"Cui Lao, this is a boiled frog in warm water, first look for you to see the patient, and then as long as you can't wipe your face, you will be given benefits and let you work in the emergency department. Su Yun said.

Zheng Ren also thought of the careful thinking in this. But with the Nobel Prize project in hand, who would go to work in such a busy, tiring and unprofitable place as the emergency department.

Zheng Ren just smiled and didn't answer Su Yun's words.

Both of them knew in their hearts that like Director Pan, Cui Lao was also unwilling.

There are no newcomers to the emergency department, but it must still exist. They just desperately burned what little life they had left to survive.

Do your best, and in the end you can only die.

But does the power of the individual work?

It's completely useless, even if Cui Lao insists on lecturing across the country at the age of seventy or eighty, he will gain very little.

However, to improve the treatment of emergency doctors, and other problems will cause a chain reaction, this kind of thing is not something that an academician of the Academy of Engineering can decide.

It sounds lofty, an academician, but it's just a signboard. Say it works, that's useful. It's useless to say it's useless.

Let the hospital and society regulate themselves? What is the cost to make improvements?

Some time ago, the matter of beating and scolding bus drivers was taken seriously, and now those who beat and scolded drivers have begun to be sentenced to endanger public safety.

But when it comes to medical care, the situation is more complicated.

Forget it, he's just a little doctor, Zheng Ren sneered.

All the way to the emergency department, Zhou Litao, the chief hospitalist, was already standing in the corridor waiting.

He has a short figure, his face is full of pockmarks, and his dark face is glued together with Su Yun, forming a stark contrast.

"Boss Zheng, there is a patient whose symptoms do not match, and Mr. Cui happened to be on call today to take a look at you. Zhou Litao greeted him and said very politely.

"Don't dare, don't dare. Zheng Ren immediately replied: "Cui Lao is wrong to love, this is not true." ”

Zhou Litao smiled and said a few polite words, and took Zheng Ren to Cui Lao's clinic.

After entering the door, Zheng Ren saw an old man with a white beard sitting in the consultation room, asking for a consultation.

"Hello Elder Cui. Zheng Ren bowed deeply and expressed his respect first.

"Well, Xiao Zheng, come and see this patient. "Cui Lao bowed his head," Li Tao, tell Xiao Zheng about the patient's condition. ”

Zhou Litao immediately said: "The patient came to our hospital for intermittent epigastric pain for 1 day, accompanied by nausea and vomiting 1 time. The patient had a history of smoking for more than 30 years and a history of hypertension for 12 years. ”

"There was no distension in the abdomen, no intestinal pattern and no peristaltic waves, no skin scarring and no abdominal wall varicose veins.

Deep epigastric tenderness without rebound tenderness and muscle tension. The liver and spleen were not subcostal, Murphy's sign was negative, and no obvious mass was palpated. Abdominal percussion showed tympanum, no percussion pain in the liver and spleen, no percussion pain in both kidneys, negative moving dullness, about 3 bowel sounds per minute, and no abnormal vascular bruits were heard. ”

"B-ultrasound return, mild fatty liver, Yu negative. However, the patient complained of severe pain, and Cui Lao judged that it might be an aortic or mesenteric artery dissection, and was preparing to do a 64-row vascular CTA in the emergency department. ”

Zheng Ren understood that it was estimated that there were still patients on the other side of the 64th row, waiting for a call, so he looked for himself during the interval.

This must be what Cui Lao meant.

While listening to Zhou Litao's narration of the patient's medical history and looking at the patient, Zheng Ren saw that the system panel was bright red.

Several diagnoses, such as isolated superior mesenteric artery dissection type II.b and hypertension, appear in front of the eyes.

It's a troublesome disease, Zheng Ren thought to himself.

Vascular dissection is very troublesome. From Cui Heming's aortic dissection to the patient in front of him, if the level is lower in the hospital, he will be admitted to the hospital or outpatient for observation with abdominal pain.

If the diagnosis is not made in time, once the dissection ruptures, death awaits the patient.

Especially in small and medium-sized hospitals, the misdiagnosis rate is quite high when encountering this disease.

And Cui Lao, just by using physical examination, the diagnosis of the disease was basically determined, and this level and experience are not blown.

Zheng Ren nodded and began to check his body.

As Zhou Litao said, the patient's abdominal tenderness is not obvious, and there is some deep tenderness, but it is not the main thing.

The tenderness on examination is mild, but the patient is pale and sweating profusely, which is a self-reported severe symptom.

This is the case of the so-called physical inconsistency.

After Zheng Ren's physical examination, he glanced at the emergency B-ultrasound and laboratory test sheets. The patient can be said to be healthy, with few positive test indicators other than severe pain.

"Elder Cui, I think it's more likely to be mesenteric artery dissection. Zheng Ren said: "You can choose to do 64-row CTA examination or interventional imaging to confirm the diagnosis and surgical treatment. ”

"What about conservative treatment?"

"Hmm...... Conservative treatment depends on the opinion of the patient's family. I come from a surgical background, and I'm not too much in favor of conservative treatment. Because whether it is an isolated mesenteric artery dissection or a concurrent aortic dissection, once treated conservatively, assuming a sudden dissection rupture at night, it will cause more damage to the patient. Zheng Rendao.

He also knows that his attitude is more radical.

Surgeons, in general, are more aggressive. If you can solve a problem with surgery, why should you keep a dark thunder by your side?

Of course, for isolated superior mesenteric artery dissection, the recovery rate of conservative treatment is also very high, which Zheng Ren knows.

However, Cui Lao just asked for his own opinion, and Zheng Ren also said his inner thoughts.

Cui Lao looked at Zheng Ren, and then said lightly: "Can you do the patient's surgery?"

"If you want to match the table with the general surgery, I have no problem. Zheng Ren said: "I will try to minimize the damage of the patient." ”

"Okay, you and Litao take the patient for an examination, and tell me when that side is done. After Cui Lao finished speaking, he waved his hand and motioned for them to push the patient to do 64-row vascular CTA.

The old man was full of momentum, and Zheng Ren recalled the picture of Cui Lao pointing at Director Kong's nose yesterday, and then smiled bitterly.

It is impossible for people who are engaged in emergency treatment not to be in a hurry. Even if it is a chronic child, in the emergency department, it will be grinded out quickly.

But the old Cui in front of him was very kind, told him to pay attention to the patient's blood pressure, and personally looked at the concentration and speed of the blood pressure medication pumped in by the micropump, and then let Zheng Ren and them push the patient away.

"Boss Zheng, do you think the patient has an isolated dissection or a concurrent aortic dissection?" Zhou Litao asked in a low voice as he walked.

The patient's family is all around, and everything is hypothetical without an objective basis. If you can be quiet, you can be quiet.

"I look at the patient's signs, and they seem to be isolated. Zheng Ren replied: "The point of pain is wandering, unlike the pain point of aortic dissection that is fixed with radiating pain. ”

This is the reverse thrust, according to the reverse thrust of the system panel.

Zheng Ren thinks it is normal, the physical examination is consistent with the diagnosis of the system panel, and it is estimated that the big pig's trotters are still right this time.

He thinks it's normal, but listening to it in other people's ears is a different story.