Chapter 914: Physical Symptoms Did Not Match
“Cui Lao is boiling a frog in warm water. He first looks for you to see the patient. Then, if you can’t save your face, he will give you benefits so that you can work in the Emergency Department,” Su Yun said.
Zheng Ren had also thought of this little idea. However, with the n.o.bel Prize project in hand, who would work in the Emergency Department, which was busy, tiring, and did not earn any money.
Zheng Ren only smiled and did not answer Su Yun’s question.
Both of them knew in their hearts that Old Chief Physician Pan was also unwilling to give up.
There were no newcomers in the Emergency Department, but they had to exist. They were only trying their best to burn what little life they had left to barely hold on.
After putting in all their effort, they could only die in the end.
But was the strength of an individual useful?
It was completely useless. Even though Cui Lao was in his 70s or 80s and had insisted on lecturing all over the country, he had gained very little.
However, raising the treatment of Emergency Department doctors and other issues would cause a chain reaction. This kind of thing was not something that an academician from an engineering inst.i.tute could decide.
It sounded high and mighty for an academician, but it was just a signboard. If it was useful, it was useful. If it was useless, then it was really useless.
Let the hospital and society adjust themselves? How much would it have to pay before it could be improved?
A while ago, the matter of beating and scolding the bus driver was taken seriously. Now, the person who beat and scolded the bus driver had already started been judged and sentenced for endangering public safety.
But when it came to medical treatment, the situation was even more complicated.
“Forget it. I’m just a junior doctor.” Zheng Ren smiled sheepishly.
Along the way to the Emergency Department, the Chief Resident, Zhou Litao, was already waiting in the corridor.
He had a short stature, his face was full of pockmarks, and his tanned face was far different from Su Yun’s, forming a sharp contrast.
“Boss Zheng, there’s a patient whose symptoms don’t match. Cui Lao happened to be out today, so he asked you to take a look.” Zhou Litao went up to him and said very politely.
“I don’t dare, I don’t dare.” Zheng Ren immediately replied, “Cui Lao’s wrong, I don’t dare to accept it.”
Zhou Litao smiled and said a few polite words, then brought Zheng Ren to Cui Lao’s consultation room.
After entering the door, Zheng Ren saw an old man with a white beard and hair sitting in the consultation room, asking about the patient.
“Cui Lao, h.e.l.lo.” Zheng Ren bowed deeply and first expressed his respect.
“Well, Little Zheng, come and take a look at this patient.” Cui Lao nodded. “Litao, tell Little Zheng about the patient’s condition.”
Zhou Litao then said, “The patient came to our hospital once for treatment because of intermittent upper abdominal pain for one day accompanied by nausea. The patient had a history of smoking for more than 30 years and hypertension for 12 years. He was given Luohuoxi treatment and his blood pressure was well controlled.
“There was no swelling in the patient’s abdomen, no bowel type and peristaltic wave, no skin scar or abdominal varicose veins.
“There was deep tenderness in the upper abdomen, no rebound tenderness and muscle guarding. The liver and spleen did not reach below the ribs. Murphy’s sign was negative and did not touch the obvious ma.s.s The percussion of the abdomen was drum-like. There was no percussion pain in the liver and spleen, no percussion pain in the kidney and kidney regions. The movement of the voiced sound was negative. The sound of the bowel was about three times per minute. There was no abnormal vascular murmur.
“The ultrasound reported that the patient has mild fatty liver and was negative. However, the patient complained of intense pain. Cui Lao guessed that it might be a dissection of the aorta or mesenteric artery. He was preparing to do 64 rows of CTA in the Emergency Department.”
Zheng Ren understood that there was still a similar patient who was waiting for a call, so he asked him to take a look during the interval.
This must be Cui Lao’s intention.
As he listened to Zhou Litao’s description of the patient’s medical history and looked at the patient, Zheng Ren saw that the System panel was bright red.
Isolated superior mesenteric artery dissection type II B, hypertension, and other diagnoses appeared before his eyes.
‘It’s quite a troublesome disease,’ Zheng Ren thought to himself.
Vascular dissection was very troublesome. From Cui Heming’s aortic dissection to this patient in front of him, if the standard of the hospital was lower, they would be admitted to the hospital or the outpatient clinic for observation of the abdominal pain.
If the diagnosis was not confirmed in time, if the dissection ruptured, the patient would be dead.
Especially in small and medium-sized hospitals, when encountering this kind of disease, the misdiagnosis rate was quite high.
As for Cui Lao, he had basically confirmed the diagnosis of the disease with just a physical examination. This standard and experience was not to be bragged about.
Zheng Ren nodded and began the physical examination.
Just as Zhou Litao said, the patient’s abdominal tenderness was not obvious. There was a little bit of deep tenderness, but it was not the main point.
The tenderness was very mild, but the patient’s face was pale and he was sweating profusely from the pain. This was a case of severe self-reported symptoms.
The so-called physical symptoms did not match, and this was the case.
After the physical examination, Zheng Ren looked at the emergency b-scan and laboratory report again. The patient could be said to be very healthy. Other than the intense pain, there were very few positive indicators for other examinations.
“Cui Lao, I think the possibility of a mesenteric artery dissection is higher,” Zheng Ren said. “You can choose to do 64 rows of CTA examination, or after the interventional radiography is confirmed and surgery is performed.”
“What about conservative treatment?”
“Well… Conservative treatment depends on the patient’s family’s opinion. I come from a surgical background, so I don’t really approve of conservative treatment. This is because whether it’s an isolated mesenteric artery dissection or a concurrent aortic dissection, once conservative treatment is performed, if the dissection suddenly ruptures at night, it will cause more damage to the patient,” Zheng Ren said.
He also knew that his att.i.tude was the more radical type.
Surgeons were usually more radical. Why would they leave a problem that could be solved with surgery?
Of course, the recovery rate of an isolated superior mesenteric artery dissection with conservative treatment was also very high. This was something Zheng Ren knew.
However, Cui Lao only asked for his opinion, so Zheng Ren also voiced out his innermost thoughts.
Cui Lao looked at Zheng Ren and said calmly, “Can you perform the patient’s surgery?”
“I have no problem matching it with the General Surgery Department,” Zheng Ren said. “I will try my best to minimize the patient’s injury.”
“Okay. You and Litao will take the patient to the examination room. Let me know when the examination is done.” After Cui Lao said that, he waved his hand and signaled them to push the patient to do 64 rows of CTA.
The old man was full of vigor. Zheng Ren recalled when Cui Lao pointed at Chief Kong’s nose yesterday. Then, he smiled bitterly.
It was impossible for people who worked in the Emergency Department to not have a quick temper. Even if they were slow-tempered, they would soon be worn out in the Emergency Department.
Cui Lao, who was standing in front of him, was very kind. He reminded the patient to pay attention to his blood pressure. He also personally checked the concentration and speed of the antihypertensive drugs that were being pumped in a small amount before he let Zheng Ren and the others push the patient away.
“Boss Zheng, do you think the patient has an isolated dissection or a concurrent aortic dissection?” Zhou Litao asked softly as they walked.
The patient’s family members were all around them. Without objective evidence, everything was just an a.s.sumption. If they could keep it down, they would keep it down.
“From the patient’s physical signs, it seems to be an isolated dissection,” Zheng Ren replied. “The pain points are wandering. It doesn’t seem like the pain points of the aortic dissection are fixed with radiation pain.”
This was a reverse deduction, based on the System panel.
Zheng Ren felt that it was very normal. The physical examination matched the diagnosis on the System panel. He reckoned that the System was right this time.
He felt that it was very normal, but in the ears of others, it was another matter.