"Doctor Zhou, what kind of cold does my granddaughter have? Why doesn't taking medicine work? ”

She asked Zhou Can, who was measuring the little girl's physical signs.

While talking, she also took out the cold medicine and showed it to Zhou Can.

"You say it can't be a fake, right? My granddaughter was sick at night, and I bought medicine at the nearest small clinic. ”

Patients who take the medicine and do not have it work, and most likely to wonder if the drug they bought is fake.

There is indeed a probability of 'winning'.

Especially now, in order to increase profits, many pharmacies will choose to buy some small manufacturers' drugs to sell. In terms of quality, it is not as guaranteed as the drugs of large manufacturers.

After all, it is not easy to make a brand, and the high cost of making mistakes by large manufacturers makes them dare not take risks.

In order to survive, small manufacturers sometimes play some sloppy eyes and do some bastard things.

Zhou Can took the cold medicine that the patient had taken and looked at it carefully.

"There is no problem with the medicines, they are all drugs produced by regular manufacturers, and they are symptomatic."

If he heard this, the owner of that small clinic would definitely thank him.

The owners of some small clinics, the sales staff, basically have studied pharmacy and even medical students who have been eliminated from clinical medicine. Or they crave freedom and don't want to stay in a big system like a hospital, so they choose to come out and do it alone.

So, these people have a certain amount of expertise.

It is even more impossible to sell drugs indiscriminately.

In case something happens to a patient after taking the medicine, the clinic or pharmacy will have to follow suit.

"Your granddaughter, moderate heat, fast heart rate. In terms of symptoms, it is indeed very similar to a cold, but it may also be other diseases. Is her bowel and bowel movements normal for the past two days? ”

"I really don't know." The old lady shook her head.

My granddaughters are all eight years old, and adults rarely pay attention to such things as urinating and urinating.

The little girl felt that the eyes of her grandmother and the doctor fell on her face, and she was a little embarrassed and said, "It's just a little diarrhea, everything else is fine!" ”

Diarrhea is also one of the most common symptoms of a cold.

Zhou Can almost understood the basic information of the patient, and the next thing was to think about what examination items to prescribe.

In her case, it is necessary to check blood and urine.

There is no need to do a chest x-ray for the time being, and you can wait for the blood and urine test results to come out before further investigating the relevant biochemical items. Zhou Can's mind quickly sorted out the diagnostic ideas.

He now finally understands why the Ministry of Health regulates the number of outpatient and emergency doctors to see in a single day.

Because there are so many patients in the hospital, the doctor's mind will be confused.

If you see more than 100 patients a day, you will definitely not be able to remember the information and condition of the patients. Even many patients meet in person, have a little chat, and then they will be sent away after the examination.

In this case, the quality of diagnosis and treatment can be imagined.

It is almost an open secret that there is a serious overload of doctors in the inpatient department and operating room of the hospital. In particular, interns and trainees are simply the hardest hit areas.

It's just that I didn't expect that the outpatient clinic was also overloaded.

This is never a good thing.

Doctors and nurses suffer, patients do not receive high-quality medical care, money is spent, time is wasted, and the disease is not cured.

If the doctor is too tired, the probability of misdiagnosis and missed diagnosis will also be greatly increased.

Zhou Can dared to assert that if any hospital could come up with a proper solution to these problems. That hospital will be more competitive than any other hospital.

"Let's go for a blood routine and urine routine first! I'll see how it goes. ”

After checking the basic condition of the patient, Zhou Can issued an application for examination.

"Okay! When you get here, we'll definitely listen to you. ”

The old lady readily agreed.

With Zhou Can's list, the old lady went out with her granddaughter.

This is also the first difficult case that Zhou Can has encountered since receiving the treatment today.

Before he could take a sip and rest, the door was pushed open again, and a new patient came in.

He could only brace himself to cope.

This is the fifth patient to be seen today, and less than an hour has passed.

The momentum is gratifying!

It seems that sitting in Tuya Hospital, thanks to the home advantage, the outpatient and emergency volume is completely different from Xinxiang Women's and Children's Hospital.

The fifth patient was a half-grown child with a dislocated left arm, only nine years old, and was already over 1.7 meters tall.

Dealing with this kind of bone injury, Zhou Can is very good.

It's much easier than diagnosing and treating those incurable diseases.

However, he still inquired about the injury in detail and understood what happened to prevent a missed diagnosis. Sometimes, some inconspicuous injuries may be overlooked by the patient, but they can seriously threaten the patient's life.

On the news, there are often car accident victims who choose to go private, and there is nothing wrong at the time. As a result, I came home and suddenly died in a day or two, or four or five days.

This kind of thing sounds scary, but it's actually preventable.

If you can go to the hospital for a professional doctor to diagnose and find out the hidden danger after a car accident, you can control the injury as soon as possible and prevent the serious consequences of death.

Zhou Can benefited from Dr. Xu's strict teaching and had a very good style in medical safety.

No matter how common the illness is, he is always on high alert.

After doing a physical examination for the big boy, no hidden dangers were found, he was given an X-ray examination, and he was sent away.

After the patient and his family left, two patients came in at the same time.

One is a new patient, and the other is the first patient to be seen today – the girl who sprained her foot while dancing.

"Doctor Zhou, we've finished the examination."

The girl's mother gave him the test results.

"Please wait a minute, they are the first patients to come to me in the morning. I'll take care of it for her first, and then I'll treat you. ”

Zhou Can explained to the family of another patient.

"Yes! They came first, and they should have been dealt with first. ”

This family member is reasonable and easy to talk to.

After Zhou Can calmed the other party, he began to check the little girl's film unhurriedly.

"Little girl, next time you dance, you have to take it easy! You directly caused the dislocation of your right ankle this time. Fortunately, there were no fractures, which is a blessing in disguise. ”

After Zhou Can watched the patient's X-ray, he already had a plan in his heart.

There is no open wound like this, there is no bone crack, just an ankle dislocation, and it can be reduced manually.

"Did you hear what Dr. Chow said? The body is your own, don't be so fierce the next time you practice dancing. When the girl's mother scolded her daughter, it was clearly three points of scolding and seven points of love.

After she finished training her daughter, she looked at Zhou Can with a flattering expression, with a trace of worry between her eyebrows.

"Doctor Zhou, what should I do with my daughter's injuries?"

"I tried to help her with manual reduction, which was much better than doing surgery. But be sure to take care of recuperation. When the time comes, I will prescribe some anti-inflammatory and pain-relieving medicine for her. ”

Zhou Can gave a treatment plan.

"Okay, okay, all listen to you. We were afraid of surgery, so we came to you for treatment. Looks like you've come to the right place. The girl's mother was visibly relieved to hear that it could be manually reset.

For families, the absence of surgery means that the cost of treatment is greatly reduced, and the child can suffer less.

If the operation is not done well and the right foot is disabled, there is no place to cry.

"You can't rejoice too soon. The success rate of manual reduction is not 100%, and there is a possibility of failure. All I can say is to do everything possible to reduce the burden on the family and give priority to the most affordable and effective treatment options. ”

Zhou Can may not have noticed it himself, but when he communicated with his family, he gradually mastered the communication skills of the chief physicians.

Create a good positive image to the greatest extent possible, so as to gain the gratitude and trust of the family.

"Sit down! Manual reduction will definitely be a little painful, you don't have to be afraid, the pain is very short. Zhou Can explained the precautions to the little girl, squatted down and began to reset her technique.

In order to prevent accidents, Zhou Can looked at the girl's mother.

"Otherwise, you might as well hold on to her."

"Okay!"

The family walked up to the little girl's side and held the little girl.

The little girl didn't dare to look at Zhou Can's hand.

She turned her head and closed her eyes tightly.

Zhou Can just started to slightly adjust the angle of the manual reset, and the girl began to scream "ahh

He ignored the girl's cries of pain, but found the best angle for the ankle to be realigned, and sent it forward with a slight force.

"Da!"

There was a clear bone sound, and the little girl also screamed.

"It's okay, it's okay, the pain is normal! You try to hook the toe of your right foot again. ”

Zhou Can comforted the patient.

In the seemingly short treatment time just now, Zhou Can has successfully helped her complete the reduction of the ankle joint.

The girl tried to hook her right foot on tiptoe.

"Wow, I can really do it!" The girl said to her mother in surprise.

"Great! Dr. Zhou's medical skills are excellent, and he really helped you to reduce the position successfully! The girl's mother smiled happily. She looked at Zhou Can, "Thank you, Doctor Zhou, thank you!" ”

"You're welcome! Saving lives is what our doctors should do, and I am actually happier than anyone else to be able to successfully help her with manual reduction. Such a young girl, if she had surgery, she would definitely have an ugly scar. The recovery time is also much longer. It's okay now, and you and I can breathe a sigh of relief. ”

After Zhou Can helped her carefully check, she confirmed that the ankle joint had indeed been successfully reduced, and then sat back in her seat.

"I'll prescribe some medicine for her, celecoxib can relieve pain and prevent joint inflammation...... "His current pharmacological differentiation skills are level 4, which is more than enough to deal with such small scenes.

When prescribing to a patient, the most appropriate medication and dosage can be used precisely for the patient.

This ability may seem simple, but many residents need to work their way up to the next level, or even longer.

Even if you are a senior resident doctor, you must be careful when prescribing medical orders to patients, and from time to time you have to turn over the information and consult the senior doctor. The difficulty lies in prescribing.

Medication errors can directly lead to rapid deterioration of the patient's condition.

The dosage of the drug is large, and there will be drug damage. It's small, and it doesn't have a therapeutic effect. Even the method of administration is exquisite.

For example, the most common infusions, most novice doctors do not know, and some patients need to keep the temperature of the infusion fluid at about 30 degrees during infusion.

Zhou Can also mastered the advanced experience of these infusions after three months of training in the intensive care medicine department.

Some patients are admitted to the intensive care unit, because of major physical problems, poor blood circulation, heart failure, poor internal circulation, and the maintenance of body temperature needs to consume a lot of energy stored in the patient's body.

The cold liquid is injected into the blood vessels, and the number of drops is slow, but if it is a rapid infusion, it is very easy to cause the patient to burp directly.

During the training of the intensive care medicine department, many senior doctors told Zhou Can about this.

Physician Hystery, an anesthesiologist, also mentioned it.

After prescribing the medicine, the little girl with a sprained right foot was treated.

Outpatient physicians rarely perform manual reduction of patients in person.

Because this is already a special skill.

Mainly other doctors don't.

Usually, patients who require manual reduction must go to the manual reduction room of the Department of Orthopedic Surgery.

Zhou Can was in the outpatient room of the pediatric department, and directly reduced the patient's technique, and he didn't know if it would break the rules.

However, from the patient's point of view, I definitely like this one-stop medical service.

Otherwise, after the family has finished the pediatric examination, they will have to take the results of the examination to the orthopedic surgery department and register again.

The young mother took her daughter with a thousand thanks.

She is very satisfied with the results.

Zhou Can has accumulated another 'iron fan'.

The accumulation of fame needs to be like this, gathering sand into a tower, and accumulating water into a river.

"Dr. Zhou's hand is so powerful! Please help my nephew, he has been talking about pain in his legs, especially in his knees. ”

It seems that this thirty-five or sixteen-year-old temperamental woman is not the mother of this boy.

There are many causes of leg pain, ranging from leukemia and malignant tumors to arthritis and rheumatism.

After Zhou Can learned about his condition and medical history in detail, he did a physical examination, and then prescribed three examination items, blood routine, B-ultrasound, and X-ray. Each examination has its own profound purpose.

It can quickly detect the direction of the patient's disease.

……

The kid named Lele who had macrodactyly came back after the checkup.

After Zhou Can saw the results of the examination, he was basically determined to be type II neurofibromatous megadactyly. This neurofibromatosis occurs in 1 in 3,000 and is chromosomally dominant.

Most of these patients will be stillborn, or a malformed fetus will be detected in the womb and eventually be induced and removed.

In the early years, the birth rate of disabled babies in the country was very high.

Many children are born with stupidity, mutilation, major congenital defects or diseases, and so on. It is not until recent years that China's medical technology and level have made great progress, with the addition of a number of screenings to pregnancy tests and the elimination of consanguineous marriages, which has greatly reduced the birth rate of disabled babies.

The vast majority of pregnant mothers should know about Down's screening and four-dimensional color ultrasound.

Take Down syndrome, for example, which is also known as congenital stupidity or Down syndrome.

It is a disease caused by a chromosomal abnormality. This type of fetus has one more chromosome 21 than a normal person. 60% of the children were aborted in the early stage of the fetus, and the survivors had obvious mental retardation, special facial features, growth and development disorders, and multiple malformations.

Screening for this disease is most beneficial around 12 weeks of pregnancy.

After being detected, the pregnancy can be terminated immediately by abortion, which greatly reduces the loss of parents and the harm to the family. Just imagine, if such a stupid fetus is born, the parents need to raise him/her for a lifetime. It is believed that it is a great disaster for any family.

Many couples who were originally in a good relationship broke down and their families collapsed after carrying such a heavy burden.

"I need to take off his clothes and check the child's body."

Zhou Can said to the patient's grandmother.

There are a variety of diagnostic methods to determine whether neurofibromatosis is present.

At present, only X-rays and ultrasound have been done for the child.

X-rays can clearly see the patient's skeletal deformities, as well as long streaks. These features are consistent with neurofibromas.

Also, when he did a Hugh exam, he found that the child had a café au au laud spot on his neck.

I didn't think much about it at the time, thinking it was a birthmark.

Now after reading the test results, he thinks that the plaque may not be a birthmark.

After the child's clothes were removed, multiple plaques of cafe au lait were found on his body, varying in size.

The largest is more than four centimeters in diameter.

Usually, as long as there are more than six café au lait plaques on the body, it can be used as a basis for the diagnosis of neurofibromas. However, this is not a gold standard, it is only a superficial diagnosis.

Genetic testing for NF1 or NF2 mutations can be the gold standard.

In addition, X-ray, ultrasound, CT, and MRI can also provide diagnostic evidence.

For example, the patient's X-ray shows a skeletal deformity with a striated image, which is a diagnosis.

Diagnosing the true cause of the disease is based on a comprehensive diagnosis based on the symptoms, examination data, medical history and other information, and the diagnosis can only be confirmed.

(End of chapter)