Director Shang was already alert to the diagnosis and treatment of this case, thinking that Dr. Huang Liang was just reducing fever and cooling down, and there was something wrong with fluid rehydration and expansion.

After all, the patient's pain has become like this, indicating that the intra-abdominal symptoms have not been relieved, but are gradually worsening.

Some diseases progress very rapidly.

Once it develops to a certain stage, it is like a rock-cracking landslide, unstoppable.

There are many patients who die in Tuya Hospital every year, and many of them die after the onset of the disease.

There are very few deaths from extubation.

Director Shang heard Zhou Can say so seriously, and his expression became serious.

Others don't know Zhou Can's strength, but he has seen it deeply.

On the first day of Zhou Can's admission to the Department of Gastroenterology, he saved a medical accident. Subsequently, it has made great contributions to the diagnosis and treatment of many cases.

With such strength, the difference is just qualifications.

Otherwise, they are fully capable of standing alone and directly becoming the backbone of the department.

"Director Zheng, this patient is from your group, I don't know what your opinion is?" Director Shang looked at Zheng Hongtao.

In terms of age, Zheng Hongtao is two years older than him.

However, in any unit, status is never determined by age. Rather, it depends on ability, talent, connections, education, performance, etc.

Director Shang and Zhou Can both chose to ignore Dr. Huang Liang, which made Huang Liang's face turn red for a while, and then slowly turned blue.

In front of so many doctors, nurses, as well as family members and patients, he must be treated as a transparent existence, and his heart must be uncomfortable.

If you want to blame, you can only blame him for not being able to carry it clearly.

The patients are already so serious, and he is still brushing up on his personal presence, so Director Shang is polite not scolding him in public.

"Could it be that Director Shang also supports Zhou Can's point of view?"

Zheng Hongtao was a little hesitant.

This patient's condition was somewhat out of his control, and he had to admit that he lacked experience in diagnosing such patients.

Not to mention him, even Director Shang also felt difficult when diagnosing this patient.

In fact, there is a boundary between surgery and internal medicine.

They are proficient in gastroenterology, and they are really a little unsure when they encounter this kind of symptom that is biased towards surgery.

"Zhou Can, tell me about the basis of your diagnosis."

Director Shang turned his head to look at Zhou Can.

"My diagnosis was based on two factors: first, the patient had persistent abdominal pain that did not lessen after symptomatic treatment, but worsened. This morning, the body temperature has risen and the fever has begun, which indicates that the symptoms of sepsis have been leaning towards sepsis. If the patient does not have a cold, the body temperature rises, and I think it is likely that the intestines are perforated, the abdominal cavity is infected, and the body has an inflammatory reaction. ”

Zhou Can introduced his diagnosis very calmly.

After doing a lot of surgery, patients have some symptoms that are easily ignored by other doctors, but Zhou Can can keenly judge the possible dangers.

When everyone heard that the patient had intestinal perforation, the nerves tensed.

Especially Director Zheng Hongtao, who didn't care much about it, his expression has become even more serious than Director Shang.

This patient is his responsibility, and if something happens, he will definitely be unlucky.

Intestinal perforation is extremely dangerous and can easily lead to death.

"Second, the blood white blood cells were 32.08×109/L, which can also help prove that my diagnosis of intestinal perforation is probably correct. In addition, the patient's compensated metabolic acidosis and low urine output further indicate that the patient has not only developed intestinal perforation, but also that the perforation has been for a long time. These diagnoses occur when intestinal contents contaminate the abdominal cavity and begin to cause systemic symptoms of acute sepsis. ”

Zhou Can's diagnosis logic is rigorous and his thinking is clear.

The internal medicine doctors at the venue were only blind to the eye, because of the paralysis and carelessness, coupled with the unfamiliarity with the diagnosis of surgical symptoms, they were not able to detect the danger.

After listening to Zhou Can's analysis at this moment, they all had solemn or serious expressions.

"Director Zheng, I think it's better to be cautious, and immediately ask the doctor from the gastrointestinal surgery department to come for consultation, or directly send the patient for a second abdominal CT."

A deputy chief physician under Zheng Hongtao persuaded.

"I also think that we should pay attention to it and seize the time to rescue it. If it is really intestinal perforation, the disease progresses extremely rapidly, and once shock occurs, it is too late to rescue. ”

Another chief physician agreed with Zhou Can's diagnosis.

"But...... When the patient was admitted to the hospital, he had already done abdominal ultrasound and abdominal CT examination, and no problems were found! ”

Huang Liang is still a little unwilling to admit defeat, and is still defending for the sake of the so-called face.

"Stupid! The patient was admitted to the hospital a day ago, and after such a long time, it is very likely that the patient's intestine will be perforated. It's stupid to argue here with the inspection you did a day ago. ”

Zheng Hongtao was the first to listen to it, and he didn't need Director Shang to scold, he directly stiffened his neck and jumped to scold Huang Liang angrily.

Any virtuous doctor hates not taking the patient's life seriously for the sake of the so-called face.

In the face of the patient's life, all personal reputation and interests should give way.

Hospitals allow competition, even promote it, but never allow infighting.

From the first day of medical studies, the first lesson a doctor learns is to revere life.

Huang Liang was scolded by Zheng Hongtao in public, but he woke him up a little.

After being stunned, he immediately lowered his head and said with a face full of shame, "It's me who is confused." ”

No one sympathized with him, but everyone felt that Director Zheng scolded well.

"Dr. Zhou, what do you think should be the next step for the patient?" Zheng Hongtao asked shamelessly and asked Zhou Can's opinion in public.

This is also a little reward for Zhou Can's success in helping him resolve a medical accident.

In other words, it is more appropriate to highly identify with Zhou Can's diagnostic ability.

"In my opinion, it would be best to send it to general surgery immediately. However, according to the hospital's diagnosis and treatment procedures, it may be necessary to do an abdominal CT scan to determine the location of the intestinal perforation and the current situation in the abdominal cavity before surgery. ”

Zhou Can gave his opinion.

The hospital has relevant procedures for diagnosis and treatment.

It is uncertain whether this patient is currently having intestinal perforation. If the patient's abdominal cavity is opened and no intestinal perforation is found, it will be difficult to explain it to the family.

Also, the large and small intestines of the human body cover almost the entire abdominal cavity.

Only when you know where the piercing is specifically located can you accurately choose the scalpel position for laparotomy.

"Okay, send the patient for abdominal CT immediately!" Huang Liang, you take two interns to send the patient over, you must be fast, directly explain the situation to the doctor who examined the patient, this patient can't wait."

Zheng Hongtao directly arranged for Huang Liang to accompany the patient for examination.

In addition to the fact that this patient is under the management of Huang Liang, there is also a small punishment for Huang Liang.

Otherwise, they are all senior residents who are about to be promoted to attending doctors, and rarely do this kind of errands.

Zheng Hongtao quickly applied for an examination for the patient, and the family members were already in a panic when they heard that the patient's life was in danger.

They did whatever the doctor told them to do.

All we have to do now is to save the lives of our loved ones.

"Director Zheng, I have another immature suggestion!"

Zhou Can was not arrogant because of his meritorious service.

Instead, he was not shocked by the humiliation, and still maintained humility and politeness.

"Please!"

Zheng Hongtao's current attitude towards Zhou Can is completely different.

It's not as lukewarm as it was two days ago.

Instead, he directly talked to Zhou Can as a character at the same level.

"I estimate that the patient's condition will progress very quickly, and after the CT scan, the surgery should be done immediately. It is recommended that you say hello to the Department of General Surgery now, be prepared there, and send the patient to the rescue as soon as the diagnosis is made. ”

Zhou Can proposed.

All things are foreseen, and those who are not prepared are wasted.

Only by planning ahead can we stop wasting every precious minute of rescue time.

"Okay, I'll call Director Xiao immediately."

Zheng Hongtao agreed so easily, which shows that he has a good relationship with Director Xiao of the Department of Digestive Surgery.

Many times, the chief physicians met and worked hard to expand their contacts, greet each other, and make all kinds of friendships. In order to be able to get things done when there is something, you can go through the relationship of acquaintances to get things done.

Zheng Hongtao called to communicate with Director Xiao on the spot, and it was done in just a few words.

The surrounding physicians looked at it with envy.

It's easy to get things done with acquaintances.

Director Zheng has a deep friendship with the newly built director of gastrointestinal surgery, which is really enviable.

"Director Zheng is worthy of being the boss of our gastroenterology department, and his wide network is really enviable."

Director Shang stayed at the scene and watched Zheng Hongtao deal with the matter.

If Director Zheng has something that he hasn't dealt with properly, he will definitely help. It is impossible to watch a patient have an accident.

"Hey, what kind of connections do I have! Director Shang knows a lot more people than I do. Today, thanks to the help of Director Shang, Dr. Zhou and others, this patient almost caused a catastrophe. ”

Zheng Hongtao had already been scared out of a cold sweat.

Because of this incident, he also changed his hostility towards Director Shang and Zhou Can.

Sometimes, people, it's just that tone of contention.

An opportunity for both sides to shake hands and make peace.

"Everyone is a doctor in the same department, and they should help each other, Director Zheng must not be polite. In the future, if there is a patient in my group who has a condition and can't find it in time, don't I have to ask you for help? ”

Director Shang said with a smile.

"You're right, we are all doctors in the same department, and we are a family."

Director Zheng said this, and the two sides basically released their previous suspicions and shook hands and made peace.

The two strongest chief physicians in the department shook hands, which was a blessing to all the doctors and nurses in the department.

Sometimes, it's really hard to stand in line.

"It's not too early, let's continue our rounds."

Director Shang led everyone to continue the rounds.

When they found the female lawyer with cirrhosis in bed 79, Zhou Can reminded Director Shang about doing splenic venography for the patient.

Director Shang didn't say a word, and opened an examination for the patient on the spot.

From this trivial matter, it can also be seen that Zhou Can's status in Director Shang's heart has risen to a very high level.

Before the ward rounds were over, Huang Liang, who took the patient for an examination, had already called.

CT examination revealed a free air shadow in the abdominal cavity, dilated bowel, and severe effusion between the intestinal loops.

This indicates that the patient did have intestinal perforation, and the perforation had been for some time.

No wonder the patient is in pain like that.

Computed tomography (CT) is generally preferred for intestinal perforation because it is more sensitive than traditional x-rays.

There are many old doctors who are particularly fond of X-rays.

This is both a complex and a habit developed because of previous medical conditions.

At that time, MRI had not yet come out, and CT examination equipment was also gradually introduced into China in the 70s, close to the 80s.

In the past, the most commonly used examination methods in large hospitals were Doppler ultrasound and X-ray.

A lot of older doctors grew up in that era. This also makes them have a soft spot for traditional inspection methods.

When Director Zheng heard that the patient was really diagnosed with intestinal perforation, and the condition was extremely serious, he really felt a sense of the aftermath of the disaster.

This patient was able to detect the danger in time thanks to Zhou Can.

So many chief physicians and deputy chief physicians didn't see the patient's intestinal perforation, but Zhou Can, a regular trainee, saw it. This is because Zhou Can happens to have surgical experience in general surgery and rich clinical accumulation.

This is also why today's big hospitals, when training core cutting-edge doctors, will select from the general practice trainees.

Because doctors with clinical experience in all departments, whether they are assigned to surgical work or internal medicine work, their diagnostic ability is obviously stronger than that of regular trainees.

Trainees who are recruited to hospitals are only familiar with the diseases in that field.

They lack awareness of diseases in other fields, and after formal work, they dare not touch patients in other fields in clinical work.

"Director Shang, I have to rush over immediately to send the patient to the gastrointestinal surgery department for emergency surgical treatment, and I will withdraw first."

After Zheng Hongtao answered the phone, he hurried to the general surgery department.

The diagnosis of the 7-bed patient also brought Zhou Can into the field of vision of many doctors, and everyone began to know this young and promising doctor.

During the ward rounds, many doctors took the initiative to talk to Zhou Can and chatted a few words.

It is enough to show that his status and popularity in the Department of Gastroenterology have risen to a big level.

……

After checking the room, Zhou Can's really busy day began.

He sent 77 stomach cancer patients to the interventional operating room for endoscopic surgery.

It will be operated by Director Shang himself.

This female patient is currently in the early stage of gastric cancer.

The medical convention is to say that the disease is more serious.

In fact, her stomach cancer is still in the early stage, and it is not a stage II stomach cancer in the true sense.

That's why Director Shang agreed to endoscopic surgery for her.

Usually, if stomach cancer progresses to a severe stage of stage 2, the cancer cells have metastasized severely. At this time, the opportunity for surgery is lost. It's more about interventional treatments, as well as chemotherapy.

This treatment can only prolong the life of the patient.

It's already hard to cure.

Gastric cancer should be operated on in a timely manner, as long as it is cleaned, and then combined with radiotherapy to consolidate the treatment effect. Satisfactory results are generally obtained.

In the interventional operating room, the patient has made preoperative preparations and lies quietly on the operating table waiting for the operation.

Director Shang hurried to arrive with Huang Xinggui and three graduate students.

Zhou Can was thinking in his heart that if he could get this operation, it would be easier for him to get it if there was an opportunity for endoscopic surgery in Director Shang's group in the future.

Gastroenterology is one of the departments with the most endoscopic surgeries.

Several of his surgical skills are only level four, if he can take advantage of the opportunity of training in the gastroenterology department in the past two or three months, he can upgrade them to level five. This will be very beneficial to Zhou Can's future development.

One step first, one step at a time.

In particular, incision, dissection, and anastomosis are particularly difficult to escalate.

Endoscopic surgery often rewards 100 XP points at every turn, making it a great way to quickly level up these three skills.

"Director Shang, you see that you have checked my endoscopic surgery experience last time, can you let me do this surgery?"

Zhou Can gritted his teeth, and before Director Shang stood in the main surgical position, he directly opened his mouth to grab the opportunity for surgery.

Different from the main surgical position of traditional surgery, the surgeon in charge of endoscopic surgery generally chooses a position that is easier to operate, and at the same time, it is also convenient to look up and view the endoscopic screen in front of it.

"Are you sure you're serious?"

Director Shang stared at Zhou Can, and the invisible pressure still made Zhou Can quite stunned.

However, he also understood that at this time, he had to show strong self-confidence in order for Director Shang to rest assured that he would hand over the operation to him.

"I'm serious. If I am not sure, I will definitely stop in time and will never force the operation. I have carefully studied the patient's film many times and am sure that I am confident that I will complete the surgery before I dare to ask you for it. ”

Zhou Can's tone was sincere, and his eyes were clear.

A faint sense of confidence came out.

(End of chapter)