bookpower Chapter 257
Chapter 257
After Lin Feng coordinated the relationship with the urology department,
Afternoon
Continue to sit.
First patient.
This is an old man, in his 70s.
Covering his chest, his feet trembling.
His son, who is in his 40s, helped him into the consultation room.
"Old man, come, sit down first..."
Lin Feng helped the old man and sat down.
"Thank you doctor..."
"Old man, where are you unwell?"
"I have chest pain, I've been going on for days, and now I can't stay up a bit..."
"Do you have a medical history?"
"What?"
"I mean, did you have any illness before?"
"Yes, chest pain, 10 years..."
"??? 10 years!"
After Lin Feng's detailed consultation,
Patient complaints:
Patient Zhang Tieshan, 72 years old,
Paroxysmal chest pain for 10 years, aggravated for 5 days. 10 years ago, the patient had chest pain without obvious cause, which was left chest pain, which was more severe, accompanied by sweating, and did not radiate elsewhere.
No nausea, vomiting, no wheezing, no blackness, no convulsions, rest or take "10 quick relief pills" for about 20-30 minutes can be relieved.
Occasional seizures, 1-2 times a year, without seeing a doctor.
Before 1 month, the patient visited the outpatient department of Harmony Hospital and cardiology, and the doctor considered "coronary heart disease" and gave conventional drug treatment.
5 days ago, the patient had chest pain again without obvious triggers, the nature was the same as before, accompanied by sweating, mostly appeared at about 21:00, including "10 quick-acting heart saving pills" for about 1 hour to be relieved. For 3 consecutive days, 1 episode per day.
Lin Feng fell silent.
The outpatient came over...
The son had a fawning smile at this time: "Doctor Lin, the expert number is quite difficult to hang up now, I heard that you are very good at medical skills here, so I brought my father directly here." "
Lin Feng nodded.
Obviously, this son did not believe the original harmonious doctor who diagnosed the old man.
If "chest pain" is the main symptom,
According to the process, first of all, it is necessary to exclude four life-threatening diseases such as "acute coronary syndrome", "acute pulmonary embolism", "acute aortic dissection", and "pneumothorax"!
Because of these four diseases, people can die at any time!
Therefore, they need to be excluded first.
And a month ago,
The outpatient clinic gave the patient a detailed cardiac ultrasound and electrocardiogram.
Lin Feng looked at it carefully,
Then with a stethoscope, I listened to the patient's chest sound.
Still no problem!
Other words
These four major diseases can be ruled out!
Lin Feng breathed a sigh of relief.
"Here, do an electrocardiogram..."
Lin Feng asked nurse Xiao Ai to connect the ECG to the old man.
10 minutes later...
A long ECG has been produced.
The result shows: Normal!
It's no different from the electrocardiogram a month ago.
Lin Feng was surprised.
Isn't it caused by heart disease?
The four major diseases were ruled out,
Then you can carry out the next round of investigation: diagnose the diseases manifested by chest pain one by one according to the circulatory system, digestive system, respiratory system, motor system...
Lin Feng continued to ask carefully: "Just now, you said that this chest pain mostly appears around 21:00... Every day is... Between 20:00-21:00, did you ever do anything?
The son did not hesitate to say: "20:00-21:00... Eat, watch TV, eat fruit..."
Lin Feng suddenly lifted his spirits
dine
That is digestion, and it is very likely that there is a problem with the digestive system.
Lin Feng: "What time do you eat?"
The son recalled: "It's hard to say, but it's around eight-thirty, because I came home late..."
Lin Feng continued to ask the old man: "When eating, do you feel any discomfort?"
The old man nodded: "There is a little, when swallowing, I don't feel very comfortable, and after eating, it's easy to burp up..."
burp,
Hiccups and burps are one of the common symptoms of various digestive tract diseases.
Lin Feng: "Is there anything else uncomfortable? When eating, and after eating..."
The old man thought for a while: "When eating relatively hard and dry meals, it will feel a little difficult to swallow, but when drinking porridge, there is no problem..."
Lin Feng nodded.
The growing suspicion in my heart is a problem of the digestive tract.
Lin Feng suddenly thought of a question.
"Wait, I don't seem to see chest CT, didn't you do CT?"
The old man: "I didn't do it, there were too many inspections, and it cost a lot of money, so I didn't do it at that time." "
Lin Feng sweated furiously.
"Okay, go for a CT, I'll call the CT room for this painful location... After the CT, come back and see..."
Lin Feng brushes brushes, bills...
"Well, thank you doctor!"
The son helped the old man to the CT room.
...
After 2 hours,
The old man came back with the Ct results.
Examination results: cardia position, manifested as a lump of soft tissue, cauliflower-shaped, lobulated...
The murderer has appeared!
"Cardia cancer"!!
Cardia: Located at the junction of the esophagus and stomach, it is part of the digestive tract. It has a muscle contraction function to prevent food and stomach acid from entering the stomach from flowing back into the esophagus.
......
"Old man, the results came out, not a heart problem, but spray door cancer ... Your chest pain is caused by spray door cancer. "
"Huh? Spray door cancer?"
The old man and the son don't know whether to be happy or sad.
The heart is fine, that's a great thing.
As a result, there was a cancer!
"Wait, then do "tumor five" and "esophageal barium meal angiography", so that you can get more accurate results..."
"Okay, thank you Dr. Lin!"
The father and son soon took Lin Feng's checklist and went to check.
Soon after,
The results come out.
It is indeed "cardia cancer".
Then the next step is to pay, admit, try conservative treatment, chemotherapy.
In the end, Lin Feng did not accept the patient, but sent the patient to the gastrointestinal surgery.
......
So here's the problem.
The original Harmony Heart Doctor, if he did not find the reason, does it mean that his level is poor?
No!
It's just that during the consultation stage, something went wrong.
Patients do not understand the disease, so the description is sometimes unclear or even wrong, which can be misleading to the doctor.
And the doctor's consultation, like solving a case, a series of seemingly unimportant symptoms during the consultation may be the 'truth'.
For example, this time "dysphagia, hiccups", cardiologists did not notice.
After all, he is a cardiologist specialist, not a general practitioner ...
......
Inpatient building.
The attending doctor, Ding Guan, was on duty in the ward today, he went downstairs to get something, and then continued to return to the ward on duty.
In the elevator,
"Huh..."
He saw a familiar patient, Zhang Tieshan, an old man who had just been diagnosed by Lin Feng.
This patient is very special, when he said chest pain, he was shocked, and after investigation, it was ordinary coronary heart disease.
At this time, Zhang Tieshan completed the admission procedures and prepared to go to the digestive surgery ward to check in.
"Old man, are you admitted to the hospital?"
Ding Guan was curious, why was he suddenly hospitalized, obviously there is no problem with the heart, just ordinary coronary heart disease, just take medicine?
Zhang Tieshan saw Ding Guan and snorted coldly.
Ding Guan: "???"
Confused.
How can I say that I helped him diagnose the disease, right?
The son apologized, "I'm sorry doctor. "
Dr. Ding Guan was curious: "What's wrong, your dad?"
The son said: "That's right, in the past five days, my father was in severe pain, and then just now we saw Dr. Lin in the emergency department, it was cardia cancer, not coronary heart disease." "
"What?"
"It's not coronary heart disease? It's cardia cancer?"
"Am I misdiagnosed?"
Ding Guan was surprised!
At this moment, his face couldn't help but blush.
It's so embarrassing!
Ding dong......
At this time, the 6th floor of the ward floor of the cardiology department arrived.
"I'm sorry..."
Ding Guan quickly stepped out of the elevator, and his figure was a little embarrassed.
Although cardia cancer is not a specialty he is good at, and he cannot be blamed for this misdiagnosis, he is still a little weak-hearted.
Go first!
......
At this point,
The results of the driver's patient (anterior L gland tumor) have been improved before surgery, and the results have come out.
Bad news!
The tumor is getting bigger!
A third bigger!
"Dr. Lin... This..."
When the driver heard the news, he almost cried!
Just because I wanted to find an expert professor to perform the operation, I forced the registration to cancel 7 days.
Now it's okay, not only has it hurt for 7 more days, but the tumor has also become bigger!
The tumor becomes larger, which means that the meat to be cut off by the fine naan needs more!
That's the most important place for men!
After surgery, will it be abolished?
The driver cried to death!
Lin Feng didn't expect this, so he could only pat the driver's patient's shoulder and comfort him silently.
Miserable!
......
For the next three days, the storm was calm.
The driver patient completed enema cleaning, shaving and the like in accordance with the surgical requirements...
On the third day,
The driver patient, finally waited for the day of the operation.
These three days, like years!
He was really afraid that the tumor would become bigger again!!
......
urology,
"At 17:00 in the afternoon, Dr. Lin Feng did that operation, do you go to watch?"
"Go!"
"Of course, Dr. Lin is going to extend the evil hand to our department, how can we not go to see it?"
"Yes, we are going to criticize!" (righteous indignation serious face ·jpg)"
"Yes, let's criticize!"
Not far away,
Director Zhao's office, Director Zhao heard the discussion of the subordinates outside the door and smiled.
Then decided to see for myself.
See if Lin Feng is as strong as the legend!
......
Afternoon, 17:00
The patient is pushed into the operating room...
Surgery: posterior pubic anterior L gland naanectomy
Main knife: Lin Feng
· One assistant and two assistants: two attending doctors of urology surgery (upgraded, previously only Gui Pei was willing to be Lin Feng's assistant, and now the attending doctor takes the initiative to come)
Onlookers: Director Zhao Yingjun, a total of 25 urological doctors...
"Epidural block anesthesia!"
Disinfect......
Spread the towel...
"Air bag catheter!"
。