"......" Luo Hao glanced back at Meng Liangren.

Meng Liangren realized that he seemed to have said the wrong thing.

Bah, how can you say such a slap in the face.

"He pretends to be poor, you don't care." Chen Yong said disdainfully, "I went out for surgery a few days ago and earned a few hundred. If you change someone else, you have to buy a BBA to open, if it were me, I would definitely buy a U8. ”

"In the Northeast, the tram is not suitable, and the power feed is serious." Luo Hao said, "Wait a few more years, the blade battery technology will be perfected, and I will change this car to a petrol-electric hybrid." ”

"We have a garage downstairs in the dormitory, and the hospital also has a garage. Luo Hao, shouldn't he be preparing to open for a lifetime. ”

"If you get used to it, why can't you drive it for the rest of your life."

Luo Hao twisted the key, marking the launch of 307.

Meng Liangren felt that something was wrong, but he couldn't say it.

[People say that a man is a teenager until he dies, but how can there be a teenager ......]

Luo Hao's phone rang.

glanced at it, it was Feng Zixuan calling.

"Feng is good." Luo Hao picked up the phone.

"Xiao Luo, are you off work?"

"I just got in the car, and I haven't moved yet."

"Busy? Coming to the emergency room? The daughter-in-law of a friend of mine had a stomachache after she was discharged from the hospital after giving birth. ”

"Okay, that's it." Luo Hao readily agreed.

Now Feng Zixuan and himself don't see each other at all, and they summon directly when they have something, just like a summoner.

Luo Hao didn't care, turned off the engine, got out of the car, and rushed to the emergency room.

"Xiao Luo, my nephew and daughter-in-law's condition is quite serious, with a sudden large amount of ascites and acute kidney failure." Feng Zixuan stood in the corridor with a serious expression.

"Huh? So heavy? Didn't you just give birth? ”

"Yes, I had a caesarean section 6 days ago, and I went to see it when I was discharged from the hospital 1 day ago, and nothing happened. I went home for 1 day, and then I was sent to me lying down. Feng Zixuan scratched his head.

In a young woman, there is a large amount of ascites in 1 day and acute renal failure......

Feng Zixuan had never encountered this.

"Oh, don't worry, I'll take a look." Luo Hao smiled easily.

Seeing Luo Hao's smile, Feng Zixuan felt as if a stone had fallen to the ground in his heart, and he was not so irritable, and he had a bottom in his heart.

"Xiao Luo, what are you thinking about initially?" Feng Zixuan asked.

"I haven't seen ...... yet"

"Tell the truth."

"A large amount of ascites within 1 week after giving birth, complicated by acute renal failure, the first consideration is bladder rupture."

"What?!" Feng Zixuan was stunned, "Okay, why did the bladder break?" Besides, the urination was normal before discharge. ”

"Director Feng, you don't believe what I said, take a look at the patient first." Luo Hao smiled.

Feng Zixuan was dumbfounded.

If the bladder is ruptured, it would be fine, at least all kinds of malignant diseases should be ruled out.

He also hoped that this was the case, and it was Luo Hao who said it, this was the best news Feng Zixuan had heard.

When I came to the emergency room, Dr. B-ultrasound was still there and was packing up his things.

Luo Hao saw that the diagnosis assisted AI gave a diagnosis, which was similar to what he judged - a ruptured bladder.

As for the other diagnoses, they are secondary to a ruptured bladder and don't matter.

Luo Hao, a similar patient, had seen many cases when he was in school, and he was transferred to Xiehe in an emergency department from a foreign hospital.

For "ordinary" hospitals, this is an incurable disease.

For Concord, I am tired of seeing it, and the cleaning aunt knows that a large amount of ascites and kidney function changes within 1-2 weeks after giving birth are caused by bladder rupture.

Luo Hao first learned about the condition.

The patient underwent cesarean section under combined spinal-epidural anesthesia 6 days ago, and the operation went smoothly.

The urine catheter was indwelled for 24 h after operation, the urine volume was 2 100mL, the urine color was light yellow, and the patient urinated on his own 3 hours after the catheter was removed, and then urinated 4~5 times a day.

He was discharged from the hospital on the 5th day after surgery, with normal body temperature, normal blood count, good abdominal wound healing, and normal bowel and bowel movements.

I ate too much at noon today, and suddenly felt severe pain in my upper abdomen when I turned over, accompanied by nausea and vomiting.

General examination: acute distress, global abdominal tenderness, rebound tenderness, positive moving dullness, unsatisfactory palpation of the liver and spleen, and no palpable mass.

Abdominal ultrasound showed that: (1) the right renal sinus area was slightly separated, (2) a large amount of ascites, no intestinal dilation and free gas were found on the abdominal orthostatic plain x-ray, and hypoglycetic ascites was aspirated by abdominal puncture.

"Director Feng, admitted to the hospital, cystography." Luo Hao said to Feng Zixuan firmly.

Feng Zixuan hesitated slightly.

Luo Hao didn't urge, looked at Feng Zixuan, and didn't explain to Feng Zixuan directly, just waiting for him to make up his own mind.

Feng Zixuan was silent for less than 3 seconds, then picked up his mobile phone and called the Department of Urology.

After exchanging a few words, Feng Zixuan hung up the phone.

Soon, the urology inpatient always rushed down.

After learning about his condition, he was a little annoyed, but in the face of Feng Zixuan, he still tried to suppress his anger.

"Director Feng, the patient's bowel and bowel movements were normal before discharge, and he ate a little more when he was discharged home, so why did he rupture his bladder." The hospitalized boss explained helplessly, "It's really not our surgical business, and it is also the nephrology department that wants to admit it." ”

"Huh?" Feng Zixuan snorted with his nose, and the hospitalized always shuddered.

"Where's your director?" Feng Zixuan didn't want to meet with the general hospital, and asked lightly.

"When I get home from work, I turn around halfway and come back, I guess it's almost there."

"Okay, I'll talk about it after your Director Pei comes." Feng Zixuan saw that the patient's vital signs were stable, and he was not in a hurry at this time, so he went to comfort the patient's family.

Fifteen minutes later, Director Pei of the Department of Urology rushed over.

"Director Pei, considering that it is a ruptured bladder, I received an imaging from your department." Feng Zixuan said.

"Director Feng, it's okay to accept patients." After seeing the patient, Director Pei said, "But I firmly deny a ruptured bladder." Who gave the diagnosis? We are the first hospital of the Medical University, the ceiling of medical care in the province, who gave such a nonsensical diagnosis! ”

Feng Zixuan listened to Director Pei's tirade, led to the First Hospital of the Medical University itself, and glanced at Director Pei deeply, and then glanced at Luo Hao.

His eyes were staggered, and Director Pei was in a trance, but Luo Hao understood.

If you don't say it, you don't have friends. There are many things, just do it, there is no need to say it.

Luo Hao and Feng Zixuan have this tacit understanding.

"Hello Director Pei, my diagnosis." Luo Hao smiled and came to Feng Zixuan and Director Pei.

"Luo ...... Doctor. Director Pei frowned and looked at this young man who had been in the limelight recently.

Then, a disdainful smile emerged, how could he be everywhere, and it would be annoying to look at him.

Chen Yan takes care of him, but he may not be used to him! It just so happened that he didn't know how to bump into his gun, so he taught him how to be a subordinate...... No, it's to be a group leader.

"Xiao Luo, it's not that I'm playing with old qualifications, do you have a basis for diagnosis?"

"Yes, the diagnosis is based on ......"

"Forget it, there's no need to debate the scriptures, I'm still the same sentence - Director Feng wants me to accept it, I will definitely accept it, but the patient has a wrong diagnosis and who is responsible for delaying the treatment!" Director Pei asked.

That is, there is no table in front of him, if there is a table, Director Pei will definitely get up and question sharply.

Feng Zixuan looked at Luo Hao, without saying a word, his eyes were firm.

"Well, since the Department of Urology does not recognize the diagnosis of bladder rupture, then I will accept the patient." Luo Hao smiled, "I wrote all of these in the medical record, Director Pei, you don't object." ”

"Against? Why should I object. The corners of Director Pei's mouth had already reached the root of his ears, and he didn't care about Luo Hao's words at all.

"Chen Yong, admit the patient and prepare for the emergency cystography."

Luo Hao arranged.

Chen Yong didn't care about any contradictions, went to the emergency physician, chatted for 30 seconds with a smile, opened a hospitalization order, and the emergency physician sent Chen Yong out.

Meng Liangren was dumbfounded.

What's going on right now?

I don't know how many times he's seen a similar situation, and it's hard to see this kind of thing immediately, and it's all because of whom.

This is friction within the hospital, and as for the result of friction...... It's hard to say.

As if looking for death, Professor Luo admitted a patient with a sudden and large amount of ascites for unknown reasons.

The key is that the patient is also accompanied by renal failure, acute, not received by the relevant department, received by the interventional department.

What's the matter?

And after that?

How do you write this medical record?!

Meng Liangren's head hurt for a while.

The point is that Professor Luo also mentioned that it is seen in the medical records, which is a clarion call for battle between doctors.

If the medical department hosts a case seminar, whoever loses will not be able to hold their heads up for the rest of their lives.

But in Meng Liangren's view, Professor Luo Haoluo is likely to lose.

He saw that Luo Hao was talking to Director Feng Zixuan Feng, so he tiptoed to find Chen Yong.

"Teacher Chen......"

"Don't, just call me Xiao Chen." Chen Yong hurriedly stopped, "Lao Meng, do you have something?" If it's okay, send the patient back to the ward and prepare for cystography. ”

Meng Liangren pulled Chen Yong's cuffs, but before his hand could be put on it, Chen Yong dodged him.

"There's something to talk about." Chen Yong's face was full of vigilance.

Meng Liangren sighed helplessly, this medical team looks messy, and it doesn't even know how to throw the most basic pot.

It is estimated that Professor Luo is too young and has little clinical experience.

Chen ...... Xiao Chen, if you go and persuade Professor Luo, you are not a patient in our interventional department, so there is no need to admit it. ”

"Lao Meng, Luo Hao has the final say in the medical team, and there can only be one voice." Chen Yong said seriously.

Holy!!

Meng Liangren was educated by the young Chen Yong.

There can only be one voice in the medical team!

This kind of matter of principle is important, but it is only a principle, and it is not at all the same thing when it is actually put into practice.

Meng Liang's heart was awe-inspiring, he stopped talking nonsense, and began to help Chen Yong push the patient, and he was admitted to the hospital to prepare for cystography.

The results of the emergency examination returned that there were no contraindications to surgery, and the patient was pushed to the DSA room after an indwelling urinary catheter.

Because the urology department had a negative opinion, Luo Hao did not use their imaging room, but chose his own operating room.

"Emergency?"

As soon as he entered the operating room, Yuan Xiaoli greeted him.

"What disease?"

"Director Yuan, considering that it is a ruptured bladder, do a radiogram, it is not an emergency, it is not an emergency." Luo Hao explained.

Yuan Xiaoli's eyes were like table tennis balls.

……

"Director Feng, it's really not that I don't accept it, the patient has nothing to do with our urology department. Shake the pot, not like that. If you want me to see, the patient should be sent to the ICU, our hospital has a strong critical care force. Director Pei didn't leave, but accompanied Feng Zixuan to nag.

Feng Zixuan had a weird smile on his face, and looked at Director Pei unabashedly, looking at him in a panic.

"Director Feng, how many years have we been, let's just say, is my old Pei that kind of person?" Director Pei could only set his feelings, "The patient is admitted, the contrast agent increases the burden on the kidneys, if there is no urine, you say whose responsibility it is." ”

"Hehe, I believe in Xiao Luo." Feng Zixuan said.

Director Pei was speechless for a moment.

The fewer words, the more information.

Director Feng Zixuan Feng said that he believed Luo Hao, and then what? He said so much, he didn't believe a word, this is the subtext.

Have you offended Director Feng Zixuan recently? Director Pei is doing self-examination.

The larger the tertiary hospital, the greater the energy of the director, and the higher the possibility of saying "no" to the head of the department.

But Feng Zixuan is an exception.

For so many years, no matter which clinical director played with him, he ended up in an extremely miserable end.

Director Pei shuddered when he thought of the depths.

"Feng Chu, tell me, is there a basis for the diagnosis?" Director Pei asked stubbornly.

You, unconsciously, have become you.

"Xiao Luo was going to say just now, I was interrupted by you, and I don't know if there is any basis for diagnosis." Feng Zixuan replied lightly.

Gan!

Director Pei was stunned.

Interrupted by me, you don't speak? What did you do then? This is to beat himself, Director Pei understands in his heart.

He had already begun to regret it, at that time, it would be good to take in the patients without 3721, and as for the future, Director Feng would definitely be responsible.

"Let's go, take a look." Feng Zixuan didn't say much else, and beckoned Director Pei to intervene in the catheterization laboratory.

Director Pei was apprehensive, but he still couldn't pull his face down, and now he would admit defeat.

Just got off work, eating hot pot and singing, who would have thought that he was about to be beaten by Director Feng!

Misfortune is coming.

But Director Pei is still confident in the diagnosis, and feels that as long as he doesn't make mistakes, Feng Zixuan has to be cautious even if he wants to beat himself.

"Director Feng, if you say a word, my old Pei has nothing to say. But Xiao Luo is too young, and the diagnosis is still imaginative, I really don't understand. Director Pei pondered while chatting with Feng Zixuan.

Feng Zixuan didn't say anything else, and slowly came to the interventional catheterization laboratory with his hands behind his back.

Slippers and a sterile surgical gown entered the operating room.

Without a technician, a cystography cannot be said to be a surgery, it is only an "operation".

In the operating room, Luo Hao had already injected the contrast agent into the urinary catheter.

A few hundred milliliters of liquid are poured out.

"The contrast agent also needs to be metabolized by the liver and kidneys, and the patient has acute renal insufficiency, and I am also responsible for the patient." Director Pei's sarcastic explanation.

But Feng Zixuan was noncommittal, and sat directly in the position of No. 66 technician and watched quietly.

It's stepping on the line inside.

On the screen, retrograde fluid with contrast agent ripples slowly in the bladder.

Although Director Pei did not approve, he unconsciously clenched his hands into fists.

He inexplicably began to be afraid.

Even if he was discharged from the hospital one day after giving birth, no matter how nonsense and impossible the diagnosis of bladder rupture was, he was afraid.

What if.

No, absolutely not, Director Pei comforted himself in his heart.

The flexibility of the bladder is so great that it wants to rupture, except in some specific circumstances.

The patient's children have been born, and he has been discharged from the hospital smoothly, and his urine and bowel movements have been smooth before discharge, which is provided in the past history.

Unless someone deliberately conceals it.

But in the hospital, this can be ruled out.

It's not a white giant tower, and if there is a conflict between doctors and directors, they would rather use their fists to speak, and they will not make a fuss about each other.

Just thinking about it, Director Pei suddenly saw a trace of contrast agent "floating" out of the bladder.

Holy!

No way!!

When pigs fly!!!

The eyes are spent, it must be the eyes spent.

Director Pei leaned in front of the computer screen, and a trace of contrast agent appeared clearly on the screen.

It's not that I'm dazzled, it's that the contrast agent injected through the urethral tube does overflow the bladder along the bladder leakage, forming an image that is displayed in front of me.

How is this possible!

Director Pei leaned in a little closer.

"Director Pei, you're blocking my view." Feng Zixuan said lightly.

He was not surprised, nor surprised, but said with a slight play.

"Huh?"

"If you get closer, you'll be on the screen."

"......" Director Pei was stunned and took half a step back.

"Director Pei, I don't understand it, I'll ask you for advice." Feng Zixuan stretched out his hand, and his delicate fingers fell on the screen, "Here, it's a contrast agent." ”

Director Pei nodded in a trance.

"This should be the bladder."

Director Pei continued to nod.

"Does the patient have a bladder malformation? How do I remember that the bladder doesn't grow like this. Feng Zixuan asked sneeringly.

Director Pei's face turned red, and he didn't know how to answer.

Luo Hao kicked open the airtight lead door, and with a "stab" sound, the lead skirt was torn open and thrown on the ground.

Meng Liangren was stunned for a moment, remembering the picture of Technician No. 66 following Luo Hao's ass to clean up his things during the afternoon operation.

He had been shocked just now, but how a ruptured bladder came about after giving birth was not as important as packing things.

Meng Liangren has no teacher.

The old attending has accumulated rich clinical experience and ...... for so many years Clinical experience.

He is second to none when it comes to observing words and looks, as long as he wants.

Now Meng Liangren definitely wants to!

Following behind Luo Hao, Meng Liangren picked up the lead skirt.

"Director Feng, the diagnosis is clear - bladder rupture." Luo Hao smiled.

"Sting~"

Luo Hao tore open the lead coat and threw it on the ground, and Meng Liangren then picked it up and hung it back in its original position.

"Hehe, Xiao Luo, it's really, how did you come here?" Feng Zixuan asked with a smile.

"Special causes such as drunkenness, pregnancy, childbirth, etc. can be caused.

During pregnancy, the enlarged uterus compresses the urethra, causing difficulty in urination, overfilling the bladder, thinning the bladder wall, prolonging labor, and increasing abdominal pressure during delivery. Postpartum bladder muscle tone decreases, sensitivity to intravesical pressure decreases, and acute or chronic urinary retention is predisposed.

If not detected and treated promptly, it can lead to spontaneous bladder rupture. ”

"What about acute kidney failure?" Director Pei asked astringently.

"Due to the reabsorption of urinary ascites in the abdominal cavity, it causes abnormal increases in blood BUN and Cr, resulting in pseudorenal failure, which is an important indicator for diagnosing intraperitoneal bladder rupture." Luo Hao explained flatly, "Fake, don't care." ”

"Among the auxiliary diagnosis of internal and external bladder rupture, cystography is the most intuitive, important and reliable examination method for diagnosing bladder rupture.

The bladder water injection test is also commonly used to diagnose bladder rupture, but there are often certain false negatives and false positives, and 200~300 mL of water injection is generally required."

"As for the treatment, the indwelling urinary catheter will continue to be open, and the cystogram will be done again tomorrow night or the day after tomorrow morning, and the fistula will not be visible."

“！！！”

“！！！”

"Spontaneous bladder rupture has a very poor prognosis if treatment is delayed, with a mortality rate of up to 25% with a delay of 24 hours or more."

"However, if it is detected in time, as long as the indwelling catheterization is placed, the patient can recover on his own."

"Why haven't I heard of it?" Director Pei asked in a low voice.

"The patient had a large amount of ascites with renal failure. As long as hospitalization, indwelling urinary catheters are inevitable, so the vast majority of patients are 'inexplicable' and discharged. ”

"......" Director Pei was stunned after listening to Luo Hao's explanation.

He was extremely experienced in clinical practice, and instantly thought of several cases of patients who had inexplicably improved.

！！！

So that's it!

"Director Feng, you tell the patient's family that they can be discharged from the hospital after three days of observation. Besides, I have to live in the corridor with an extra bed, and the conditions are not good, so you can move up the dry ward. ”

"Okay, there's no rush for this." Feng Zixuan smiled slightly, "Xiao Luo, you should write the medical records well, and you will ...... early tomorrow morning Director Pei, how did you operate? ”

"Many." Director Pei hurriedly said.

"Then tomorrow at 3 p.m., organize the relevant departments to study, and I will preside over it." Feng Zixuan finalized this matter.

As he spoke, the corners of his mouth rose and he looked at Director Pei.

Director Pei felt bitter in his mouth.

"Director Feng, then I'll go and get busy first."

"Go ahead, the patient will go directly to Gao Gan after stepping down, and I'll contact you. Isn't there a rush in the medical records, isn't there nothing to deal with? ”

"Well, indwelling catheterization is fine, antibiotics are not recommended, it depends on the situation first. If the blood doesn't come down early tomorrow morning, it's too late to give it again. ”

"Go get busy, hard work." Feng Zixuan said.

Luo Hao smiled and was not polite to Feng Zixuan.

With the "fighting friendship" in India, the estrangement between Luo Hao and Feng Zixuan has almost disappeared.

Feng Zixuan and Luo Hao glanced at each other, their eyes staggered, and Luo Hao nodded.

Waiting for the patient to be sent away, Feng Zixuan was still sitting on the technician's chair, swaying slightly, looking leisurely.

He didn't rush to explain the situation to the patient's family, just made a phone call.

Director Pei didn't dare to leave, and stood quietly to the side, waiting for Feng Zixuan's next words.

"Director Pei, check the information." Feng Zixuan said with a smile, "Don't be able to say a word when the medical case is discussed tomorrow, it seems that the technical level of the urology department of our hospital is too poor to be put on the table." ”

"Smack~"

This sentence slapped Director Pei's face like a slap in the face, making his old face red.

After Feng Zixuan finished speaking, he got up and left.

An hour and a half later, Feng Zixuan finished his busy work and picked up his mobile phone.

"Director Pei, where is it?"

"Director Feng, I went home, searched for relevant information, and asked friends from other hospitals in the group, and I benefited a lot." Director Pei replied.

Director Feng smiled and shook his head.

It's been quiet for too long, and Director Pei has lost the most basic vigilance.

What's the most important thing about this?

How does a ruptured bladder come about after giving birth? A living misdiagnosis is here, and it will be difficult to forget it in the future.

That's not the point, the point is Luo Hao's medical records!

Feng Zixuan has seen Luo Hao's medical records.

Luo Hao's medical records are well written, and Director Chen Yan and Director Chen have come to ask for people.

The medical record is like a knife, Feng Zixuan believes that Luo Hao will spend a few hours polishing this knife and sharpening it quickly.

(End of chapter)