"Huh?"

It seemed that the untimely question caught Senior Brother Qiu Ming off guard.

"This ...... The first time I didn't know, the last emergency gastroscopy was not done by me. But the last gastroscopy ......"

Although it was not very clear why Zhang Tianyang asked such a question, Senior Brother Qiu Ming still recalled it seriously.

"I didn't teach him to position himself last time during the gastroscopy, he just lay down by himself. ”

"Usually?"

Zhang Tianyang felt that he vaguely seemed to have grasped the key point.

"I remember mentioning in the patient's medical record that he had low hemoglobin and was ordered to stay in bed. How did he lie when he was in bed?"

"This ......"

Senior Brother Qiu Ming couldn't answer.

He is an attending physician, and if you ask about the patient's condition and subsequent treatment, he can say the truth.

But he really didn't have time to pay attention to these details.

So Chen Jiajie, who had just been kicked out, was called in again.

"You are the doctor in charge of this patient, and now Dr. Zhang has some questions to ask, and you can answer them well. ”

Senior Brother Qiu Ming, who was in an irritable mood, even forgot that Chen Jiajie and Zhang Tianyang were actually roommates, and directly treated him as an ordinary intern.

Zhang Tianyang didn't have time to explain, so he directly repeated the question just now.

The patient has just had a bleeding episode, and now is the best time to look for a bleeding spot.

How can you have time to explain so much!

"Yes, the patient has been bedridden most of the time since he was admitted to the hospital. ”

Chen Jiajie also knew the severity of the matter, and he already had a vague guess in his heart when he was kicked out before, but at this time, he had a correct attitude and a serious face.

"I haven't really asked this question, but every time I go to see a patient, he's in the left side decubitus position!"

Zhang Tianyang's eyes lit up. "Are you sure?"

"Sure!"

Chen Jiajie nodded firmly, "I also asked once, and the patient said that the left decubitus position is more comfortable, and it is not easy to want to vomit." ”

It's not easy to want to throw up!

Zhang Tianyang and Senior Brother Qiu Ming subconsciously glanced at each other.

The patient recently had active bleeding from the digestive tract, and it was clearly written in the medical record that he was fasting!

All three meals a day are replaced by needle water.

What is there to vomit on him!

Unless......

It's blood!

Moreover, if you don't want to vomit in the left lying position, it means ......

It's the position that hinders the bleeding!

The bleeding point, when in the left decubitus position, should be covered or even firmly pressed!

I see.

No wonder several gastroscopies did not find the bleeding point.

Senior Brother Qiu Ming's eyes had an obvious look of surprise.

At the same time, there is a hint of chagrin.

Such a simple question, why didn't I think of it!

"Come on. ”

Zhang Tianyang spoke, "Try turning the patient over." ”

Chen Jiajie closed his mouth tightly, but his eyes widened.

He is the patient's bedside doctor.

Although he is just an intern, his experience, experience and even basic skills are not enough, but the basic condition is still clear.

Even if it is half a beat slower, after the two of them showed an expression of "finally found the reason", after Zhang Tianyang directly said that he wanted to "turn over" the patient, he could always react.

So that's it!

At the same time, he subconsciously looked at Zhang Tianyang.

The key point of the matter turned out to be discovered by his roommate first......

Somewhat surprised.

But when you think about it, it seems to be expected again?

Chen Jiajie's heart quickly flashed over these things, and then suddenly his eyes widened again.

Because Zhang Tianyang actually stretched out his hand towards Senior Brother Qiu Ming: "Give it to me." ”

Now that there has been a major breakthrough in the condition, an intern doctor actually stretched out his hand to the attending doctor?

It's not the same as saying, "You can't, I'll do it."

However, what shocked Chen Jiajie even more was that Senior Brother Qiu Ming didn't say anything and directly gave up his position.

The gastroscope doesn't even exit the patient's mouth.

There was a jolt on the screen, but it was obvious that the camera didn't move much.

It was so easy, and the gastroscope handle fell into Zhang Tianyang's hand.

There is no contempt for those who belong to the superiors, there is no anger at the shame of losing face, there is no roar of "you dare!", there is no surrender of the boss outside the world, and there is no shock of two levels of reversal.

He didn't smile crookedly.

It's plain as if Zhang Tianyang is actually a senior doctor.

"What are you doing in a daze, come and help!"

Senior Brother Qiu Ming frowned, but not at Zhang Tianyang, but at Chen Jiajie, who was stunned.

"Oh, oh!"

Chen Jiajie finally reacted, hurriedly took two steps forward, and together with Qiu Ming, he used his old strength.

"Slow down, flip a little bit, and be careful not to knock over the camera!"

Fortunately, the patient is just an underdeveloped boy, and because of anemia and malnutrition, his body is quite light.

With the combined efforts of the two, the patient's body was slowly reversed.

Zhang Tianyang pinched the operating handle with one hand and controlled the depth and angle of the gastroscope with the other, the lens rotated with the contents, and the picture on the screen was not too bumpy.

"Turned it over, did you find a bleeding spot?"

Senior Brother Qiu Ming came over.

A little gasp.

"It's time for you to work out. ”

Zhang Tianyang glanced at him, his hand moved slightly, and soon the camera was close to a small piece of stomach wall.

"This should be it. ”

On the screen, it's still flesh-colored.

In the middle, a small depression is visible.

"Is this it?"

Senior Brother Qiu Ming took two steps forward to the screen, "This looks like ......"

"Dieulafoy's disease. ”

Zhang Tianyang helped make up the second half of the sentence.

So Senior Brother Qiu Ming was left with only a chicken pecking rice and nodding.

While nodding, he sighed quietly, "It's really true......"

and even quieter muttering.

"Why didn't I think of it......"

"With a titanium clip, right?"

Zhang Tianyang turned his head and asked the little nurse who cooperated.

"Are you ready?"

"Ready!"

The little nurse nodded like a chick pecking rice.

She didn't know Zhang Tianyang, and Zhang Tianyang was wearing a surgical gown when he came, so she directly regarded him as a foreign aid invited by Senior Brother Qiu Ming.

The attending doctor must at least ask for foreign assistance from the attending doctor, right?

Besides, he still looks so young!

It's right to have a better attitude.

What if I don't have a girlfriend yet?

Even if there is, what if they break up?

Even if you don't break up, what if you want to have two?

"Come on, then. ”

Zhang Tianyang nodded at the little nurse.

After a short period of preparation, he took the time to look at his roommate Chen Jiajie.

Sure enough, I saw a slight blankness on his face.

"Dieulafoy disease, accounting for 1.2%~5.8% of the causes of acute upper gastrointestinal bleeding, typical cases of clinical manifestations of intermittent, recurrent episodes of massive hematemesis or melena, prone to shock and other peripheral circulatory failure. ”

Zhang Tianyang sighed softly and began to explain.

"Under normal circumstances, the blood supply to the gastric wall mainly comes from the short arteries of the stomach, and after entering the gastric wall, the branches gradually tapere, and finally form a capillary system in the gastric mucosa.

However, in patients with this disease, the branches of the short gastric arteries enter the muscular layer of the gastric mucosa and maintain a constant diameter, so they are called constant-diameter arteries. ”

After a pause, Zhang Tianyang changed to a more popular explanation.

"Just like a normal uncle, the branches should be more and more thin. But this kind of patient, he is a rough stem to break the sky.

Such a thick blood vessel, and so close to the mucosal surface of the stomach wall, if there is any friction, ulcer, inflammation or something, it will be like now. ”

The silver titanium clip has appeared in the field of vision of the screen, and Zhang Tianyang operated the titanium clip and shook it around the small hole.

"It's no wonder that the arteries open the gates to bleed, and the patient doesn't vomit blood. ”

"I see. ”

Chen Jiajie nodded busily, looking like he had "learned".

But there was still a slight confusion in his eyes.

"However, this hole is not very obvious, and there is no bleeding, how can it be ......?"

Zhang Tianyang turned his head to look at him and blinked, "Look at the screen carefully." ”

"Hmm, why do you want to look at the ...... screen?"

As he spoke, Chen Jiajie's eyes widened suddenly.

I saw the silver titanium clip poking forward, and poked it at the small hole that didn't look inconspicuous at all.

Then, with a gentle pick—

"Poof!"

A thick stream of blood spurted out in an instant.

No, that's not blood, that's a column of blood!

"Lao Zhang, what are you going to do......"

Chen Jiajie subconsciously exclaimed.

"Click"

Zhang Tianyang stepped on his feet, and the special effect of screenshots obviously appeared on the screen.

With a pinch of the hand, the titanium clip went upstream.

"Click"

Two clicks passed.

The blood column is gone.

In the center of the screen, the tail of the silver titanium clip still trembles slightly.

"What ......"

Chen Jiajie's exclamation seemed to have spanned a century, and finally called out the last two words.

Zhang Tianyang blinked, and asked the little nurse to ask for two titanium clips, one on the left and one on the right next to the first titanium clip.

Then, he turned his head and looked at him, and then at Qiu Ming.

"That's it, call it a day!"

Step on it again, and it's another screenshot.

Zhang Tianyang's body leaned back slightly, and the mirror exited smoothly.

Then, put the mirror, drag the gloves, wash the hands, and leave in style.

Only Qiu Ming, who sighed, and Chen Jiajie, who was still immersed in shock, stayed in place.

"Don't be stunned, take a hand, and send the patient back later!"

Senior Brother Qiu Ming slapped Chen Jiajie on the face.

It was like a paused movie was suddenly pressed to replay.

Chen Jiajie suddenly gasped-

"Shhh

————————

Gollum~

Stealing incense