"To accept or not to receive?"

"Close!"

Zhang Tianyang agreed simply, and Senior Brother He was even more straightforward.

"Okay, then you can look at the medical records first, and I'll go with you to see the patient in five minutes. ”

"Good. ”

After receiving a stack of medical records and various examination sheets handed over by Senior Brother He, Zhang Tianyang began to look through the patient's past medical records.

The patient's home is in Zengcheng and he has not been treated at the East Hospital in the past, so Zhang Tianyang can only read the paper report.

A whole stack, one hand can barely grasp it, showing the patient's tear-stained medical history.

The patient, a 60-year-old male, was admitted to the hospital with "20 years of cirrhosis, 2 months after splenic thrombosis and intermittent fever for more than 1 month". ”

......

Five minutes later, Zhang Tianyang and Senior Brother He appeared together in front of the 82-bed hospital bed.

"Come, rounds. ”

Lifting the layers of quilts and clothes that the patient had wrapped tightly, I finally saw his true face.

The patient looked a little emaciated, and the cheekbones on his face were protruding.

But when I lifted my clothes, I saw that my belly was bulging like a big fat man of two hundred pounds.

After inquiring about the medical history in detail, Senior Brother He gestured to Zhang Tianyang.

"Physical exam, are you coming?"

"Good. ”

Zhang Tianyang answered, and his hand pressed on the patient's stomach.

With a gentle force, Zhang Tianyang pressed and asked, "Does it hurt here?"

The temperature of the skin under the hands is significantly increased, and the skin tension in the patient's abdomen can be noticeably increased when exerting force.

Positive for mobile dullness indicates that he has at least 3000ml of ascites in his stomach.

Ascites is a common complication in people with cirrhosis, and sometimes the patient's belly can be larger than that of a pregnant woman.

Figuratively speaking, it is equivalent to the amount of six bottles of mineral water, all piled up in the stomach.

It is a great burden on the daily life of the patient.

After hearing the chest and abdomen, Zhang Tianyang lifted the quilt that wrapped the patient's legs.

When I opened the hospital gown, I obviously saw that the patient's lower limbs were also white and swollen, and when I pressed it gently, it was concave into a big pit.

"Did the nurse take your temperature?"

Zhang Tianyang asked, asking the family to urge the little nurse to hurry up and take her temperature and blood pressure.

"Senior brother?" Zhang Tianyang looked at Senior Brother He, "I think you need to put ascites, preferably within today." ”

"Wait a minute. ”

Although he watched Zhang Tianyang's technique throughout the whole process and did not find any mistakes, Senior Brother He still rigorously re-did a physical examination.

Clinically, caution is the best.

Back at the doctor's office, Zhang Tianyang began to prescribe various examinations and various treatments and medications for the 82 beds.

This uncle has had an intermittent fever for more than a month, and now the fever and chills are his daily routine.

There is too much ascites, and Zhang Tianyang suspects that the fever is related to ascites, so abdominal puncture still has to be done.

Just wait for the patient to quickly finish the B-ultrasound of the abdomen, hepatobiliary, pancreatic and spleen, and set the puncture point.

"Blood routine, liver function, kidney function, six ions, two infections, ascites routine, ascites culture, electrocardiogram, chest X-ray, abdominal B-ultrasound......"

"Liver protection, yellowing, albumin, diuretic, stomach protection, antibiotic ......"

Senior Brother He sat behind Zhang Tianyang and watched silently, a little surprised.

"Xiao Zhang, haven't you just been out of clinical practice for a short time?

He just saw that Zhang Tianyang was careful and found the problem of 8 beds, so he tried to give him a patient.

I didn't expect to have an unexpected surprise.

Zhang Tianyang said modestly, "I still need more guidance from my senior brother, but I still don't have enough experience." ”

"Come on!"

Senior Brother He laughed and scolded, and his heart moved.

"No, I'll have to test you. In this way, you can talk about the diagnosis of fever chady, and the situation of this patient. ”

As soon as the words fell, Senior Sister Chen, the head of the explosion, quietly grabbed the small notebook and came over.

"How?"

Senior Brother He thought that there was something wrong with the patient she was in charge of, but Senior Sister Chen smiled embarrassedly, "If you say it, I'll listen to it." ”

The senior doctors have more experience than them, and sometimes their casual words can benefit the junior doctors a lot.

Seeing that Senior Brother He is about to start instructing the little junior brother, Chen Shishi, as a positive and motivated young man, of course can't let go of this opportunity.

Senior Brother She was typing the medical records on the computer next to him, his brows furrowed.

Of course, he noticed the situation here, but his men did not move.

Senior Brother He is indeed experienced and skilled, but now it is the junior brother who speaks first.

"Senior brother is talking nonsense, I will affect my judgment if I listen to it, so I will listen to it when Senior Brother He says it. ”

Even if Zhang Tianyang discovered the problem of 8 beds earlier than him, Senior Brother She still didn't have a high opinion of him.

Even for some subtle reasons, it is even more unpleasant.

Senior Brother He glanced at Senior Brother She, who was not moving at all, and gestured to Zhang Tianyang, "Tell me?"

Zhang Tianyang is also not stage frightened.

"Fever Chain, I mainly consider the following points.

First, infections, whether bacterial or fungal, viral or parasitic, can cause fever. At this time, tests such as infection and bacterial and fungal cultures of body fluids should be completed.

Second, tumors, especially hematologic tumors. Lymphadenopathy is common in such patients, and the diagnosis can be confirmed by a complete blood test, bone marrow aspirate, and biopsy of the enlarged lymph nodes.

Thirdly, some endocrine diseases such as hyperthyroidism can also cause an increase in body temperature, and some drug fever, etc. ”

Reasonable.

Senior Sister Chen nodded vigorously with a look of anticipation.

This junior brother looked a little different, not at all like the interns she had met before.

Everyone came from the internship stage, what the hell did it look like during the internship, who didn't have points?

Normal interns don't know anything when asked questions by senior doctors, and even if they can say something, they often talk a little bit about it.

But what about this junior brother?

It is justified and well-founded, and it also lists 123 points for you......

"And what do you think about this patient?"

Senior Brother He was also surprised, so he became more interested, "Come, let's talk about it." ”

Zhang Tianyang turned out the medical records of the 82-bed uncle.

"The patient had a history of liver cirrhosis for the past 20 years, had a splenic thrombosis due to hypersplenism 2 months ago, and had intermittent fever for more than 1 month since then.

I think that the patient's fever should be related to the splenic plug, consider absorbing heat?

However, normal heat absorption does not burn for so long, and it is considered that there is a co-infection or that the splenic plug is too large. ”

Senior Brother He nodded approvingly, "Yes! I think it's okay for you to analyze this!"

He also flipped through the patient's medical records, "It's a pity that the patient didn't bring the record of doing the splenic embolism."

But it's okay, let's make up an abdominal MRI for him, and look at the picture to see if what you said is true. ”

"But, Xiao Zhang, are you really a five-year system?"

Zhang Tianyang blinked, "Yes." ”

"What do I say, the children who come out of our school can't be pitted. ”

Senior Brother He laughed.

"The teaching secretary also told me that you are going to die in the five-year system, and we should not give you patients easily.

I'll talk about her going back, it's clearly a rumor!"

Senior Sister Chen listened beside her, her eyes brightened.

Damn, I shouldn't have picked up the treasure!

"In the past, I used to fill holes and wipe my ass for my interns, but this time I finally came to a reliable one!"

Thinking that she could stay more relaxed in the next two weeks in the Department of Infectious Medicine, Senior Sister Chen couldn't wait to give Zhang Tianyang a thumbs up.

Good job!

Even if you are excellent, the old lady can secretly salted the fish!