Li Min's hands were a little hot because of the fever.Sticking to the old lady's slimy skin in a cold sweat, the old lady didn't feel anything uncomfortable, but the touch of Li Min's hands made her feel very bad."
Does it hurt here?
Does it hurt here at first?
Is it the most painful place right now?
”According to the requirements of diagnostics, Li Min carefully examined the old lady's abdomen little by little.Although the old lady looked a little in a trance, the reaction of the muscles and skin of Li Min's hands told Li Min that the old lady was not lying.After carefully inspecting it, Li Min carefully helped her pull up her clothes and pants.Turning his head to Dr.
Zheng, he said, "Dr.
Zheng, the rebound pain is not obvious.It is better to say that there is pain in the lower abdomen on the right side, and it is obvious in the lower abdomen.You saw that clearly, right?
”"Yes."
Dr.
Zheng was embarrassed."
Outpatient examinations are outpatient.You can rewrite the first journey according to the physical examination I just did. ”"Okay.""
You go and call the gynecology ward and ask them to come over for a consultation to rule out a gynaecological acute abdomen."
Li Min took out his seal and said to Xiao Wang, "Consultation form." ”Xiao Wang flipped out the consultation form, and when Li Min finished stamping, she stamped the trauma surgery stamp.I'll bring it back when the gynecologist comes over in a while.She watched Li Min sit on the bench tiredly, and then turned her head to see Dr.
Zheng to make a call."
Dr.
Li, do you want to take your temperature?""
I'll wait until she's done."
The two women looked at Li Min and felt that Li Min's state was okay.He surrounded her and asked, "Dr.
Li, when are you going to operate on my mother?"
”Li Min flipped out the test sheet and B-ultrasound sheet and pointed it out to the two women: "You two look at the old man's test sheet, although the white blood cells are 20,001, the B-ultrasound indicates that there is fluid in the abdominal cavity and intestines, and there is fluid in the pelvis."
This is telling us that there is peritonitis.But there is not enough evidence that this is peritonitis caused by inflammation of the appendix.The diagnosis is uncertain, and there is no way to operate on her for the time being.It is also possible that it is caused by an acute gynaecological abdomen. ”"Gynecology?
My mom is so old, doesn't it say that there is no abnormality in the uterine appendage. ”"The absence of abnormalities does not rule out a gynaecological disease."
Li Min didn't understand why this woman had opposed gynecological examinations from the beginning.The other woman grabbed Li Min's sleeve and asked, "Then Doctor Li, what should my mother do now?"
Can't I have surgery right away?
She had been in pain for days. ”"Eliminate inflammation first.Consult a gynaecologist to rule out an acute abdomen caused by gynecology before proceeding with the next step of treatment. ”Li Min's attitude was very resolute and said: "You are hospitalized in the provincial hospital, and the treatment plan has to be decided by our doctor."
None of you are doctors, you have been in pain for several days, and this is not the basis for the diagnosis of appendicitis.You can't say it's appendicitis, I'll just push the patient onto the operating table for surgery. ”After Li Min finished talking about his decision, he dragged the medical records over.After asking the old lady if she had no history of allergies, she ordered a skin test of penicillin and procaine on the makeshift doctor's order.Write down your physical findings and treatment advice on a blank page.Then when nurse Xiao Wang did a skin test on the old lady, she explained to the patient's family: "There are no beds in our department."
Hospitalized patients can only live in the corridor. ”Li Min frowned, an old lady of this age lives in the corridor, and she may not have to catch a cold until tomorrow afternoon.That may not be a big deal to others, but for this old lady with peritonitis, once it causes pneumonia, it will kill her.
*Dr.
Hong from the gynecological consultation came very quickly.The old lady was very reluctant, but was still pushed to the disposal room for examination.Li Min only stood outside the screen and waited, one of her daughters went in with her, and one accompanied Li Min and waited."
There are contusions on the outside, lacerations on the tract, a mixture of old and new, senile tractitis, cervical manifestations after childbirth, erosions, II.°.Residual fluid may be seen at the cervical opening and posterior fornix.This should be semen and purulent.I'll have to send it to the lab for a check-up in a moment. ”Gynecology Dr.
Hong was examining inside, and Li Min was recording outside.But the old lady and daughter who accompanied Li Min were not happy.She pressed the pen that Li Min was recording on the sticky note paper, raised her voice and said inside: "My mother is 80 years old this year, what are you talking about." ”"I have to tell Dr.
Li what I have checked.What's wrong with 80, 80 shouldn't have sex?
”The gynecology doctor Li Min was not familiar with her, but Li Min supported her."
We have to do a good job of testing to get a good diagnosis.Why have you always been against gynecological exams?
”"My mom doesn't have a gynaecological disease."
The woman roared in annoyance, as if she were going to eat people."
Senile disease is a gynecological disease.Yin Dao old lacerations and cervical erosions are all gynecological diseases.And this freshly wounded wound.You're her daughter, come and have a look. ”The woman next to Li Min didn't move, and Wu Zi emphasized: "What does that have to do with her stomachache?"
”"These can cause stomach aches."
Li Min and the gynecologist spoke at about the same time.The woman who accompanied the old lady in began to coax the old lady: "Mom, don't cry." ”"I said don't do it, don't do it, my stomach hurts, my bottom hurts, and it's been hurting for almost half a month."
The old lady said vaguely, but everyone heard it clearly.Li Min and other gynecology doctors came out from behind the screen and asked, "How about transferring to your department?"
”"It is not appropriate to receive our section for the time being.There is insufficient diagnostic evidence to suggest that the acute abdomen is caused by those signs.Why don't you treat anti-inflammatory in your department first, wait for our director to come during the day, and let the director come to see before deciding?
”Dr.
Hong said it very politely.Li Min is a student of Chen Wenqiang and a popular person in the provincial court, and he can't comply with her requirements or offend her.Although I got an answer for asking for advice, the meaning of refusal was very thorough.Li Min understood the results of B-ultrasound and the current signs, and reluctantly referred Dr.
Hong from the gynecology department.She had no choice but to explain: "There was a traffic accident yesterday, and the surgeon performed 20 or 30 surgeries during the day and night, and there were no beds on the 11th floor.Received the twelfth floor and did not meet the regulations.She lives in the corridor at her age, and I'm afraid she won't be able to stand it, in case she catches a cold, has a lung infection or something.Isn't it troublesome, you say?
”Li Min was really embarrassed.Zhang Zhengjie had refused to refer the patient upstairs before, and now he can't take the patient upstairs.The embarrassment and hesitation on her face fell into Dr.
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Hong's eyes, and Dr.
Hong guessed her mind without much thought.It's so young!
There is still such compassion.Forget it, for Dean Chen's sake, he will do a good deed that day.So she advised Li Min: "It's definitely not okay for her to live in the corridor."
There are a lot of empty beds in the gynecology department, but it is not good to pass like this.You think this is the case of peritonitis that you received the surgery and will be transferred back......
Or if you ask the general public, her current diagnosis of peritonitis is not wrong. ””Li Min understood what she meant.If it is not a gynecological acute abdomen, it will be classified as a misdiagnosis and statistics.But when I received a general surgery hospitalization, I didn't have any trouble with that.She immediately called Dr.
Puwai Chen in front of Dr.
Hong and his family.To be honest, it's really embarrassing.After Li Min told the patient's situation, Dr.
Chen immediately agreed: "Send the patient over." ”He also joked with Li Min: "Doctor Li, you remember to owe me a favor." ”"Okay."
Li Min was very happy to be able to send this patient to live in Puwai.It's not to shirk responsibility, it's for the good of the old lady.Nurse Xiao Wang said very strongly: "I don't register for admission here."
Let's go straight to the general hospital. ”Dr.
Zheng knocked on the consultation list and reminded her: "There is also this." ”Yes, when the gynecology department comes for consultation, it is necessary to charge consultation fees and examination fees.This was transferred from the Trauma Surgery Patient's Hospitalization Deposit to the Obstetrics and Gynecology Department.Xiao Wang sighed and said, "Doctor Li, then I can't help it."
Director Zhang wants to find you, so you can ask for more blessings. ”Li Min can't take care of these now, and in which department is now to be treated with anti-inflammatory treatment first.With the diagnosis of acute abdomen, I send it to the general surgery to be able to hang up.Tomorrow, I will report the old lady's age in front of Zhang Zhengjie, and I hope to explain the past.She told Dr.
Zheng to send it away in person, and also reminded Dr.
Zheng that Dr.
Chen must pay attention to the opinions of the gynecological consultation and the results of the gynecological examination, and must ask Director Li to come over for a consultation during the day.* Seeing off the patient and the accompanying family members, Li Min leaned back on the bench in prostration.The little nurse who followed Xiao Wang handed her a thermometer: "Doctor Li, I have disinfected this."
Hurry up and take your temperature. ”"Thank you."
Li Min looked at the position of the Hg pillar of the □□ thermometer and clipped the thermometer to his armpit.Xiao Wang pestered the gynecologist and asked, "Doctor Hong, what's the matter with the old lady?"
”"Just what you think.But it is estimated that her old man did it.Her two daughters were in the mirror.The son may not know anything about it.The old ones don't repair, alas!
”"Oh, when you didn't come just now, they kept urging Dr.
Zheng to do surgery, saying that it was emergency appendicitis."
Li Min smiled weakly and said, "Dr.
Zheng doesn't have the right to issue a surgery notice, and it's useless for them to urge." ”"yes.Dr.
Zheng also said the same, so I will ask you to see the patient.I called Nuan, and the family went upstairs to find you. ”"The diagnosis is not clear, and there is no ink at all for the peritonitis, so I will not have surgery.Just come back with a drain?
Then the patient's family will not be able to talk easily.Besides, Director Zhang won't let it, and the medical record inspection can't be passed. ”"What do you think is peritonitis?"
Xiao Wang was interested, and she wanted to know the diagnosis."
The ultrasound is done, the uterine appendages are fine, I can't think of anything for the time being."
Li Min bluntly told Xiao Wang that he didn't know.Dr.
Hong smiled and said, "B-ultrasound may not be accurate.I don't look like appendicitis anyway.If there is no uterine perforation, no adnexitis, then where does acute peritonitis come from?
Where does pelvic fluid come from?
Let me tell you Dr.
Li, you are young, and you have not seen a few gynecological acute abdomen sent to surgery.Like Xie Xun and Xiao Chen, they have been conditioned by gynecological acute abdomen in the past few years.Open a belly of blood, dumbfounded a lot of things. ”Li Min smiled gratefully at her and said, "You came over quickly just now."
I don't think this opening belly should be appendicitis either.She's 80.I think her son must be fifty or sixty years old. ”Dr.
Hong had just left a consultation opinion on the medical record, and after a while, he wrote the transfer suggestion in the doctor's order book.She put away her pen and said, "What is so rare?"
I went back. ”Li Min owed her a debt, and Xiao Wang sent her out.came back and stretched out his hand to Li Min and said, "Doctor Li, it's almost okay." ”"Oh, 38°9, it's about the same as the old lady just now.What's wrong with you?
”"I'm tired.I went back upstairs.I can sleep for two hours if it's fine. ”Li Min grabbed the phone and called Nuan: "Warm, go to the stairs and open the door for me." ”"Can you do it?"
Xiao Wang took the key and accompanied Li Min to the stairs."
It's okay, just go back and get some sleep
.
"* Li Min returned to the duty room, thinking that Xiaoyan was going to bring food to herself in the morning, so she didn't lock the secret lock of the duty room.After filling half a jar of hot water, she climbed into bed and fell into a coma."
Aunt Min, Aunt Min."
Xiaoyan shouted a few times, and seeing that Li Min didn't answer, she thought that Li Min was not in the house, so she took out the key and opened the door to put breakfast in for her.She walked to the desk and put down the thermos bucket in her hand, and saw Li Min sleeping on the side of her face.That abnormal face made her realize that Li Min was sick.Xiaoyan took off her gloves and touched Li Min's forehead, God, it's so hot!"
Aunt Min, Aunt Min."
Xiaoyan pushed Li Min.Li Min snorted indistinctly: "Don't make noise, let me sleep for a while." ”"Aunt Min, you have a fever.Have you taken any medicine?
”Li Min closed his eyes and fell asleep, ignoring Xiaoyan.Xiaoyan couldn't, so she picked up the phone and called home.When the phone was connected, she said anxiously, "Aunt Hong, Aunt Min has a fever."
I couldn't wake her up. ”"Rainbow," it was Pan Zhi who answered the phone.Xiaoyan called and said that Li Min had a fever.Can't wake up. ”"Hmm.Let her sleep first.I'll go over after eating.Let Xiaoyan wait there for a while. ”Pan Zhi told Xiao Yan what Yan Hong meant, and when he put down the phone, he said worriedly: "Li Min is sick, you can't pass."
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Let Xiaoyan take care of it there. ”"It's fine.Minmin: It's an old habit, tired.Just in time for the menstrual period to come, she will be like this.Pour her more hot water to drink, get a good night's sleep, and it will cool down tomorrow.It's fine. ”"Yesterday was quite tiring."
Pan Zhi said with palpitations.In the past half a year, he can be regarded as touching the rhythm of ordinary work, but in the past few days of the Spring Festival, especially the three surgeries yesterday, the first one has made him tired."
Are you alright?"
Pan Zhi saw that Yan Hong continued to eat in no hurry, and asked.Yan Hong nodded and said, "What am I fooling you about?"
She was sick last winter and the winter before that.In her own words, from childhood to adulthood, she will inevitably have a fever in winter.Above 39° for 24 hours is enough to kill all the errors that occur in the process of replication and transcription of RNA, and then she is reborn. ”What is this?
Pan Zhi disagreed.He continued: "You really don't need to take medicine?"
”"No, you don't."
Yan Hong replied confidently."
She's sick and doesn't have any medicine.She couldn't stand the irritation of penicin allergy and erythromycin to her stomach.There is a cross-allergy between cephalosporin and penicillin, who dares to give her a skin test.The year before last, I took acetylspiramycin tablets for a few days, and as a result, I had a drug rash.She's allergic. ”"That's not good medicine.Rainbow, I don't think you'd better go over.I'm not against you caring about Li Min, but I'm worried about you and the child.In case you have a fever, you are now in a special period, and it is not easy to use medicine.You say, don't you?
”"I'll just take a look.I'm not going forward.You go home to the bookcase, take my those, forget it, I'll look here for Min Min and see where she put the sanitary napkins. ”Pan Zhi hesitated for a while and said, "Then I'll accompany you."
In fact, it is more suitable to let Xiaoyan take care of her there.I'll come back when Li Min is well. ”Yan Hong smiled and pointed at Pan Zhi with her finger: "Are you afraid that Xiaoyan has been infected by Min Min now?"
”"If Xiaoyan is infected at this moment, you will be even more unsuitable to see her."
Pan Zhi put down the steamed bun and said to Yan Hong seriously: "You wait at the door, I'll go in to see Li Min."
That's okay, right?
”"Okay.She's fine.We didn't ask for leave to take care of her when she had a fever before, so we bought her some rice porridge and small pickles, and she would get up and drink hot water herself. ”After eating, the two went to the hospital a little earlier than usual."
I'll go to the cafeteria at noon to buy food, and if it's too late, I'll find someone to buy it for you."
Pan Zhi lowered his head to tie Yan Hong's shoes, and told Yan Hong uneasily."
You don't have to worry about me eating.At noon, I came back here to cook dumplings.Tonight's night shift, afternoon off. ”Yan Hong saw that Pan Zhi didn't seem to react, so he added: "Xiaoyan has the key to Minmin's house, I will ask her for the key, and I will rest here in the afternoon." ”"Okay, let's rest here."
When the two arrived at the duty room, they saw that Chen Wenqiang was asking Xiaoyan to test Li Min's temperature.Yan Hong hurriedly said Li Min's medication taboos.Chen Wenqiang said very openly: "Since this is the case, let her sleep well for two days, and the fever is also a good opportunity to clean up the mutated cells in the body."
Let Xiaoyan take care of you here, you two are fine, right?
”Pan Zhi hurriedly said, "No problem."
There are a lot of dumplings at home, which are made by Li Min and his parents during the Spring Festival.I can cook too, and we can both go to the cafeteria to eat. ”Chen Wenqiang saw Pan Zhi say this, and nodded approvingly.Yan Hong handed the big plastic bag she was holding to Xiao Yan.Tell her that there are sanitary napkins inside and that clean underwear is to be changed with sweat.She asked Xiao Yan for Li Min's door key, and asked Xiao Yan to feed Li Min water and guard Li Min here.explained it all before leaving under Pan Zhi's urging eyes.She and Pan Zhi broke up in the elevator room, went back to their respective departments, and prepared to attend the morning meeting of the new year.
*Dr.
Chen received the old lady who was transferred in the early morning, carefully studied the medical records, and gave the old lady an intravenous infusion of antibiotics according to the results of the allergy test.When Director Liang came, he immediately reported the patient to Director Liang.Director Liang has worked at the grassroots level for so many years, and there is nothing he has never seen.He went to the ward to see the old lady, and was guarded by the old lady like a thief.He doesn't care about old ladies, such old ladies can't be persuaded.When he returned to the office, he asked Xiao Chen to make an appointment for an emergency CT scan for the old lady, and when the results came out, he asked Director Li of the obstetrics and gynecology department to come over and consult the old lady as soon as possible.At the same time, let the head nurse explain to the nurses on the day shift and pay attention to the changes in the old lady's condition.
*Today is the first day of work at the beginning of the year, and all medical staff, including doctors and interns, are all present.Zhang Zhengjie routinely went to Corey to see the list of inpatients first, counting the increase in Corey's patients, he touched his chin and laughed with great ambition.The head nurse also smiled."
We're off to a good start this year.""
yes, yes, yes.What time is it, is it time for the shift?
”"Almost, let's take over."
At 7:45, the trauma surgeon was handed over early.Nurse Xiao Wang read the conditions of the postoperative patients one by one, and Zhang Zhengjie always listened with a smile.But in the last one, it was the old lady.Xiao Wang clearly explained peritonitis and gynecology consultation, and then transferred to the general hospital, and Zhang Zhengjie's brows wrinkled together."
Why did you turn away?"
Zhang Zhengjie's tone was not good.The referral was stacked with the tribal of yesterday's patients, and a small flame of anger began to burn in him.Xiao Wang replied hesitantly: "There are no beds in our department, and there are two more beds in the No. 3 room, and I can't add them anymore." ”"Then you two agreed to transfer out?"
The extra bed in the corridor doesn't live in?
Zhang Zhengjie did not want to indulge the doctors and nurses on duty.There will be two in this matter.An indulgence is tantamount to promoting a bad tendency not to take the hospital regulations into account, and someone will definitely follow suit.Xiao Wang shrunk into a small ball under Zhang Zhengjie's questioning, and she couldn't wait to get under the table."
Raise your head and speak."
Seeing her cowering and can't get on the stage, Zhang Zhengjie became even more angry.The head nurse hurriedly played a round and said, "Who told you to turn it?"
The director didn't lose his temper with you, you talked well. ”Xiao Wang shrank and reported in detail that the patient refused to be examined by Dr.
Zheng and Dr.
Zheng asked Li Min to come over, and even the words of Dr.
Hong from the gynecology department, she relayed it word for word.Zhang Zhengjie became more and more angry.The head nurse saw that his face was pale, for fear that he would say something inappropriate in front of everyone, so she hurriedly said, "Director, there were many patients admitted yesterday, let's do the ward rounds first."
Then I went to see the patient outside the general area, and then asked Li Min. ”The head nurse skillfully put the accountability of Li Min at the end.Zhang Zhengjie understood that what the head nurse said was the right way to deal with it, he put down his unhappiness, looked up at the electronic clock and said to everyone: "8:35 starts the big round, and 10% of the bonus will be deducted if you are late." ”Then he went out angrily through the crowd of shifts."
Adjournment."
The head nurse could still speak in a calm tone, and she carefully told all the medical staff: "You all be careful today, don't be late for a big round." ”All the people dispersed in understanding.* At about ten o'clock, Dr.
Chen hurried to the director's office on the twelfth floor to find Director Liang."
Director Liang, the CT results are out, it's a uterine rupture."
Dr.
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Chen handed the CT film and report to Director Liang."
I've sent a consultation notice to the obstetrics and gynecology department."
Director Li stood up to look at the CT film, and Director Shi also leaned over."
Tsk, this needs to be operated on immediately.""
yes.Acute abdomen came in, did you call Director Li?
”Director Liang asked while watching the film."
Nope."
Xiao Chen didn't dare to make his own decisions, he still had to go through the normal procedures during the day, and he was on the kang across the pot......
What if it upsets Director Liang?
Director Liang grabbed the phone and called Director Li of the Department of Obstetrics and Gynecology."
Lao Li, I'm Lao Liang.Last night we received an 80-year-old acute peritonitis on the night shift, please have a gynecological consultation, just finished the CT scan, uterine rupture, you come and have a look.Ah, ah, okay, okay, then I'll go back to Corey and wait for you.I'm here on the twelfth floor, and you don't want to see me when I go to your place, how dare I annoy you.Hehe, I'm waiting for you, see you or leave. ”Leaving the phone, Director Liang said to Director Li and Director Shi, "I'm going back." ”"Let's go back."
Director Li responded.Director Shi said, "Then it's decided that everyone will come to my house tomorrow night." ”"Okay."
Director Liang answered and walked out with Xiao Chen.As he walked, he said, "You should be a little more aggressive."
When the results of this patient's CT scan come out, you should call Director Li. ”Xiao Chen replied respectfully, "I have to tell you first." ”"Haha, now you're timid, when you accepted this patient this morning, you weren't quite bold."
Director Liang teased Xiao Chen."
I am, that's for Dr.
Li's sake.She said that the old lady was 80 years old and was afraid that there would be an accident in the corridor in this weather. ”Xiao Chen explained cautiously."
What a bit of.You see if you still look like a man.I said that if you dare to accept this patient this morning, just do it.Don't be afraid, it's okay, it's afraid there, it's too important to affect your ability to improve your skills. ”"Yes, yes.I'm just afraid that Director Zhang will come to our department to find fault later. ”"If Zhang Zhengjie comes to you, you let him talk to me."
Director Liang waved the paper tube rolled into the bag of CT films he was holding in his hand, and said domineeringly: "With this report, none of us are afraid." ”() The distance is a bit far