"So you must be rigorous in the future, and this kind of problem can't happen again!"

The doctor who did the examination nodded repeatedly.

The others also listened to Lin Yi's words and nodded in a daze.

Subsequently, they reacted immediately.

That's not right!

It's not them who do the pregnancy test, why should they listen to this kid's teachings?!

"The cause of the bleeding has been found, so what to do next?"

A doctor asked.

It's not that they don't know how to do it.

If it is an ordinary patient, they will also make a list.

But the problem is, it's a psycho with schizophrenia.

Lin Yi thought for a moment.

"First tell all the personalities that they have cancer, although uterine villus carcinoma is a malignant tumor, but fortunately, this is at an early stage, give her 5-fluorouracil and chemotherapy."

The reason why I want to tell all personalities is that I am afraid that during the treatment process, a certain personality will suddenly appear and want to escape from the hospital, thus delaying the treatment.

After listening to this, everyone nodded in unison.

As for how to treat split personality disorder, leave this to the psychiatrist.

After arranging, Lin Yi returned directly to the consultation room.

He took a sip of water and finally took a breath!

I didn't expect it to be like this in the end......

………………

"Xiaolin, I have a patient here, you have time to come and help me take a look, the patient has severe toxemia and jaundice."

Two days later, Director Liu from the Department of Gastroenterology came over and said.

Subsequently, Director Liu briefly explained the patient's situation.

Lin Yi suddenly became interested, anyway, there was nothing to do in the past few days.

"What does a patient CT look like?" Lin Yi asked.

"Non-contrast abdominal CT scan can show that the patient has pneumata in the biliary tract and an abscess in the liver, with an area of 3 cm x 4.2 cm."

Liver abscess? Jaundice?

Any one of them is a tricky operation, and two of them come at once, which can be fatal!

"MRCP results showed that the proximal end of the duodenum and the common bile duct between the intrahepatic and external bile ducts were not clearly contoured, and the initial diagnosis was filling defect." Director Liu said.

Lin Yi hurriedly quickened his pace, followed him to the Department of Gastroenterology, and asked, "Have you had a consultation?" ”

After all, the patient's condition is so serious that consultation is needed to determine the direction of surgery.

"I asked the general surgery department for consultation, but the general surgery department said that the operation was not very certain, the patient's condition was not good, and the preoperative diagnosis was not accurate enough, so I did not dare to rush the operation." Director Liu said.

Lin Yi's heart sank after hearing this, sometimes it is not that the doctor is unwilling to save people, but that he is unwilling to take responsibility, after all, the preoperative diagnosis is inaccurate, and the possibility of failure of the operation is very high.

"Does the patient have a past medical history?"

"Yes, more than ten years ago, I had a gallbladder removal operation."

Is there only a cholecystectomy? Lin Yi was a little puzzled, knowing that the sequelae of cholecystectomy were not jaundice and liver abscess.

"Take me to the ward." Lin Yi also didn't believe in the diagnosis of gastroenterology.

"Okay." Director Liu took Lin Yi to the ward.

At this time, at the request of Director Liu, the junior doctors of the Department of Gastroenterology stood near the ward with medical record clips one after another.

"Study hard and watch well." Director Liu said with a wrinkled face.

The junior doctors all lowered their heads, most of them were regular trainees and interns, and after Director Liu knew that Lin Yi was coming, he asked them to come and study if they were fine, saying that it was a once-in-a-lifetime opportunity.

Walking into the ward, Lin Yi saw the patient.

Lin Yi analyzed that the patient had blind end syndrome, also known as blind fossa syndrome, which is an extremely rare complication after surgical common bile duct or duodenal lateral anastomosis.

Complications are likely to occur because food debris and stones accumulate in the biliary anastomosis, causing a series of symptoms.

The patient's skin was a little too yellow, just like the bronze man in the Shaolin Temple, and his body was covered with gold dust.

Lin Yi touched the patient's skin, it was very hot!

If the patient's body temperature is at least 38 degrees Celsius or above, it is a high fever, which should be caused by the decline of the body's immunity caused by an abdominal infection.

Lin Yi conducted another physical examination and found that in the patient's right upper abdomen, near the duodenal segment, the patient's tenderness was obvious, accompanied by rebound tenderness and muscle tension, and there were obvious gastrointestinal symptoms.

"Director Liu, is there a B-ultrasound?" Lin Yi turned his head and asked.

Because the patient's medical history has not undergone relevant surgery, and there are no corresponding predisposing factors, Lin Yi still wants to cautiously do other examinations, see what exactly caused it, and find the inducing point before proceeding with the operation.

"I'll ask the ultrasound doctor to come over and do the bedside ultrasound." Director Liu asked a junior doctor to go to the ultrasound room.

After more than ten minutes, the doctor in the B-ultrasound room came to the ward with the emergency B-ultrasound car, and began to prepare for the patient's B-ultrasound examination, just when the B-ultrasound doctor applied the couplant to the patient's abdomen, Lin Yi suddenly frowned.

"Let me see the patient first." Lin Yi said.

The B-ultrasound doctor's movements paused, the B-ultrasound doctor knew Lin Yi, after all, in addition to the ICU, Lin Yi's emergency department needed the most bedside B-ultrasound.

"Dr. Lin can also do ultrasound?" The ultrasound doctor half-jokingly.

"I know a little bit, but I don't know much." Lin Yi took the B-ultrasound probe, scratched it on the patient's stomach a few times, determined the position, and looked at the B-ultrasound image.

The B-ultrasound doctor also hugged his shoulders and watched Lin Yi's operation, and he didn't speak, in fact, Lin Yi's behavior belonged to contempt for the B-ultrasound doctor, and the B-ultrasound doctor didn't turn his face on the spot.

Lin Yi looked at the B ultrasound and found that the distal bile duct of the patient was indeed blocked, Lin Yi changed the lateral position again, and by comparing it with the positive position, it was determined that the blockage was not a stone, but a rotting and fermenting food residue.

The occlusion is also consistent with postoperative complications of choledochoduodenomitomy, ruling out several other related surgical possibilities.

The most important point is that the patient's bile duct is obviously dilated, which is also the cause of the patient's obstructive jaundice, the biliary tract can see pneumatosis, the cystic wrap can be seen in the liver, and the preliminary judgment is liver abscess, and the patient's current condition can only be used for emergency surgery.

Lin Yi put the B-ultrasound probe back on the B-ultrasound car and asked the B-ultrasound doctor to wipe the couplant on the patient's body.

"Cow."

The ultrasound doctor sighed.

"Director Liu, give an explanation to the patient's family, see if they agree to the operation, if they agree, let's operate now." Lin Yidao.

Director Liu nodded, his expression becoming serious.

Lin Yi walked out of the gastroenterology department, thinking about what method is better for this operation, and there are currently two options, one is laparoscopic surgery, and the other is laparotomy.

If the laparoscopic surgery is done, the patient's trauma is small, but the complication problem cannot be solved by Lin Yi, it is very likely that Lin Yi will do a good job of the patient's front foot laparoscope, and the patient will be discharged from the hospital on the back foot.

When complications occur, it is not a good thing for the hospital and the patient's family.

If you open the abdomen, I am afraid that the patient's family will not agree, if the surgery is open, Lin Yi will definitely solve the complications of the patient, and the opening will be very large.

This is what Lin Yi is tangled in, after thinking about it, Lin Yi still looks at the preoperative explanation with his family, the family does not agree to the operation, everything is in vain.

Lin Yi returned to the office for a while, and then received a call from Director Liu, saying that the patient's family agreed to the operation, Director Liu was arranging for the patient to be transferred to the emergency department to prepare for surgery, and Director Liu was making preoperative preparations, and Lin Yi needed to make a preoperative explanation later.

The preoperative explanation of this operation, Lin Yi was ready to do it himself.

The patient's family soon came to Lin Yi's office under the leadership of Director Liu, a middle-aged man and a middle-aged woman, and the two looked kind, not like the kind of faces that looked like they were careful.

Lin Yi first asked the patient about the previous situation, and the patient's family was vague, after all, they didn't know some professional knowledge, they could only describe some general symptoms, and Lin Yi judged by the symptoms.

After understanding, Lin Yi also probably understood the situation, it was not that the family concealed the medical history, but that the family members were young when the patient had the operation, and they didn't know if they had had had a similar operation.

After understanding the situation, Lin Yi began to explain the preoperative explanation, explaining the patient's current condition to the patient's family, the patient must have surgery, and if he does not do surgery, he will definitely die, and there is a 20% chance that he will not be able to get off the operating table after surgery.

After Lin Yi finished speaking, the patient's family members looked a little ugly, and they probably didn't expect the situation to be so serious.

"Doctor, is my father's illness so serious?" The middle-aged man asked urgently.

"Well, if you agree to the surgery, sign it." Lin Yi pushed the signing slip in front of the two patients' families.

The patient's family is obviously entangled, if you don't have surgery, you will die, and if you do surgery, you may die, which makes it difficult for the family to choose.

The middle-aged man and the middle-aged woman negotiated for a long time, and even the two quarreled, and finally the middle-aged man silently signed to agree to the operation, while Lin Yi and Song Borui went to the operating room to change clothes.

In the operating room.

"Dr. Lin, how do you anesthetize?" The anesthesiologist asked.

Lin Yi had already withdrawn from the training room at this time, glanced at the patient, and said, "General anesthesia." ”

The anesthesiologist nodded and began to prepare general anesthesia for the patient's injection, while Wang Qiaoya prepared the instruments that might be used in this blind end syndrome surgery.

Lin Yi and Song Borui lifted the patient onto the operating table, and the anesthesiologist began to administer anesthesia.

After the anesthesia was completed, the sterile sheet was laid out, Lin Yi came to the stage to look at the patient, holding a scalpel in his hand, Wang Qiaoya stood aside, hemostatic forceps holding iodophor gauze, ready to hand it to Lin Yi at any time.

Lin Yi still chose an oblique incision under the right costal margin to open an incision of about 15CM, because the patient had had laparotomy surgery before and had a scalpel on his body, Lin Yi needed to bypass this scar tissue when making the incision, otherwise it would be fun to have cross-infection.

When the incision is made, it looks weird, and the whole thing is crooked.

Lin Yi opened the abdominal cavity, and the patient had an operation, so some of the patient's organ structures were changed, and this time the immune resistance of the human body function decreased, the patient was stimulated by inflammation, and the tissues inside the abdominal cavity appeared edema and adhesions of different sizes.

Seeing the structure inside, Song Borui, who was a helper on the side, showed a shocked expression.

"Brother Yi, the adhesion of this abdominal tissue is too serious, and I can't see the tissue structure at all, can this operation still be done?" It was the first time for Song Borui to see such a complex abdominal adhesion tissue.

"It's okay, you can help me pull up the field." Lin Yi is still confident in doing a good job.

Lin Yi didn't react when he saw the changes in the abdominal cavity, he had already seen it in the training room, Lin Yi reached out and took the blunt scissors in Wang Qiaoya's hand, and Lin Yi began to use the blunt tip of the blunt scissors to separate the connective tissue of tissue hyperplasia, peel and cut it, and the action was faster.

Song Borui was shocked on the side, he also studied clinical surgery, and the tissues in the abdominal cavity were so adhesional, how did Lin Yi distinguish the location of the abnormally proliferated blood vessels?

This kind of judgment is not in the textbook, otherwise, why do so many doctors choose to close the abdomen after opening the abdomen and give up the operation directly.

Song Borui couldn't understand Lin Yi's operation a little, but he admired Lin Yi in his heart, and found that he still had a long way to go, at least to see Lin Yi's footsteps on the road of medicine.

Lin Yi detached, clamped, and ligate a slightly thicker blood vessel with a 4# thread.

Lin Yi felt that this operation was very meaningful, so he started the live broadcast.

At this time, the live broadcast room also exploded.

"I'll go, Brother Yi is too cowhide, isn't this a perspective? Can this abnormal blood vessel be detected? ”

"You don't understand this, in our general surgery another technique called pulsation and pulse, that is, you can keenly feel the pulse of blood vessels through your fingers, which is similar to the cut in traditional Chinese medicine, it is a big guy who groped it out, but this technique needs to be tempered to learn, anyway, no one in our hospital will know it, but I just heard my tutor say it."

"It's amazing, I've heard of this technique, and it's no problem to walk sideways in general surgery."

Someone explained, the doctors in the live broadcast room were very surprised, this is a technique that some of them have never heard of, and if you think about it carefully, it is indeed the same as touching the joy pulse in ancient times!

Lin Yi continued to operate, and the layers of tissue were broken down by Lin Yi, and the anatomical structure, which originally seemed complicated, instantly became clear.

Although Song Borui didn't know how Lin Yi found the blood vessels, Song Borui could accurately pull the retractor to the position that Lin Yi wanted according to Lin Yi's movements, helping Lin Yi expose his vision in advance.

Lin Yi is very satisfied with Song Borui, and opening the surgical field is also a test of a doctor's basic skills.

When the surgeon is doing the surgery, Ichisuke is also thinking about how to do the operation, so that he can learn from the experience.

Peeling off the last layer of connective tissue, a smell of decay came to her nose, Wang Qiaoya subconsciously took two steps back, and even Song Borui frowned.

"Suctifier." Lin Yi stretched out his hand, Wang Qiaoya slapped the suction device into Lin Yi's hand, and just as Lin Yi was about to insert the suction device, he found that a thick green juice appeared in the blind socket.