"How long have you been rotten on this foot?"
Chen Wenqiang consciously saw too many patients, but he didn't think it was caused by one or two years."
It didn't take long."
The patient's eyes wander and squeak and refuse to answer directly.Chen Wenqiang stared at him silently.Huang Jiaqiang couldn't stand the pressure Chen Wenqiang gave him, and finally couldn't stand it anymore, so he opened his mouth to tell the truth."
The year before last, it started with the calf stick of the left leg, and no, it seems to start with the big toe.At first, it was a little dark, and I didn't know the pain.I went to the district hospital and the doctor hospitalized me to control my blood sugar with insulin.He also said that if I don't take hypoglycemic drugs on time at home, I will get diabetic foot, and the worst outcome is amputation.But I see that there are several people around me who are just as sick as me, and they are all well.Besides, I have been a cook for many years, and after retirement, I don't want to earn a few more for my children, so I often go to the people who do red and white ceremonies.It's at least half a day or a day or two, where to remember to take medicine on time.Later, it didn't, it took three or four years to become like this. ”Look, this person is talking about Director Luo's words that the water is too big and not much credibility.The previous sentence said that lesions began to appear before last, and the latter was delayed for three or four years.Chen Wenqiang knew that it was too unlikely that a person like him would be able to spit out the truth in his mouth.So let's not talk to him for a few years, let's look at the feeling of the skin and see where the nerves are affected."
You lie on the bed and close your eyes.I'll give you a check. ”Chen Wenqiang stretched out his hand to Li Min, who took out a small bag wrapped in medical tape from the pocket of his white coat, which contained discarded acupuncture needles from the Chinese medicine practitioner."
Do you feel it?""
Do you prick me with a needle?""
What about here?"
Chen Wenqiang started from his left knee and slowly tried downward, and the distance between them was only about half a centimeter, and when he was close to the middle of his calf, the patient's response to acupuncture began to become sluggish, vague and inaccurate.By the bottom third, there was no response to acupuncture.The skin of the right calf looks better than the left leg, but the response interface is basically the same as that of the left leg."
Alright, open your eyes.We will discuss and then tell you the specific treatment. ”Chen Wenqiang turned around and saw the discarded millineedle handed it to inexplicable and said, "This is a good disinfection, you can keep it." ”Blushing inexplicably, she was saddened by her negligence in the physical examination.She didn't expect to let the patient close his eyes, and the patient actually looked at his wound skin ......* returned to the office, and said to Director Luo: "First control blood sugar and fight infection at the same time."
Hurry up and amputate his leg, otherwise if he drags on, he will not have difficulty walking, but his life will not be guaranteed. ”Everyone in the room understands that if the blood sugar is not lowered below 11 mmol/L, the chance of non-healing after amputation is more than 80%.Even if it is barely healed, necrosis will occur again.As for the ulcerated wound, the occurrence of bacteremia, sepsis, sepsis, etc., is also a very reasonable pathological outcome."
Is it possible that this patient's feet have ulcerated, but his blood is normal?"
Director Liang looked through the test sheet and asked questions."
That's what the test sheet that the patient brought from the district hospital looks like.The same is true for the test results for admissions.I'm also very curious about this.There is also a referral from the following district hospital to go to your orthopedic department for treatment.When he came to our endocrinology clinic yesterday, he only took the blood sugar test sheet from the district hospital, saying that his blood sugar could not come down and he wanted to be hospitalized.The referral form from the district hospital was only given to us last night.He said he didn't want to have his leg amputated. ”Patients don't want amputation everyone understands, but this blood routine?
Director Liang shook his head in disbelief: "That's weird."
Could it be that the lymphocytes in his body pretended not to see the ulcer?
I suggest you do a repeat blood test tonight when you test your blood sugar. ”Director Liang showed Li Min the medical records."
When I was in the commune hospital, I saw patients ask their families to draw blood for them.Now this patient's blood routine can be normal, which is beyond our medical understanding.Maybe in the future, his family members will not be able to participate in his examination and care. ”Director Liang's words are like pushing open another window, Rao is the people here, except for inexplicably, they have seen many patients who tell lies, but they have never encountered the matter of asking their family members to draw blood for themselves.It's also incredible.Director Liang smiled at the inexplicable solution of the question."
The patient thinks he's sick and can't lose any more blood.Ha, it's as simple as that. ”Inexplicably, he hurriedly said: "I watched the nurse draw his blood tonight." ”Chen Wenqiang waited for Li Min to read the medical records before speaking."
I agree with Director Xiang's opinion, control blood sugar and fight infection, and then amputate the limb within a time limit to save your life.Director Luo has time to communicate with patients more and do his ideological work.Tomorrow we have surgery in our department, I will be fine in the afternoon, at 4 o'clock, I will bring the intern over.If you can't get out, I'll ask Xiao Li to bring the students over.Director Luo, this is my student Li Min. ”"Director Luo."
Li Min stepped forward to recognize Director Luo."
What do you tell Xiao Li?""
Okay."
Director Luo has been in the provincial hospital for almost a month, and he already knows Chen Wenqiang and the people around him.Director Liang said, "Then I'll bring the students here at 3 p.m. tomorrow, is it okay?"
”Director Luo immediately nodded: "Yes."
As long as you arrange the surgical side first, the internal medicine department is in the same building, and it is easier to go upstairs and downstairs. ”Director Xiang hesitated and asked, "When can I pick up this patient?"
”Director Luo replied: "Director Xiang, I am trying to control blood sugar with insulin, if your department has the ability to control his blood sugar in a short time, you can take it now." ”Director Xiang hurriedly said: "It's better for you to come, our orthopedics department doesn't have that meticulous person who has such a ability." ”When Director Luo saw Director Xiang admit defeat, he smiled and said, "The endocrine nurse has just done more in this area, and she is more proficient." ”She avoided the words that endocrinology was more detailed than orthopedic doctors and nurses, and that was the way it should be."
I'm also slowly figuring out his response to insulin.It is necessary to wait for the patient's sensitivity to insulin during the operation, and to cope with the possible stress blood sugar changes after surgery. ”Xiang knew that Director Luo was also telling the truth.Leaving the same thing to the nurse in the orthopedic department is definitely not as good as the endocrine side."
Then I'll thank you in advance.When my blood sugar is almost up, I'll take it again. ”"Lao Xiang, look at the students in obstetrics and gynecology and pediatrics, are you waiting for the patients to pick them up, or will you give them a lecture in the next day or two?
Anyway, this patient is going to be taken to your department for surgery. ”"I had surgery on Tuesday, Wednesday and Thursday and came back on Friday to see how the patient was doing.Before the surgery, I must arrange a lecture time for interns in obstetrics and gynecology and pediatrics. ”Chen Wenqiang nodded and said, "Then let's do it first."
Director Luo here in the Department of Internal Medicine, you work a little harder, and let the directors of each department bring the interns over to have a look before the patient is transferred. ”"Good.Just follow your arrangement, Dean Chen. ”* Li Min followed Chen Wenqiang and others back to the department.To get back to their respective Coreys, they had to take the elevator to the second floor, then through the sky corridor connecting the twelfth and seventeenth floors, and then transfer to the elevator on the seventeenth floor.On the way, Chen Wenqiang asked her: "Director Luo, do you know that graduate student?"
”"Acquaintance, a department but not a large class.She followed Director Luo over, how will she be counted in the future?
”"I discussed with the Medical University, and after completing the thesis in time, I will go back to defend it, and it will still be handled according to the graduation of the Medical University.Director Luo hopes to count her as an on-the-job graduate student. ”"Why?"
Li Min felt that this request was too amazing."
House."
Director Liang replied for Chen Wenqiang: "Didn't there still leave a few two-bedroom houses?"
”"Is that okay?
Lao Chen?
”Director Xiang was very interested: "Your three-room and two-room houses are still waiting for the cubs."
Sent out early, early worry. ”"It is all the Lord's.All three rooms were assigned to the department directors who were introduced, and two sets of two rooms were reserved for the attending doctors of pediatric surgery.In addition, our provincial hospital wants to expand the dialysis room, and the strength of the nephrology department is too poor, and there must be two attending doctors who can be on duty independently.Graduate students are currently not in their turns. ”As soon as Chen Wenqiang said this, Director Xiang didn't speak again.Originally, he hoped that if someone took the lead, he could follow, but he didn't expect Chen Wenqiang to be tight, and the reason was so sufficient.But he turned his head and said to Li Min: "Xiao Li, you are really cost-effective."
Your classmates didn't even have a two-room house, and you're going to live in a three-room house soon. ”Li Min pursed his lips and smiled at the director.Because Director Xiang is in her eyes, she belongs to the kind of people who can't be provoked, have to be respectful, and hide from afar.Director Liang said: "That's a graduate student of the Medical University, and it will be difficult to say after five years."
Maybe ten years later, people will be able to lead graduate students when they become associate professors, and we Xiao Li won't be able to catch up with people.Xiao Li, you have to come on. ”"If you come on, our provincial institute won't give you the graduate exam, isn't it Dean Chen?
There is still a shortage of people to work in this clinic. ”"I'll have to think about what you two said.Our provincial hospital has recruited so many associate chief physicians and associate professors with graduate qualifications, that is, our provincial hospital is short of people and cannot let young doctors go to full-time study, but we can't waste these professors.As long as I don't delay my clinical work, well, I will think about how to get young people to try to study as part-time graduate students of our professors. ”Director Liang's heart fell to the ground all of a sudden, and he knew that Chen Wenqiang would think of a play.In this hurry, he made another matter.According to Chen Wenqiang's dick nature, before the professors of this hospital recruit clinical graduate students, he will not toss other things for the time being.But in this way, Lao Li should remind him that before the directors of each section are in place, and before the end of the third-level A meeting, it is best for him not to talk about it.Fortunately, this has been done, which will not only enhance his prestige among the directors of various departments, but also increase the weight of his voice in the leadership team of the provincial academy, and will not affect or shake his position as assistant to the dean.Director Liang felt that it was not easy for him, and he had to worry about Chen Wenqiang when he went to the Department of General Surgery, alas!
* It was almost five o'clock when they returned to Corey, and Director Li had already finished talking about the main points of lung cyst surgery.On the small blackboard, a stick figure of a brain CT scan was drawn with chalk, and it was a patient with a lateral ventricular tumor who would be operated on tomorrow.() The distance is a bit far