Doctor of Healing

"Second, viral myocarditis..."

"Third, spontaneous pneumothorax..."

"Fourth, acute pancreatitis..."

"Fifth, myocardial infarction..."

Meng Qingfei "talked to himself", his right thumb kept pointing at the other fingers, as if he made a differential diagnosis every time he clicked.

But he never found the right answer.

Soon, the emergency serum troponin was reported negative, and viral myocarditis and acute myocardial infarction could be ruled out temporarily.

Now Meng Qingfei was even more puzzled.

Ji Xiang also felt that the patient was weird, so he went to the operating room of the system attentively.

Meng Qingfei's lips had already started to move, he muttered, concentrating on the differential diagnosis.

His level is not bad. Generally speaking, the patients in the emergency department are relatively simple, unlike the patient in front of him who doesn't even know who to consult.

"Mr. Meng, I want to see the patient." Ji Xiang said suddenly.

"I finished the investigation just now." Meng Qingfei replied casually, "What do you think?"

"During your physical examination just now, the armpits of the patient's upper limbs were not visible."

"Oh, indeed, but not all of them..." Meng Qingfei spent [-]% of his time making differential diagnoses, and originally wanted to casually tell Ji Xiang that not all places should be checked.

It’s like having chest pain and you go to see the lower body, and you have to be beaten to death by the patient or the patient’s family.

Even if it is not beaten to death, if it is posted on the self-media by a good-for-nothing, there is a high probability that it will be a social death.

However, what Ji Xiang said was only the beginning, and Meng Qingfei thought of a lot.

"You mean there might be a problem with the mediastinum?!"

Ji Xiang's words opened Meng Qingfei's mind.

"Other places are fine for the time being, only the armpits are missing." Ji Xiang replied frankly.

Meng Qingfei's eyes lit up all of a sudden, and he strode out to the emergency room, opened the patient's clothes, and told the patient to raise his arms.

When the hand touched the armpit, a slight snow-holding sensation was transmitted. Meng Qingfei checked carefully and found that there was indeed an atypical snow-holding sensation.

"Damn it, it's really not about internal medicine, go get an emergency CT scan." Meng Qingfei hurriedly said to the nurse, "There is something wrong with the patient's condition, I will send the patient for an examination, and some patients will ask Old Li of the internal medicine department to take a look for me first! "

After finishing speaking, he hurriedly went out to make an order, then remembered something, turned around and said, "Call Pu Chest and ask them to prepare a bed."

Ji Xiang really admired Meng Qingfei.

Chest pain, armpits are not mandatory, and spontaneous pneumomediastinum is extremely rare.

Mentioned by himself, Meng Qingfei listened to the goodness of others.

He is really flowing, like the water of the Yellow River, overturning all his previous assumptions.

His unobtrusive thinking is impressive, and his brains are extremely fast, only a little slower than the system NPC.

"Xiaoji, stay here. If there are any patients, please take a look at the internal medicine doctor first. Don't let them go, wait until I come back to see." Meng Qingfei hurriedly finished, pushing the patient all the way.

The oxygen bag on the flat car almost fell off, and Meng Qingfei disappeared around the corner with the oxygen bag under his arm.

"Xiao Meng's diagnosis is not bad, but he is a little impatient." The physician had already been called up, and stood in the corridor, seeing Meng Qingfei disappearing, he gave a soft comment.

Ji Xiang felt a little regretful, he also wanted to know the patient's final diagnosis, but Ji Xiang didn't say no, but stayed according to Meng Qingfei's wishes.

"You are Ji Xiang, right? I heard that you broke the record for so many years in the martial arts competition." Dr. Li from the internal medicine department looked at Ji Xiang and asked.

"Coincidentally." Ji Xiang smiled.

"Little Monte likes you. By the way, it is said that you were the one who diagnosed the tetanus patient a while ago?"

"happen."

Dr. Li from the Department of Internal Medicine took a deep look at Ji Xiang. One thing can happen by chance, and if one happens one after another, there must be something wrong.

"What did the patient diagnose just now?" Doctor Li asked.

"I don't know either. I just said something casually, and it seems that Mr. Meng has a diagnosis." Ji Xiang pushed it all the way, no matter what others asked him, he said he didn't know.

"This is our internal medicine problem, but... alas." Dr. Li sighed, and suddenly smiled again, "We all know that Xiao Meng's diagnosis is good, and patients and nurses from other hospitals come to see Xiao Meng directly. That's okay, we It's peace of mind."

"Xiaomeng looks like he's doing nothing, but he's actually pretty good. You're also pretty good. There are so many doctors in the emergency department, so you've taken a fancy to Xiaomeng. I think you always follow him on duty."

"Ms. Meng's words are interesting. When I first came to the regular training, Mr. Meng told me that the bathroom in the emergency department had been opened, and patients with urinary stones were willing to go to the toilet here."

Ji Xiang laughed.

Chapter 302 Make a bet

"Xiao Ji, doctor." The physician called Ji Xiang with a strong sense of frustration, "Dr. Meng is so anxious, what disease do you think?"

"There is subcutaneous emphysema under the armpit, which is considered to be pneumomediastinum."

"Ephysema of the mediastinum?!" Dr. Li from the Department of Internal Medicine burst out laughing, with a slight sarcasm, "Young man, did you see that the patient had trauma?"

"No."

"Without trauma, you diagnose spontaneous pneumomediastinum? Tell me, where did it come from?" Internal Medicine Doctor Li sneered.

In his opinion, Ji Xiang is the kind of young man who knows a little bit of clinical knowledge, but half understands it, and just speaks out any weird diagnosis.

Are ignorant people fearless? After learning a little bit of superficiality, there is no way to talk about it.

"Esophagus." Ji Xiang said with certainty.

He was educated by the system NPC in the system operating room, and wanted to come out and say something.But Meng Qingfei got it right, went to touch it and asked Pu Chest to prepare the hospital bed.

It's not good to be too smart, Ji Xiang wanted to say a lot but didn't know where to start.

Ji Xiang didn't want to show off, but wanted to "review".

"Spontaneous rupture of the esophagus? Hahaha, have you ever seen it? Or did your teacher tell you about it when you were in school?" Dr. Li from the Department of Internal Medicine laughed like a goose.

"Spontaneous esophageal rupture refers to the full-thickness rupture of the esophageal wall caused by non-traumatic conditions. Due to the non-specific clinical manifestations, it is often misdiagnosed as angina pectoris, acute myocardial infarction, aortic dissection, and acute pancreatitis."

"..." Internal Medicine Doctor Li himself didn't know how long he had heard such professional words, and now these words came out of a student's mouth, it was extremely weird.

He wanted to refute, but what Jixiang said was right, and he didn't know where to start.

"As for the cause, it can't be broken just like that. You must know that the esophagus is elastic, and it is difficult to see spontaneous rupture. At least I have been practicing medicine for so many years, and I have hardly seen it." After hesitating, Dr. Li asked .

"The etiology is mainly seen in severe vomiting after drinking alcohol and after a full meal. The pressure difference between the inside and outside of the esophagus wall is caused by the negative pressure in the chest cavity. Since the esophagus is not protected by a serosa layer, especially the smooth muscle in the lower segment of the esophageal wall is relatively weak, and the lower segment is more likely to be torn. crack."

As Ji Xiang talked, he looked at Dr. Li suspiciously.

"Ms. Li, the cause of the disease is very clear, there should be no doubt."

"..." Dr. Li wanted to scold her.

Ji Xiang couldn't figure it out either, since he said it so clearly, why didn't Dr. Li understand it?

"The main manifestations are: chest pain after severe vomiting, chest tightness, dyspnea, mediastinal emphysema, subcutaneous emphysema, etc. Vomiting → chest pain → subcutaneous emphysema is a typical triad."

"The patient had a slight gripping sensation under the armpits. I think Mr. Meng has already made a diagnosis, and I just waited for a CT to see that the mediastinal pneumatosis was directly pushed to the general chest."

"Cut." Internal Medicine Dr. Li was not frightened by Ji Xiang, he cut, "It's such a coincidence. Almost every day in our internal medicine department, people who drink a lot of alcohol and take medicine come to the emergency department for gastric lavage. Do you know how often we see you?" A case of ruptured esophagus?"

Ji Xiang could hear the displeasure in Dr. Li's words, so he didn't argue with him, but just smiled.

After repeating what the system NPC said, Ji Xiang had a better understanding of the disease.

"I haven't seen a single case in a year!" Dr. Li from the internal medicine department raised his voice and said, "I poured water, vomited and vomited, and nothing happened under such a great pressure. You young man, you feel clinical after learning something from books. Common, not familiar."

"The symptoms are all consistent, Mr. Li."

"Let's make a bet." Internal Medicine Doctor Li smiled, "If your diagnosis is correct, I will take care of all the minor illnesses that come from surgery in the middle of the night."

"If your diagnosis is wrong, follow me on three shifts."

Doctor Li from the Department of Internal Medicine envied Meng Qingfei for having Ji Xiang to help him.

In the opinion of Dr. Li of Internal Medicine, he is sure to win.

"Okay." Ji Xiang said with a smile, "Ms. Li, the surgeon will deal with you..."

"In fact, many treatments in internal medicine and surgery are similar." Dr. Li from the internal medicine department said disdainfully, "I will definitely not reach out for major rescue, but I deal with patients with appendicitis and cholecystitis by myself, without seeking surgical consultation.

In the middle of the night, can someone come to remove the stitches?Besides, it is difficult to remove the surgical stitches. "

As he said that, he laughed, "Young man, today I will teach you a lesson. In fact, the things written in books are rarely encountered in clinical practice. We commonly see only about 2% of the diseases in books."

Ji Xiang didn't speak. Seeing Ji Xiang's silence, Dr. Li thought he was right. He had already won the young people here, and began to talk to Ji Xiang about common clinical content.

After half an hour, Meng Qingfei came back with a flat cart.

"Xiao Meng, where's the patient?" Doctor Li asked.

"I sent it to the general chest." Meng Qingfei replied.

Dr. Li from the Department of Internal Medicine was startled, "What disease is the diagnosis?"

"Spontaneous esophagus rupture, pneumomediastinum." Meng Qingfei said, "The patient drank a bit of alcohol at noon, and vomited twice, which ruptured the esophagus. The doctors in the lower-level hospital fooled around and insisted that it was acute myocarditis."

"..." Internal Medicine Doctor Li was stunned, unexpectedly meeting a patient with a spontaneous rupture of the esophagus.

"Finish, let's call it a day!" Meng Qingfei went to wash his hands, and when he came out, he wiped his white clothes' butt vigorously.

His white clothes were newly changed, and the rest of the place was very clean, except that there were two black marks on the buttocks, which were quite eye-catching.

Ji Xiang also didn't know why Meng Qingfei always washed his hands on his white clothes and was always in the same place, even though he washed his hands frequently and acted very clean.

He didn't tease Dr. Li, but said respectfully, "Mr. Meng, then I'll go back and rest."

"Go ahead. You still have work tomorrow. I'll go home and rest tomorrow after get off work. It's different." Meng Qingfei replied casually.

"Xiao Meng, go to sleep. I will take care of the emergency department in the second half of the night." Internal Medicine Doctor Li said helplessly.

"Oh, Lao Li, why are you so merciful today?" Meng Qingfei asked strangely.

Although Dr. Li did not say anything, it is a good thing for emergency doctors to be able to lie down and sleep peacefully for an hour or two without doing sit-ups when on duty.

Ji Xiang waved goodbye and walked out of the emergency department.

In the dead of night, there were fewer cars parked in the parking lot of the Second Affiliated Hospital, and the night wind was slightly cold.

Ji Xiang greeted the strong man in the dark, and was not in a hurry to go home, but touched his pocket.

With a deflated pocket, Ji Xiang scratched his head.

Always going to the operating room of the system, always chatting with Colonel Wang and the others, Ji Xiang is used to smoking a cigarette while thinking.

Find time to buy a box.

Although Jixiang knew that this habit was not good, he had already been led astray unconsciously.

Chapter 303 The Unpromising Old Attendant

Zhao Zhe rushed back to Yuanliao city excitedly.

"Old Zhao, why are you back? Didn't you go to further study? Didn't you want to drive you back?"

Seeing Zhao Zhe come back, a young doctor asked with a joke in surprise.

"Hey." Zhao Zhe's waist was straighter than usual, but he didn't explain, just smiled.

The messy hair was shining, and the whole figure seemed to be ten years younger.

"Huh?" The young doctor found something different, and he teased, "It's different to go to the provincial capital for further study. I said, Lao Zhao, how old are you, and finding someone to marry is a serious matter."

"No hurry, no hurry." Zhao Zhe said, "Where's the director?"

"The office." The young doctor jokingly said, "Old Zhao, the director is very upset about your advanced studies. Don't make trouble. I said I won't let you go. There are few people in the department and there are few people to work. You Let’s talk about you, let’s see how many little shoes the director has to wear for you when you come back.”

"Busy, busy." Zhao Zhe bowed habitually, showing great respect even to a small doctor, and turned to look for the director.

"There seems to be something wrong with Lao Zhao. Could it be that he found a wife in the provincial capital?" The little doctor said to the people around him.

"Hell, he's the only one in the department who can toss about and daydream every day." The other person said contemptuously, "He's engaged in scientific research and thinking about new techniques, and he's got a practice certificate three times. A person like him must be a bamboo It's an empty basket."

"We are ordinary people. When we were young, we felt that we were the most powerful. We must do something earth-shattering. But this is a dream. I woke up in my 20s, and Lao Zhao was still dreaming in his 40s, tsk. "

"That's right, who can fall in love with a girl from the provincial capital? The uncle they say is a man with a successful career, mature and steady. Look at Lao Zhao, except for his age, he doesn't match him at all."