The child was only five years old, conscious, his brow furrowed, showing a painful appearance, and he could not say a word.

This is a bit different from what I knew before.

His mother, a very young Tibetan woman, looked a little anxious, but more trusting of the doctor.

Through a simple exchange, everyone understood that in fact, she did not see the process of the child swallowing the foreign body, and she did not know whether it was a nail or not.

But the reason why the county hospital reported it like this naturally has a basis.

They took a CT scan and brought it with the car.

CT findings: metallic foreign body in the esophagus, located in the flat neck 5-thoracic 1 vertebrae.

The tip is clear. Flat neck 5 is the most prominent part of the flat thyroid cartilage, where the Adam's apple is located. The thoracic 1 thoracic vertebral body, on the other hand, is approximately 4 cm above the jugular notch.

The distance between the two is about 3 centimeters, which is about the same length as an iron nail, so the county hospital made this guess.

It's just speculation, not very sure.

Fortunately, in addition to the foreign body jammed, the child's indicators in all aspects were stable for the time being, which gave everyone time for consultation and discussion.

Tonight's consultation was attended by the emergency department, emergency surgery, digestive endoscopy and anesthesiology department.

It was Director Kong himself who came down from the Department of Digestive Endoscopy.

He had changed his clothes and was ready to get off work, but after hearing this, he couldn't put his mind at ease, and he had to see it with his own eyes.

He took the CT film and watched it for a long time, and then passed it on to others to watch one by one.

"It's hard to see the shape of a foreign body from a CT scan alone." He said, "What do you think?" ”

Ye Chen, as a representative of emergency surgery, immediately shook his head: "I can't see it." It does not look like an iron nail in section, and it neither punctures the esophagus nor falls into the stomach. ”

"You've got a point." Director Kong nodded, and his eyes fell on Tao Le, who was standing aside.

He noticed this little girl just now, she speaks Tibetan fluently, which is completely different from people like him who rely on Bluetooth headsets.

Recently, there are too many new things in the courtyard, and an old man like him is a bit flawless, so he hasn't poured out the time to experience any virtual teaching, and naturally he doesn't recognize Tao Le's identity.

Despite this, seeing that she is so young, and with the name tag of a resident doctor, most of them is a local doctor—his habit of being a good teacher has come up again.

There is no way, passing, helping, and leading, this is the main task of this aid to Tibet.

It is not only the time to do a good job of treatment services, but more importantly, what is left behind after the person leaves.

In this pattern, he Kong Qingmin has always been not lagging behind.

"Tell me about it." Director Kong pointed to Tao Ledao, and his tone carried the meaning of the school examination.

"I agree with the director and Mr. Ye." Tao Le replied unhurriedly: "I have a suggestion, since the shape of the object cannot be seen clearly by the CT scan, then take a chest x-ray directly." ”

"That's a good point." Director Kong nodded with satisfaction: "Image detection is a means, and the choice depends more on where it is used." CT is indeed clearer than plain radiographs in many cases, but only plain radiographs can accurately reflect the overall shape of the foreign body. ”

Soon the flat film was filmed. The position of the foreign body is similar to that seen on CT, but the shape is very different from what was guessed.

Not an iron nail, but a ring-shaped piece of metal stuck squarely under the entrance to the esophagus.

This is the thing that tortured the child for more than 6 hours.

Judging from its size and location, conventional means are still difficult to remove.

"To be on the safe side, let's do a surgical incision." Director Kong thought about it, but he was not very sure.

"No problem." Ye Chen was originally from gastrointestinal surgery, and he still had experience in this kind of surgery.

The conditions for the surgery today are quite good. There is no need to mention that the blood source has been prepared in advance, and he originally wanted to try the acupuncture and moxibustion pulse control and hemostasis technique he had just learned.

What's even more unique is that Mr. Tao Letao is also there, even if there is any problem, he can remedy it in time.

Seeing that the proposal for surgery had been unanimously approved, and it was about to enter the discussion of the anesthesia plan, Tao Le hurriedly spoke up.

"Wait a minute." Her voice was clear and focused everyone's eyes.

"I think we can try to take things directly, and if it doesn't work, let's have another operation."

When Director Kong heard this, he was both a little surprised and a little impatient. How many years has it been since his judgment and decision have been interrupted and questioned?

The anesthesiologist in the emergency department is the attending doctor of the Second Hospital of Beijing. He sat on top of Tao Le, and when he heard this, he quietly pulled her by the hand, and muttered in a very small voice:

"Teacher Tao, in this regard, Director Kong is authoritative."

"I know." Tao Le said generously: "That's why I said I wanted to give it a try and let Director Kong see if it was feasible." ”

Kong Qingmin's good impression of this young doctor has basically cleared. He has always been stingy with his keen and studious disciples, but the premise is that the other party understands the rules.

"Why can't you do it, I have a holistic thinking." He lowered his face and said, "I don't have time to explain everything to you now. In the future, you can learn more and think more on your own, and you will naturally be able to understand. ”

"The main reason is that there is no endoscope to assist you, right?" Tao Le didn't stop there, but continued to ask.

Kong Qingmin stiffened his face and did not answer. He directly turned his head and asked Le Zeng: "In terms of anesthesia, is there a problem?" ”

"The child is a little small, considering the use of intravenous anesthesia, there should be no problem." Le Zeng hurriedly replied, and by the way, he gave Tao Le a look.

It's a pity that she not only didn't want to answer, but also stood up directly and said loudly:

"The location of the foreign body is not deep, and it can be removed directly with cannula forceps. I can do blind sampling without endoscopy. ”

Kong Qingmin felt that there was a fire rushing up.

Blind picking? Who do you think you are? I've done endoscopy for so many years and know everything about the structure of the human esophagus and stomach, so why don't I go for blind retrieval?

It's not because the piece of metal stuck under the esophagus is really a bit big, and there is a great possibility that blind extraction will push it deeper, scratch or even cut the esophagus.

Rather than having to go under surgery at the end, or even facing more serious problems - esophageal fistula, even purulent mediastinitis and pleurisy, it is better to treat it directly with this option.

He was about to say something more when he heard Tao Le say, "I'll try it once." If it is not successful once, can you use your plan to perform the operation? ”

Kong Qingmin suddenly had a feeling of not being able to exert his strength.