

As soon as he finished speaking, the nurses waiting around him began to act.

This can be regarded as a habit that has been cultivated for such a long time, and it can give the fastest response. And it's methodical and unhurried.

Looking at the chest X-ray, Liu Banxia's brows furrowed even tighter. A large, well-defined mass in the right lower lobe of the lung is most likely a non-small cell tumor.

The probability of malignancy of such a tumor is too high, and the prognosis of this situation will be very poor even after five years of surgery.

"Teacher Liu, there is fluid in the pericardium. Su Wenhao, who was in charge of cardiac ultrasound, said nervously.

"Mr. Liu, what's the situation?" At this time, Chen Xuehai, who was outside his heart, also rushed over.

"There is a large, well-defined mass in the right lower lobe of the lung, which is most likely non-small cell tumor. Breathlessness, blood oxygen and blood pressure have been lowered, and now there is pericardial effusion. Liu Banxia hurriedly introduced the situation.

"If a patient is admitted to the hospital and is found to have gallstone acute pancreatitis, if we drain the patient's pericardial effusion, will it have a stabilizing effect?"

"That's enough. Chen Xuehai's brows also furrowed.

"The patient's current pericardial effusion should be acute pericarditis caused by a lung tumor, and even if we do drainage, I'm afraid it won't have any effect. ”

"The best thing to do is to remove this tumor now, but the patient still has gallstone acute pancreatitis, what are your blood test results?"

"The indicators have stabilized, blood sugar has returned to normal, and the white blood cell and amylipoenzyme levels have also decreased. Liu Banxia said.

"Which method do you prefer?" Do you directly open the chest cage to remove the tumor, or do chemotherapy on the patient to see if you can shrink some of the tumor?" asked Chen Xuehai.

Liu Banxia gritted his teeth, "I don't know much about oncology, if chemotherapy is to achieve the effect, it will take at least four courses or more, right? ”

"Rather than that, I thought it would be better to take a gamble and go straight to the surgery to remove the tumor. However, the risks are also very high, similar to the situation with chemotherapy, which is slightly gentler. ”

This decision is very difficult to make, even if it can be left to the patient's family to choose, this is to respect the patient's and family's right to choose. But as a doctor, you also need to give a medical plan that is as appropriate as possible, otherwise what else do you need a doctor to do?

It's just that for this patient, either one is very dangerous, so it's very difficult.

Chen Xuehai was in a similar mood to him, and he also felt that surgery was the best. However, the patient also has gallstone acute pancreatitis, which will also bring a lot of variables to the operation.

"Let's talk to the patient about the surgical plan. After thinking about it for less than a minute, Liu Banxia gave a judgment.

The patient can't wait that long for a discussion, his breathing is already very unsatisfactory, and he needs to come up with ideas quickly.

Because he is the general hospitalist, he is also the patient handed over to him by Wang Chao. Even the most difficult decisions he had to make.