Chen Qi came to the internal medicine ward only after hiding all the machines in the "tent operating room".

At this time, there were many fewer people visiting or mourning in the ward, and when Chen Qi came in, Cui Tongzhi was holding his wife's hand tightly.

Only those who have experienced life and death will know that the original wife is always good at the critical moment, and the bewitching and evil colors outside are all floating clouds to put it bluntly, and when you are down or going to die one day, the first to run away with the money is these women.

Obviously, Cui Tongzhi has come to his senses.

Originally, this guy was eating and drinking outside all day long, and it was inevitable that there would be things to do in the field, presumably he would definitely get off work early after work and eat the dishes cooked by his wife.

As soon as Chen Qi walked into the ward, he saw that the middle-aged couple was talking to each other, so he coughed lightly:

"Ahem, pay attention to the impact, there are still children here."

Yang Yibing and Jin Meng both covered their mouths and chuckled, as Chen Qi's master's students, these students are basically where Chen Qi goes, they follow.

Cui Tongzhi saw Chen Qi come in, and said with emotion:

"Dean Chen, I really don't know how to thank you, you saved my life, and if you can use my Cui someone in the future, I am absolutely duty-bound."

Generally, top doctors have a wide range of interpersonal relationships, know many people, and have many connections.

After all, knowing a famous doctor is a guarantee of life and health for everyone, and it is not that you will not die if you have money or power.

Cai Fengdi is more concerned about her husband's prognosis:

"Dean Chen, do you have any precautions after my family's Lao Cui? What can you eat and what can't you eat? When will I be discharged from the hospital? ”

"After the operation, I should pay attention to a light diet, including in the future, you have to quit smoking and drinking, and I have prescribed you two medicines, which must be taken orally every day in the future. The rest is not a big problem, and you can go home and rest after staying here for a day or two. ”

"Huh? Just stay in the hospital for a day or two? ”

Cui Tongzhi and his wife were very surprised, this is a heart attack, even if the patient does not die in another hospital, who is not going to stay for ten days and half a month, they are afraid of a sudden recurrence in the middle.

Chen Qi said casually:

"Myocardial infarction myocardial infarction means that a certain blood vessel in the heart is blocked, causing myocardial ischemia and hypoxia, and now I have dredged this blocked blood vessel, and a stent is installed in it, and the blood will be smooth, anyway, there is no problem in a short period of time.

But let's say it first, this stent is not cheap, all of them are imported from the United States, and there are few in our People's Hospital, so don't feel distressed when the bill comes down after a while, after all, this is life money. ”

Cai Fengdi waved her hand again and again: "We don't feel distressed, we don't feel distressed, as long as people live, Dean Chen, you are really a miracle doctor in the world." ”

Chen Qi smiled: "Where is it, it's still Lao Cui's own life, okay, you guys have a good rest, I'm leaving." ”

"Dean Chen~~~"

Cai Fengdi suddenly shouted, Yang Yibing and Jin Meng had interned as undergraduates, and knew that it was time to give red envelopes, so the two college students took the initiative to walk out of the ward and avoided it.

Sure enough, a thick red envelope was suddenly stuffed into the pocket of Chen Qi's work clothes.

"Dean Chen, thank you so much for your help today, I inquired with the doctors in the provincial hospital, there are very few people who can be saved from a heart attack, you are the lifesaver of our family."

Chen Qi touched the envelope, it was quite thick, it was estimated that there were at least two or three thousand.

That's a lot of money in 1989.

Chen Qi actually doesn't care about this red envelope, in China, he doesn't accept red envelopes and doesn't take medicine buckles is a principle, and he won't break it.

But he is not a virgin, he doesn't take it because he is not bad for money, but he will not prevent others from taking red envelopes, and he will not block people's money.

"Okay, thank you, but don't just give me one, today's Lao Cui's surgery is me, as well as Yi Zewen from the emergency department, and nurse Chen Li worked hard to complete it, and we were exposed to X-rays throughout the operation.

I don't know how much I have eaten for more than an hour, and each of us has to wear a 30-pound lead suit, and our whole body is soaked, and the little girl is so tired that she almost faints, so you should also thank them. ”

Cai Fengdi nodded again and again when she heard this: "Cheng, they are all my family's lifesavers, and I will thank them." ”

After Chen Qi came out of the ward, he then handed the red envelope to Jin Meng beside him:

"In a while, you go to the inpatient department charging window and give all the money in it to Cui Tongzhi for 15 beds to pay the hospitalization fee."

It was the first time Jin Meng had seen a doctor refuse a red envelope, and his eyes were full of little stars when he looked at Chen Qi for a while.

"Knowing Mr. Chen, I'll do it right away."

Chen Qi saw the adoring eyes of his two students, so he was ready to pretend lightly:

"Remember, when you become a big doctor in the future, there will definitely be no shortage of red envelopes and medicine buckles, but a gentleman loves money and takes it in a good way, and you have to know which money you should take and which money you shouldn't take, I don't want to find you in prison later.

Money is a good thing, but if a person becomes a slave of money, then it's not interesting, you look at me, I don't like money, do you know when a teacher is the happiest? That's when I just joined the job and got a few dozen dollars a month, cough cough~~~"

After Chen Qi finished speaking, he left, and Jin Meng's two eyes continued to bubble up little stars:

"Wow, Mr. Chen is so handsome, with a clean breeze on his sleeves, he is really a model for my generation~~~"

Yang Yibing also nodded heavily: "We also have to learn from Teacher Chen, don't take any money except salary, and insist on putting an end to red envelopes." ”

(Uh, it seems that Mr. Chen's money fell from the sky, and he didn't receive red envelopes?) ）

……

Chen Laoshi, who is not interested in money and never accepts red envelopes, officially represented the Yuezhong People's Hospital in the evening and welcomed the delegation of Xijing Hospital.

However, the doctors of Xijing Hospital ate tastelessly at this banquet, and when the banquet ended, these Northwest men who loved to drink basically did not move their glasses.

After the meal, still at the dinner table, everyone couldn't wait for Chen Qi to talk about why a patient with abdominal pain was recognized as having a heart attack?

"Dean Chen, and Teacher Tong, what is the basis for why you believe that this patient with abdominal pain may have a heart attack?"

"Did you find any special signs when you were doing the physical exam?"

"Dean Chen, you can't hide your secrets, tell everyone about it."

The atmosphere was very warm, and in addition to the doctors from Xijing Hospital, the doctors from the Department of Gastroenterology in Vietaka also had a strong interest.

Because abdominal pain is a very, very common symptom in gastroenterology or gastroenterology, more than half of the patients who receive a visit have a complaint of abdominal pain.

If a single abdominal pain could be caused by a heart attack, it would be so terrible that the doctor would not dare to see a doctor.

After all, not everyone is like him Chen Qi, and even cardiac interventional surgery can be completed.

Chen Qi was still strange when he heard everyone's questions, and looked at the young doctors present:

"No, when you were in school, didn't the teacher teach you the symptoms of atypical heart attack?"

The young doctors all shook their heads blankly: "I haven't studied, but I just said that when I have a heart attack, I will have radiating pain in my chest or back." ”

Chen Qi looked at the professors and directors of Xijing Hospital again:

"A few teachers, don't you have such a clinical concept in clinical practice, but all pain below the nose and above the navel must consider the possibility of angina, and you must do an electrocardiogram after arriving at the hospital, and if necessary, combine myocardial necrosis markers to assist in diagnosis."

The doctors at Xijing Hospital also shook their heads blankly:

"No, we haven't seen this suggestion from any literature or papers, at least our gastroenterology department rarely takes the initiative to ask patients to do ECGs."

Chen Qi now understood in his heart that the medical research in 1989 had not gone further.

The iron rule that "all pain below the maxillofacial level above the umbilicus should be electrocardiogram" known to clinicians in later generations, especially emergency doctors, has not yet been popularized in this era.

One of the reasons may be that medical research in the 80s is much behind in 2023.

In addition, there is not much research on myocardial infarction in China, which is too poor these years, many grassroots hospitals do not even have biochemical examinations, and many patients suspected of myocardial infarction cannot be diagnosed because there is no electrocardiogram and cardiac enzyme report.

In other words, there are many patients who do not have 120, or are inconvenient to transport, or have no money to go to the hospital, etc., because of various factors such as sudden death of myocardial infarction at home, and they are directly not sent to the hospital for funerals.

This also led to the fact that in the 80s, domestic doctors were both familiar and unfamiliar with the disease of myocardial infarction.

What is familiar is what I have learned in books, and it is strange because it is difficult to encounter it in clinical practice, unless it is an inpatient who has a heart attack in the hospital, but this probability is too small.

When doctors are not even familiar with typical myocardial infarction, then atypical myocardial infarction can only be said to be completely ununderstood.

No wonder Chen Qi was still strange before, why did a patient with abdominal pain check for a long time, and all the causes were there, but no one thought of myocardial infarction or coronary heart disease?

Here's why.

Professor Tong is an expert at the level of Lao Taishan, and his thinking is broader, but he has some guesses, but if he really wants to say the specific reason, he may not be able to explain it clearly.

"Xiao Chen, since everyone is more curious about why you presciently diagnosed a myocardial infarction on this abdominal pain patient, then you can tell me, our gastroenterology department often encounters abdominal pain patients, and this experience is really lacking."

Chen Qi didn't hide his selfishness, so he stood up directly:

"Okay, since everyone is interested, then I'll tell you everyone, you have done all the auxiliary examinations you can think of before, and you have all done physical examinations yourself, and you haven't found anything, right? This excludes the possibility of an organic lesion in the abdomen.

Then I found that everyone was very careless and casual during auscultation, and felt that abdominal pain had little to do with heart disease, so I would like to ask you first, when you were auscultating patients before, who heard anything abnormal? ”

In the small cafeteria of the people's hospital cafeteria, all the doctors shook their heads.

Yi Zewen, as the person in charge of the emergency department, was the first to speak:

"Dean, anyway, I didn't hear anything abnormal, and as far as I know, it is difficult to hear anything from a heart attack through auscultation, and it usually takes an electrocardiogram and cardiac enzymes to confirm the diagnosis, do you hear something wrong?"

Chen Qi nodded and said seriously:

"Yes, because I wondered if there might be a heart problem, I listened carefully and found that the patient's heart rate was very fast, and because the heart was beating so fast, you ignored the presence of a third heart sound at the apex of the heart.

There is a third mind at the apex of the heart, everyone is a doctor and should know what this represents, yes, this represents myocardial or papillary muscle ischemia, which is a positive symptom of great significance.

That's why in college, the teacher emphasizes the importance of physical examination, sight, touch and listening are the basic skills of our medical students, we can't rely on machines to see a doctor, we have to use our own brains to see a doctor.

If you don't have your own opinions, just like this patient, you all missed a very important positive indicator because of carelessness, so many doctors and so many experts in the two hospitals present, only Professor Tong and I heard that it was abnormal, and it was very embarrassing for outsiders to know it. ”

In the face of professors and experts from top hospitals in China, Chen Qi spoke mercilessly, which made many doctors in Xijing Hospital blush.

Professor Tong nodded approvingly at Chen Qi, looked back at his disciples and grandchildren, and sighed lightly.

"You guys, the stethoscopes are all decorations, and you patronize and touch your stomach, so you forgot that I reminded you at the time, it may be that there is a problem with other organs next to you, and you didn't listen to any of them at the time, right?"

Director Liang, Director Zhou, Director Yan and other professors from Xijing Hospital scratched their heads embarrassedly.

Others didn't dare to ask anymore, but Lan Lijuan was not afraid, she had never been afraid of Chen Qi since she met him in 1977, so she asked rhetorically:

"Chen Qi, your judgment of having a heart attack just by hearing a third heart sound is too arbitrary, because there is also a physiological third heart sound, which does not necessarily mean that there is a lesion, even if it is pathological, it may be mitral valve regurgitation, ventricular septal defect, patent ductus arteriosus, why do you just think of a heart attack?"

"Well, Dr. Lan asked this question very well!"

Chen Qi gave a thumbs up, and everyone in the restaurant chuckled, who didn't know that these two were two in-laws.

"As far as Cui Tongzhi is concerned, we have been able to rule out inflammatory diseases, perforation or rupture, organ blockage or dilation, and other problems such as poisoning, pulmonary embolism, aortic dissection, including abdominal pain caused by epilepsy that we previously diagnosed.

For example, aortic dissection, the onset of this disease is very similar to acute myocardial infarction, both of which are manifested as severe and sudden chest pain and abdominal pain, but these two diseases are easy to identify, that is, electrocardiogram and cardiac enzymes, aortic dissection will not be abnormal, and myocardial infarction will.

Therefore, from the perspective of differential diagnosis alone, electrocardiogram is also a necessary examination. ”

Lan Lijuan was still unconvinced, and asked, "But you still haven't answered why a heart attack causes abdominal pain?" ”

Chen Qi scratched his head: "Okay, okay, I'll answer it right away, in fact, this question is very easy to answer, Professor Tong, why don't you answer it." ”

Professor Tong laughed twice: "It seems that Dean Xiao Chen is also going to test me, an old man, okay, then I will tell you my opinion." ”

How would Professor Tong explain this?

(End of chapter)