"Koji, doctor." The internist called Ji Xiang's words with great frustration, "Doctor Meng is in such a hurry, what do you think is the disease?" ”

"There is subcutaneous emphysema under the armpits, which is considered to be pneumomediastinum."

"Pneumomediastinum?!" Dr. Li of the Department of Internal Medicine sneered, and his words were slightly sneering, "Young man, do you see that the patient has external injuries?" ”

"Nope."

"Without trauma, do you diagnose spontaneous pneumomediastinum? Tell me, where did it come from? Dr. Li of the Department of Internal Medicine scoffed.

In his opinion, Ji Xiang is the kind of young man who knows a little clinical knowledge, but he doesn't understand it halfway, and he will talk about any strange diagnosis.

Are the ignorant fearless, and after learning a little fur, they don't have a door.

"Esophagus." Ji Xiang said with certainty.

He was educated by the system NPC in the system operating room, and he wanted to come out and talk about it. But Meng Qingfei was thorough at one point, and went to touch it and directly asked the general chest to prepare the hospital bed.

It's not good to be too smart, Ji Xiang wants to say something but doesn't know where to start.

Ji Xiang didn't want to show off, but wanted to "review".

"Spontaneous rupture of the esophagus? Hahaha, have you seen it? Your teacher told me about it when I was in school. Dr. Li laughed like a goose.

"Spontaneous esophageal rupture refers to a full-thickness rupture of the esophageal wall caused by non-traumatic causes, which is often misdiagnosed as angina, acute myocardial infarction, aortic dissection, acute pancreatitis, etc., due to non-specific clinical manifestations."

"......" Dr. Li himself of internal medicine doesn't know how long he hasn't heard such professional words, and now these words come out of the mouth of a student, which is extremely strange.

He wanted to refute, but what Ji Xiang said was right, and he didn't know where to start for a while.

"As for the cause, it can't just be broken like this. It is important to know that the esophagus is elastic and it is difficult to see spontaneous rupture. At least I've been a doctor for so many years, and I haven't seen it before. After a moment's hesitation, Dr. Lee asked.

"The cause is mainly seen in severe vomiting after drinking alcohol and after a full meal, caused by the pressure difference between the inside and outside of the esophageal wall caused by the negative pressure of the chest cavity, because the esophagus is not protected by a serous layer, especially the smooth muscle of the muscle layer of the lower esophageal wall, the lower part is more likely to be torn."

Ji Xiang said and looked at Dr. Li suspiciously.

"Mr. Li, the cause is very clear, there should be no doubt."

"......" Dr. Li wanted to scold his mother.

Ji Xiang couldn't understand it, he said it so clearly, why didn't Dr. Li of Internal Medicine understand?

"The main manifestations are: chest pain, chest tightness, dyspnea, mediastinal emphysema, subcutaneous emphysema, etc. after severe vomiting. Vomiting→ chest pain→ subcutaneous emphysema are typical triads. ”

"The patient has a slight feeling of holding snow under the armpit, and I think Mr. Meng has already made a diagnosis, so I am waiting to do a CT and see the mediastinal gas directly pushed to the chest."

"Cut." Dr. Li of Internal Medicine was not frightened by Ji Xiang, he cut off, "How can it be so coincidental." In our internal medicine department, almost every day, people who drink a lot of alcohol and take medicine come to the emergency department for gastric lavage. Do you know how often you see a ruptured esophagus? ”

Ji Xiang heard the unhappiness in Dr. Li's words in internal medicine, so he didn't fight him, but just smiled.

Repeating what the system NPC said, Ji Xiang understood this disease a little deeper.

"I don't see a single case in a year!" Dr. Li of the Department of Internal Medicine raised his voice and said, "I poured water down, vomited and vomited, and I didn't see anything wrong with such a lot of pressure." You, a young man, think that clinical practice is common when you learn something from books, but you don't know it. ”

"The symptoms are all the same, Mr. Li."

"Make a bet." Dr. Li of the Department of Internal Medicine smiled, "If your diagnosis is correct, I will deal with all the minor illnesses that come from the surgery in the middle of the night." ”

"If you make a mistake, follow me for three shifts."

Dr. Li of the Department of Internal Medicine was very envious of Meng Qingfei for having Ji Xiang's help, and he tried to tell his purpose in a dagger.

In the opinion of Dr. Li of the Department of Internal Medicine, he will definitely win.

"Okay." Ji Xiang said with a smile, "Teacher Li, you ...... the small handling of surgery."

"In fact, many of the medical and surgical treatments are similar." Dr. Li of the Department of Internal Medicine said disdainfully, "I will definitely not reach out if there is a big rescue, but I will deal with patients with appendicitis and cholecystitis by myself, and I will not seek surgical consultation."

In the middle of the night, can anyone still come to remove the stitches? Besides, what's so difficult about surgical stitches. ”

As he spoke, he laughed, "Young man, I'll teach you a good guy today, things written in books are actually rarely encountered in clinical practice." Our common diseases are only about 2% of those in books. ”

Ji Xiang didn't speak, and Dr. Li of the Department of Internal Medicine saw that Ji Xiang was silent, and he thought that he was right, and he had already won the young man here, and began to talk to Ji Xiang about common clinical content.

Half an hour later, Meng Qingfei pulled the flat car back.

"Xiao Meng, what about the patient?" Dr. Lee of Internal Medicine asked.

"I've sent it to my chest." Meng Qingfei replied.

Dr. Li of the Department of Internal Medicine was stunned, "What disease is diagnosed?" ”

"Spontaneous rupture of the esophagus, pourinstinum." Meng Qingfei said, "The patient drank a little stuffy wine at noon, spit out two mouthfuls and broke his esophagus. The doctors in the lower level hospitals fooled around, not because it was acute myocarditis. ”

......Dr. Li of the Department of Internal Medicine was stunned, but he didn't expect to meet a patient with a spontaneous rupture of the esophagus.

"Fight it, call it a day!" Meng Qingfei went to wash his hands, and when he came out, he rubbed hard on the buttocks of the white clothes.

His white clothes are new, and the rest of the place is very clean, but there are two black marks on the buttocks, which are quite eye-catching.

Ji Xiang didn't know why Meng Qingfei often washed his hands and loved to be clean, but why he always wiped his hands on the white clothes and was always in one position.

He didn't tease Dr. Li of the Department of Internal Medicine, but said respectfully, "Teacher Meng, then I'll go back and rest." ”

"Go, you still have work tomorrow, I'll go home from work tomorrow to rest, it's different." Meng Qingfei replied casually.

"Xiao Meng, you go to sleep, I'll look at the emergency in the second half of the night." Dr. Li of the Department of Internal Medicine said helplessly.

"Oh, Lao Li, why are you so merciful today." Meng Qingfei asked strangely.

Although Dr. Li of the internal medicine department didn't say anything, it is a good thing for emergency doctors to be able to sleep peacefully for an hour or two without doing sit-ups when they are on duty.

Ji Xiang waved goodbye and walked out of the emergency department.

In the dead of night, there are many fewer cars parked in the parking lot of the second hospital, and the night breeze is slightly cold.

Ji Xiang said hello to the strong man in the dark, and he didn't rush home, but touched his pocket.

The pockets were deflated, and Ji Xiang scratched his head.

always goes to the operating room of the system, always chats with Colonel Wang, and Ji Xiang is used to holding a cigarette when he thinks.

Find time to buy a box.

Although Ji Xiang knew that this habit was not good, he had been led astray unconsciously.