"The so-called misdiagnosis refers to Zhao Dongdong's case, which is a liver abscess that compresses the phrenic nerve and causes shoulder pain, which is diagnosed as mild septic arthritis by our orthopedic department; ”

"In this process, my biggest mistake was not arranging for Zhao Dongdong to be examined by puncture of the shoulder joint cavity and extraction of cavity fluid. At that time, my main consideration was that the pain of shoulder arthrocentesis was relatively high, and Zhao Dongdong was relatively young, so if he chose to use procaine for local anesthesia, the effect might not be good, and if lidocaine hydrochloride was used for superficial general anesthesia, Zhao Dongdong's parents would be very resistant, worried that it would affect the child's brain development. ”

"So this incident also sounded a wake-up call for us, when arranging examination and treatment for patients, we must dare to adhere to the principles, and we cannot compromise because of the special identity of patients, which will actually cause more trouble to patients' examination and treatment!"

While Niu Dabao was speaking, Qian Fangzhao kept frowning. After Niu Dabao finished speaking, he snorted dissatisfiedly and said: "Niu Dabao, you have a bad attitude! A misdiagnosis is a misdiagnosis, where is there a saying that it is both a misdiagnosis and a misdiagnosis? Although I have said before that I will not be held responsible, let you rest assured and boldly say it." But that doesn't mean you can play around with these little cleverness!"

"I still say that I must focus on reviewing the reasons for the misdiagnosis of cases. As for those who are not responsible, you don't need to think about it! If we must be held responsible, I, Qian Fangzhao, as the convener of the consultation, will definitely bear the most important responsibility!"

Niu Dabao was ashamed of what he said, compared with Qian Fangzhao, he was indeed too petty. I knew that Dean Qian would intend to take the main responsibility, so he had to say it beautifully. ，

Fortunately, Qian Fangzhao did not continue to dwell on this issue, he took his eyes off Qian Fangzhao, looked around the venue, and asked, "Do you have any questions about Director Niu's speech?"

Before the other doctors could say anything, Fang Shengxue raised her hand at Qian Fangzhao and said, "Dean Qian, can I ask a question?"

"Of course you can!" Qian Fangzhao nodded.

"My problem is," Fang Shengxue said, "Now that it has been diagnosed, my cousin Zhao Dongdong's shoulder pain is caused by a liver abscess compressing the phrenic nerve." So why does the MRI show that there is a small amount of fluid in the shoulder joint, and does this mean that there is a certain problem with the shoulder joint itself?"

"Dean Qian, let me answer this question!" Niu Dabao was dissatisfied with Qian Fangzhao because of his speech, and wanted to make up for it, so he preemptively said.

Qian Fangzhao nodded and said, "Okay, it's up to you to answer!"

The reason why Zhao Dongdong has a small amount of fluid in his shoulder joint does not rule out the possibility that he may have some problems in his own shoulder joint. But most likely, this phenomenon is a consequence and not a cause. In other words, the small amount of fluid in his shoulder joint may be caused by the liver abscess compressing the phrenic nerve. Niu Dabao replied.

"Is it the result, not the cause?"

"It's very simple," Niu Dabao continued to reply, "The liver abscess compresses the phrenic nerve, and the phrenic nerve sends a wrong nerve signal to the brain, making the brain mistakenly think that there is really something wrong with the shoulder joint, so the brain sends a chemical signal to stimulate the shoulder joint to secrete more fluid to lubricate the shoulder joint and reduce pain. ”

Therefore, when the MRI examined Zhao Dongdong's shoulder joint, it would indicate that he had a small amount of fluid in his shoulder joint. Of course, this is only a very big possibility. As I said earlier, it is not ruled out that Zhao Dongdong also has problems with his shoulder joint. What is going on, it depends on whether the fluid in his shoulder joint will be slowly absorbed by the body and disappear automatically after Zhao Dongdong's liver abscess is cured. ”

"Okay, I understand, thank you Director Niu for your explanation!" Fang Shengxue smiled at Niu Dabao and expressed his gratitude. Then he gently touched Ren Jiangchi with his elbow and asked in a low voice, "Do you understand?"

"Understood!" Ren Jiangchi nodded and replied in a low voice: "It would be nice if I could continue to participate in this kind of case discussion in the future, it is full of hard-core knowledge points!"

"Director Niu is right, do you have any questions to continue asking?" asked Qian Fangzhao.

Seeing that no one spoke, Qian Fangzhao said: "Okay, about the analysis and discussion of this case by the Department of Orthopedics and Traumatology, let's talk about it first." Who's going to talk about the other issues in this case?"

"Dean Qian, I want to ask a few questions. "The person who asked the question was a girl, and she didn't look much older than Fang Shengxue.

"Xiao Zhu, you ask!" Qian Fangzhao said with a smile. This girl's name is Zhu Lili, and she is the only one among all the doctors here who is not the head of the department. The only reason why she was able to participate in this difficult case discussion was because she was the niece of Dean Zhu Guoqiang.

"What I want to ask here is the question of the fire mountain needle method of Dean Xiong of Tianyang College of Traditional Chinese Medicine. Zhu Li frowned, his eyes were full of questions, "Although judging from the results, Xiong Changlong's diagnosis is indeed wrong, Zhao Dongdong is not a juvenile idiopathic arthritis, but the problem is that when he performs the method of setting fire to the mountain acupuncture for treatment, will he show a certain degree of efficacy? Especially when he gives Zhao Dongdong pain relief, it can be said that he has achieved immediate results! Although this effect is not long-lasting, we cannot deny that he is indeed effective!"

"In addition to these questions, I would like to ask Dr. Shu from the pain department a question. Zhu Li turned his head to look at Shu Wenfeng diagonally opposite him, "When you gave Zhao Dongdong pain relief, in addition to giving him 17 ml of ibuprofen suspension orally, you also pinched a position below his left knee joint with your hand, and also achieved an immediate pain-relieving effect, I want to ask, what is the principle of this?"

"I'll answer these questions together!" Shu Wenfeng said, "Acupuncture treatment in Huaxia, according to traditional Chinese medicine, is related to the meridian theory. However, according to the research of modern Western medicine, especially in the field of medicine in Australia, the pain-relieving effect of TCM acupuncture therapy is mainly believed that TCM acupuncture stimulates the acupuncture point market, which will make the human body secrete a substance called endorphins, and the pain-relieving effect of endorphins is more than 200 times stronger than morphine. Therefore, even though Dean Xiong's acupuncture therapy was not symptomatic, it stimulated the learning on the arms, shoulders and back to secrete endorphins in the body, which immediately relieved Zhao Dongdong's pain. ”

"However, because this pain is actually caused by the liver abscess pressing on the phrenic nerve, the deceptive effect of endorphins can only be temporary, and after the endorphins disappear in the body, Zhao Dongdong's scapulatory nerve immediately sends a pain signal to the brain!"

In fact, if Zhao Dongdong is really a juvenile idiopathic arthritis, Dean Xiong's acupuncture treatment should have a pretty good effect. Because acupuncture treatment not only stimulates the body's secretion and release of endophenolphthalein, but also improves blood circulation, reduces inflammation, reduces muscle spasms and other miraculous effects!"

"Of course, if you want to seek an interpretation of traditional Chinese medicine, then you have to consult Director Li Xiaoxin. He is also an excellent expert in acupuncture treatment, and his perspective is certainly very different from that of modern Western medicine!"