Only mistakes will be remembered for a long time.The trap of acute abdomen: Who dares to say that they have not fallen into it?
This deafening and deafening words are the most real clinical work experience and uncompromised voices.Chen Wenqiang and the others were almost done lifting the bar to Director Liang and raised his hand to signal the two of them to pause, so that he could say a few words: "I understand what you two mean."
But instead of waiting for our young doctors, who really make clinical mistakes or are transferred into traps, they can only remember for a long time, not to mention the provincial hospital, but also to those of us who bear the name of deputy chief physicians, which is also a good thing to say. ”That's right.At that time, not only will it be unpleasant, but it will be a matter of losing money, and none of them will forget that place last summer."
And what do you want to do?"
Director Xiang has been busy in the emergency department for more than two months, and he has also put a lot of thought into the young doctor's lack of experience and incomplete consideration of things."
I suddenly had this idea tonight, you can see if it works.In the future, we will take turns to ask questions, and we will take a horizontal test every week, give symptoms, or give physical examinations and simple auxiliary examinations, so that the resident doctors can answer those diseases.Open book exams, ""Open book exams?
What's the point of that?
”Director Wang didn't wait for Chen Wenqiang to finish speaking, and rushed to speak out against it."
Closed-book, like last year's lecturer qualification certificate.""
Lao Wang, don't worry.For open-book exams, people who don't know how to check the books themselves.The purpose of our examination is to allow young doctors to consolidate their original textbook theoretical knowledge and form a new habit of thinking. ”Director Shi immediately said, "I think it's okay."
Saturday was laid out, and Wednesday was turned over to collect the papers, leaving them plenty of time to flip through the books.When I asked again on Thursday and Friday, I couldn't answer 90%, and I guess they would feel shameless. ”"Given five days, the final standard is 90 percent, and your requirements are too low.Inappropriate.100% is OK. ”Director Shi also began to bar: "100% is meaningless.For example, this abdominal pain, purpura can also be caused, and I went to the internal medicine department at the triage table of the outpatient clinic.Pointless. ”"Old Shi, it's not right for you to say that.Spondylosis can cause abdominal pain, which is even rarer, do you want young doctors to not know about it?
”"People have limited energy, and if you can deal with an acute abdomen, you can go to your emergency department.The rest of the rare causes of abdominal pain are waiting for you to show up during your ward rounds. ”Director Liang supported Director Shi.Director Wang and Xi Ni said: "Why don't we bring such a piece when we come up with a standard answer."
If you have the energy, go to the book by yourself, and if you don't have the energy, don't force it. ”"The abdominal pain caused by spondylosis can't be found in a book."
Chen Wenqiang saw that the bar was getting more and more off, so he said: "I encountered a abdominal pain for more than four hours that time, and then it was transferred to the right lower abdominal pain.Surgery prepared for acute uncomplicated appendicitis.As a result, the appendix was opened during the operation, and the appendix was fine.This didn't work, so I had to prolong the incision exploration. ”"You chose the incision of the McSs point?""
yes."
Chen Wenqiang said with palpitations: "I don't even say how ugly the extended incision is, it is a local anesthesia operation."
Fortunately, a fish bone was finally found in the ileocecal region, but it had pierced the intestinal wall. ”"It's also in line with how long the food travels through the gastrointestinal tract.""
Fish bones.That's not unusual.I once came across a fish bone that had been wrapped for more than half a year.Finally, the patient's life was limited and he came to our roving medical team for surgery.The omentum is a mess.I thought it would be an ileocecal tumor, but when I finally opened it, it was a thick and hard fish bone.I've always wondered how such a large fish bone could get down the esophagus, and it didn't pierce the intestines and blood vessels all the way. ”"Have you seen the jujube pits pierced through the duodenum?
M's, almost confessed on the operating table. ”"Are you preparing for the operation by duodenal perforation?""
It would be nice to do that.The patient has only periumbilical abdominal pain, with progressive peritoneal irritation worsening.Fortunately, I chose to have a laparotomy to explain to the patient and his family. ”"Was that repaired or excised?"
Director Liang rolled his eyes at this question and asked Director Xiang to sneer.Then he pulled back his face to the director and said, "Fish bones and chicken bones are nothing."
You know, when I went on a medical tour, a commune cadre took home the small half-box of thumbtacks left in the office.Two or three-year-olds swallowed several.M's, I only brought the child over the next day. ”"So," Chen Wenqiang concluded."
Our first exam question was abdominal pain.Open the book, how much can you answer.Go back and exchange rolls and let the young doctors judge the rolls themselves.If you look at others, you can also know whether you have answered correctly and completely. ”"Then do you want to give some bonus incentives?"
Director Wang asked."
How about 100 bucks?"
Chen Wenqiang thought for a while, and emphasized: "Just a bonus."
If you can't answer all of them, pick the best answer. ”"If you give two hundred, I think the doctors in the whole hospital will participate.""
That's going to be the whole house.""
Yes, if you give 200 yuan, it will be 800 yuan a month, and some departments don't have so much salary plus bonuses.""
Then tell me, who is so capable that he can win the first place four times a month?"
Chen Wenqiang saw that they were about to get up again, so he hurriedly clapped his hand and said, "I'm afraid that doctors from other departments won't come to participate."
The more people, the better. ”"Then how do you judge who answers the most?""
Put it on the bulletin board and let everyone comment?""
No, whoever has so much time to look at all the papers.""
The total number of hospitalizations in each department has been collected, so let's read it first?""
Let's take a look at it first, we have a number in mind.Otherwise, in the end, I posted the most complete answer, and it was pointed out that it was not the most complete, which would be a slap in the face.Let's take a look at it first. ”"I don't have that much energy to watch.""
Or send it to the Medical Department?
Anyway, they are idle.Let them get down to business. ”"No, I can't.You can't let the medical department get involved.When the time comes, they come to Corey with the answer sheet to talk to someone, and it's not annoying enough. ”"Let the hospitalization always look at it first.""
Well, let's choose one of the best answers in each subject, and let's just look at those ones.""
What if someone answers too many questions and gets them wrong?""
It's upside down.Wrong, offset, right.Otherwise, believe it or not, someone will copy the whole chapter for you, regardless of whether it's good or not?
”Letter.How not to believe it.For the sake of those two hundred yuan, no, eight hundred yuan, some departments that are too idle to do may really copy books."
Hey, Lao Chen, then your abdominal pain can't be limited to surgical diseases.Purpura should also be counted. ”"Count it.""
Originally, it wasn't limited to surgery.Heart attack also has abdominal pain. ”"Then the attending physician will not let you participate?""
Let's go, the attending physicians of each department volunteered to participate.Anyway, the test is only taken once a week, and whoever has the ability will get the two hundred yuan. ”"What about the logistics and political workers?""
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Is it to add logistics?
Don't join in the fun. ”…… After talking to each other for a while, talking about business for a while, procrastinating for a while, these old men who didn't have anything important to do when they went home were in the director's office on the twelfth floor, chatting until almost ten o'clock, and then they left together.For Chen Wenqiang, he didn't read a word that night, but he finally decided that everyone should work together to ask more questions and teach young doctors more, so as to improve the clinical thinking habits of young doctors as soon as possible.It was also a very rewarding night.For the young doctors in the provincial hospital, they didn't know that the torturous perverted examination conspired by the director of surgery was quietly approaching them.* Xie Xun went to the pediatrics on time on Sunday morning.Director Wu has prepared all the child's examination materials."
Director Wu.""
Xiao Xie, come, take a look at the medical records first."
Director Wu handed the medical record folder to Xie Xun, then checked the CT film in his hand to the reader and pressed the switch.Xie Xun carefully looked at the medical records, and found the lymph nodes mentioned by Director Wu on the enhanced film of the abdominal CT scan, frowned and thought for a while before saying, "Let's go see the child." ”"Okay."
Director Wu led the way and introduced as he walked: "This child has lost 4-5 pounds in three months. ”"That's not good.""
Yes, such a big boy is when he can eat and play to annoy the dog, and the weight is lost, and the parents pay attention to it."
Director Wu took Xie Xun into the ward and said to the parents who were looking forward to it: "This is Director Xie of the Department of General Surgery of our Provincial Hospital. ”"Director Xie, I'm sorry for you."
The parents were very touched to come and see their children on Sundays off."
Don't bother, I'm on duty today."
Xie Xun replied like this, so that the father of the child who was the same age as him could not answer.And Xie Xun himself didn't feel any embarrassment at all, and began to ask about the boy."
When did you start feeling uncomfortable?""
Before the Chinese New Year.""
How uncomfortable is it?""
It just hurts all the time.It doesn't hurt very much either.But it just hurts. ”"Where does it hurt?"
The little boy covered his navel and said, "Here it is."
It hurts all the time.It doesn't hurt when you fall asleep. ”Xie Xun carefully inquired about the medical history and found that there was no discrepancy with the record in the medical record.He rubbed his hands together and began to examine his body carefully."
Kid, let my uncle show you what's hurting."
The little boy lay down cooperatively, and her mother helped to lift his clothes and pull down some of his pants.This child probably has had a lot of physical examinations, and he actually knows how to curl up.As described in the medical records, there is only a little left of the umbilicus, and the part of the child that is the size of his own palm is tender, and the rest (-).Xie Xun pulled the little boy's clothes off and pulled his pants again.Slowly thinking about it, he said to the parents: "Director Wu is very anxious about your children.Now all the non-invasive tests that can be done have been done, and you have seen the results of abdominal CT enhancement.However, the diagnosis given by the image can only be used as a reference, which is not the basis for us to confirm the diagnosis.One of the things we're going to do now is a bone marrow aspirate, and the other is to get those suspicious lymph out.The final diagnosis is the result of pathology. ”"Going to the operating table?"
The child's mother changed her face first."
yes.Our hospital has just entered the laparoscopy, and we only need to make a small incision in his stomach, no more than 1 cm.In this way, the damage is relatively small.However, before Xie Xun finished speaking, the parents immediately said, "Okay."
That's what the mirror did. ”The parents agreed so quickly, which did not exceed Xie Xun's expectations, but he had to briefly explain the matters related to laparoscopy."
That laparoscope is the latest equipment in our hospital.This laparoscopic removal of lymph nodes has both advantages and disadvantages.The advantage is that the scalpel is small and there is less damage to the child's body.But the disadvantages are also obvious, and it cannot be seen as well and clearly as the infusion exposure of normal laparotomy. ”"Do you mean it's hard to find that lymph node?"
The father of the child said in a word."
Yes.You're right.One is that it is difficult to find, and the other is that there may be secondary damage in the process of finding.You have to understand that.I'm going to do my best to do this well.But we are not immortals, we can't do it 100%.Can you understand?
”"Understood.We can understand.So what else?
”"The rest is the same as regular surgery.Before the operation, you need to prepare the skin, and you must cooperate with the nurse to clean the child's belly button.Avoid infection after surgery. ”"We can definitely do that.""
And your child is small, you have to think more about anesthesia care after surgery.""
Yes, you can."
The child's parents spoke in unison."
The other one is laparoscopic operation, to completely expose the abdominal cavity, you need to inject air into the abdominal cavity, and carbon dioxide is injected into it.The gas propped up the abdominal cavity, and I was able to find the lymph nodes that were not much bigger than a soybean grain.This gas may cause discomfort after surgery, such as back pain.In such a situation, you should tell the nurse in time, take some oxygen, or after a day or two, the symptoms will disappear automatically. ”"Okay, we'll do as you say.""
If you agree, I will make preoperative preparations and try to arrange the operation for the child as soon as possible."
The parents of the children nodded repeatedly: "We agree." ”Xie Xun continued: "This is a situation where everything is going well, but there may be problems that cannot be solved by laparoscopy during the operation.Then I may have to go for a routine surgery, which is an exploratory laparotomy.You have to think about this, do it if you agree, and don't force it if you don't agree. ”Director Wu had talked to the parents of the children about laparotomy before.Parents have been hesitant to consider that their children are too young.Now seeing Xie Xun say this, the child's father thought about it and said, "Then let's think about it and then reply to you." ”"Good.You've thought about it and notified Director Wu. ”Xie Xun did not force them.Laparoscopy, not to mention that the patient's parents have never heard of it, but many medical staff in the provincial hospital have not heard of it - before Xie Xun went to Shanghai for further study.After Xie Xun returned from his advanced study, he held a special lecture on popular science and told the staff of the hospital about the indications and contraindications of laparoscopy.Now that the ordered instrument is back, Xie Xun is waiting for the auspicious day to open.But he really didn't expect that the first operation would be to remove lymph nodes.He had to worry like the father of the sick child that he couldn't find it.Back in the office of the director of pediatrics, Xie Xun said to Director Wu: "Director Wu, I will bring back the CT film of this child first, and I will return it to you after the shift is handed over tomorrow morning." ”"Okay, you can take it."
Director Wu took the film from the reader and put it into the brown paper bag that Xie Xun had opened."
Then I'll go back, I'm on the day shift today.""
Okay, I'm sorry for you to make a trip.""
Director Wu, you are too polite.If you say hello, I'll come right away. ”*At the end of the evening, the parents of the child took the child to the Department of General Surgery to find Xie Xun."
Director Xie, we have thought about it, and we still ask you to use laparoscopy to operate on this child.""
That's good.Then I'll do the pre-operative preparations. ”Xie Xun nodded in agreement.I said that if you had come earlier, I would have done the pre-operative preparations this afternoon.Now it can only be delayed."
That, Director Xie, do you think my child can have some kind of chronic appendicitis?
When we see a child in the pediatric surgeon, there is a child who has a stomachache similar to him. ”Xie Xun shook his head and said, "I don't dare to say this now, so it's not."
But the odds are very small. ”"Then is my child going to live here in the general surgery department?""
No, I don't.Pediatric nurses have better experience caring for small patients than nurses here.After the operation, the child will change floors and be admitted to the pediatric surgeon. ”"Do you have time to go over and see my son?""
I'll be over sooner or later.There are also surgeons in the Department of Pediatrics.Director Liu, who is a child, can do heart surgery.You can rest assured. ”The child's parents thanked and thanked the child and led the child away.The expressions on their faces are completely contrary to their hearts.They want the child to have chronic appendicitis or something, and they want to have the lymph nodes taken to prove that the child is not lymphoma.But such a hope, they can only secretly hide it in the bottom of their hearts and stay in the sight of the couple exchange.They don't dare to show any panic in front of their children.This week's inpatient examination has made the child more and more sensible and well-behaved......
Faced with children who are no longer as active as they were three months ago, they are distressed.When the family of three left, Dr.
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Chen, the general hospitalist, said, "Director Xie, let me help you with a mirror." ”"Okay.""
When are we going to do this?""
Tomorrow I will take the laparoscope out of the warehouse first, and then I will do a few animal tests.Thursday and Friday at the earliest. ”Xie Xun is not in a hurry, the first laparoscopic operation must be successful, and it must be 100% successful.
*After the morning meeting on Monday, Xie Xun reported the work arrangement of laparoscopy to Director Liang.Director Liang immediately praised with a smile: "Okay."
That's the right thing you can do.When the time comes, I will go with Dean Chen to give you a stand. ”Director Bian also wanted to see the first laparoscopic operation, but when he heard Director Liang open his mouth and asked for two visiting places, he knew that he couldn't compete, so he asked, "Old Liang, what's going on with the abdominal pain answer sheet you said?"
”"That's the young doctor's exam.Attending physicians are voluntary, and resident physicians are mandatory.Yang Yu, you go back and read the book and answer well.Let me tell you, if any of you can get the first place in the whole hospital, my Lao Liang will add another 200 yuan to his wallet. ”Director Xu joined in the fun and said, "Lao Bian, let's work together to get Lao Liang's 200 yuan out?"
”Director Liang immediately said, "You two are deputy chief physicians, and you two are embarrassed." ”"I'm embarrassed."
Director Bian shrank back: "Lao Xu, let's not join in the fun."
If you don't get that money, it's a shame. ”"You are growing other people's ambition and destroying your own prestige."
Director Xu teased him: "The more you live, the more useless you are." ”"How old am I, and I'm still thinking about it!
It doesn't matter what ambition or majesty you have.It's time to get to work. ”Director Bian greeted Xiao Chen, the hospitalized officer: "Did you give me the preoperative medication?"
Quickly pushed the patient away. ”Seeing that he refused to make fun of himself and lost his mood to laugh, Director Xu told Qin Zhang to hurry up to check the implementation of the preoperative doctor's instructions and push the patient to the operating room as soon as possible.Otherwise, you will have to wait in line for the elevator for a while.Today is the day of surgery in general surgery, and before nine o'clock, the entire general surgery department has run out of doctors.
*The 11th floor is a ward round day this morning.As in the morning of every Monday, it is close to noon when the entire ward is checked.Chen Wenqiang went to the director's office on the twelfth floor, and just grabbed the phone and wanted to dial it, Director Liang looked for it excitedly."
Old Chen.Xie Xun told me that he would arrange laparoscopic surgery this week, and we would go and see it together when the time came. ”Director Liang just got off the operating table and came over."
Which day?"
Chen Wenqiang was very interested, but he did not forget his work arrangement."
Two, three, four, five, I have surgery.Wednesday afternoons for political studies and Thursday afternoons for outpatient visits. ”"Look you're busy.Not so fast.The surgery order has not yet been ordered. ”"How's Saturday morning?""
Okay, I'll tell him.""
You told him that this first operation is not urgent, and you must pick a suitable indication and hit it out."
Chen Wenqiang looked at Director Liang's eyes, and said this sentence clearly and slowly: "You have to help him take care of it." ”Director Liang understood what he meant, and told Chen Wenqiang about Xie Xun's work plan with a smile.Then he comforted him and said: "You can put your heart back in your stomach, Xie Xun is not a reckless person, you see how careful he is arranged."
It's just a simple pathology, and it's okay to take it after it's done. ”"Pediatric patients, what if you can't find lymph nodes?""
Rub it along the mesentery.""
How can it be as intuitive as we see with the naked eye."
Only himself and Lao Liang, Chen Wenqiang's worries were no longer hidden."
Then you don't have to be too pessimistic.If necessary, the procedure was immediately switched to the usual procedure, and the family had agreed. ”"Well, that's pretty much it, both hands are ready."
Look at you, how dare you get less and less.Is this still the Chen Wenqiang I know who hit the south wall and didn't look back?!
”"How dare I be careless."
Chen Wenqiang rubbed his eyebrows and said: "In the past, Fei Baode was not able to make surgery bigger and the provincial hospital bigger, but now that I think about it, the stalls of the provincial hospital are getting bigger and bigger, and I really don't dare to have any accidents to maintain the current stable situation." ”"Then you don't have to.Besides, let's go over and give him a platform.The weight of this book is enough to put it in the province and put it in the affiliated hospital of the Medical University.What else are you worried about?
”"It's not all worry, either.Lao Liang, let me tell you my plan: Xie Xun's laparoscope can start and stand still, so I will send Pan Zhi to learn thoracoscopy and Su Ying to learn hysteroscopy.When there is money again, next year the thoracoscopy will be purchased, and the cranial endoscope and hysteroscopy will also be bought. ”"Where's the money?""
If the hospital doesn't have money, the big guy will make up for it.You see, with CT and MRI, cerebrovascular diseases that were not possible before can also be obtained through MRI angiography, and then the best surgical plan can be designed.I think that whichever hospital is ahead of the curve in terms of equipment, that hospital will be one step ahead of the provincial capital. ”※※※※※※※※※※※※※※※※※※※※ the characteristics of the era, the prelude to fundraising () is a bit far away