Since 1981 Health School

After discussing for a long time, everyone turned their attention to Chen Qi, wanting to hear the opinions of the dean.

Bianmeng has a more jumpy temper and is Chen Qi's confidant, so he was the first to ask:

"Tou Chen, what do you think is the patient's condition?"

Chen Qi stood in front of several X-rays lined up in a row and pondered for a while, then said something that surprised everyone:

"I think it's an inflammation."

"what???"

Everyone in the office was surprised. If Chen Qi hadn't been the dean, a lot of people would have booed him.

Are you kidding about inflammation, is there inflammation that lasts for 3 years?

how is this possible?

The surgical director couldn't bear it any longer, and asked:

"If it is inflammation, repeated anti-infection treatment for 2 weeks, and the best antibacterial drug in the provincial capital, how could it not be absorbed at all?"

"That's right, if it's inflammation, why hasn't the patient's lung shadow changed much in the past three years?"

"Yeah, look at this video, the boundary of this shadow is not very clear, if it is inflammation, the edge should be very clear."

With Director Bian at the beginning, everyone began to refute in a hurry. Anyway, it was you, Chen Qi, who said it. Don’t be afraid to say the wrong thing during the discussion.

Only Yan Shifan continued to look back at the film thoughtfully.

Seeing that everyone didn't believe it, Chen Qi patiently explained:

"Then let's take stock. First of all, everyone thinks that the lung mass and lung abscess can be ruled out. The diagnosis of tuberculosis is generally recognized as the most suitable, but anti-tuberculosis treatment is ineffective, so only inflammation is the most likely, right? "

Just as everyone was about to say something, Director Bian made a quiet movement.

"However, inflammation is the most unlikely diagnosis that everyone thinks, because the time is wrong, it has been 3 years. And because anti-infection treatment has already been taken, the effect is also not great, so everyone dare not even think about this possibility, but everyone Thinking about it in reverse, if you don’t look at the time, just look at the film and the clinical symptoms, does it look like inflammation?”

Zhang Xingshun interjected at this time: "But looking at this film and clinical symptoms, it is similar to tuberculosis."

hush~~~~

Everyone in the office laughed wildly, booing Chen Qi one after another.

Chen Qi didn't care too much, and was sincerely happy that everyone had such a relaxed atmosphere that didn't worship authority.

"I said it was inflammation. The first thing everyone thinks of is lung infection, or pneumonia, right?"

Everyone nodded, how much more does the lung infection focus mean?

"Okay, let's review the X-rays of pneumonia first. The first and most common one is Streptococcus pneumoniae pneumonia. Patients may show thickened lung markings in the early stage. As the disease progresses, realistic shadows may appear. Bar?

Attention everyone, bronchial airway signs can be seen in the shadow of this consolidation. In some patients, a small amount of pleural effusion may occur due to the inflammation spreading to the pleura, causing a small amount of pleural effusion. Have you seen this patient? "

Everyone shook their heads in unison.

What Chen Qi talked about was internal medicine, which was relatively unfamiliar to surgeons, so everyone listened very carefully.

"Then let's look at another very common staphylococcal pneumonia in clinical practice, which is acute suppurative lung inflammation caused by the invasion of staphylococcus. X-ray examination can show consolidation of lung segments and lobes, or Lobular infiltrates with single or multiple fluid-air sacs.

Pay attention, everyone has seen the film of the liquid air sac cavity, and the patient does not have this characteristic manifestation, so staphylococcal pneumonia can also be ruled out, no problem, right?

There are other types of pneumonia, such as mycoplasma pneumonia, which can be manifested as various forms of infiltrates, which are segmentally distributed, mostly in the lower lobe of the lung, and sometimes extend outward from the hilum.

If it is pneumonia caused by viral infection, the lungs may present ground-glass shadows, which may manifest as both lungs. In addition, patients with novel coronavirus pneumonia may also have patchy shadows, which are mainly distributed outside the lungs, and it is very easy to develop into white lungs..."

Director Bian suddenly raised his hand and interrupted:

"Wait, I know other types of pneumonia, what is the new type of coronavirus pneumonia? Why haven't I heard of this disease?"

Chen Qi was taken aback, thinking badly, how could he have leaked the word about a kind of COVID-19 that was prevalent all over the world in his previous life.

"Uh, don't pay attention to these details. This is a type of pneumonia that Medicaid has just researched and invented. It has not been officially applied clinically. It's normal for you surgeons not to know. Cough cough, where did I go?"

Wang Yuelei reminded: "Tou Chen, you mentioned the different imaging manifestations of pneumonia."

"Oh yes, you see, we have eliminated one by one, is there no pneumonia that matches Jin Wenyao's film? So we can also rule out the diagnosis of pneumonia."

Now everyone is even more confused and confused, thinking that you say it is a lung infection and inflammation, and then say it is not pneumonia. What kind of trouble is this?

You are the dean, you have the final say?

Chen Qi became annoyed when he saw everyone's confused, questioning, and surprised eyes:

"It's really good to say that you are rough surgeons. Pneumonia is the only kind of inflammation in the lungs? Don't you consider the surrounding infection caused by a foreign body entering the lungs?"

Zhang Xingshun was dissatisfied:

"Tou Chen, you said it was a foreign body in the bronchi, which is common in clinical practice, but you want to talk about a foreign body in the lung, and it is still in the patient's right middle lung. How could there be a foreign body in this place? How did the foreign body fall into the right lung lobe? of?"

"that is!"

There was another burst of doubts from the crowd.

Why do you question it? It was precisely because they were doctors that they directly doubted Chen Qi's statement.

It is possible for foreign bodies, especially small ones, to be inhaled into the lungs through the mouth and trachea.

For example, some small beans such as rice grains, small plastic grains, small screws, or mung beans may pass through the trachea and enter the lungs.

Then there may be infection and inflammation in the lungs, or long-term irritating cough, fever, chest pain, and sometimes asthma-induced attacks.

In acute cases, dyspnea, cyanosis, etc. may occur, and in severe cases, it may lead to hypoxia and respiratory failure.

From this point of view, Jin Wenyao's symptoms are indeed very similar, and the symptoms can be explained.

However, the premise of this being inhaled into the lungs is a small foreign body, at most the size of a mung bean.

Some relatively large foreign bodies, such as coins and relatively large toys, usually cannot enter the lungs through the bronchi, and in most cases will enter the gastrointestinal tract through the throat and esophagus.

Let’s take a look at the shadow of Jin Wenyao’s right lung. It is an elliptical high-density shadow with the longest diameter reaching 10cm. Even if there is a foreign object in the shadow, it must be at least 6 or 7cm in size.

This is obviously illogical.

In this way, at the case discussion meeting, you can tell your opinion, and I can tell you my observation, and no one can convince anyone.

In this way, the problem has returned to the original point. If you cannot make a clear diagnosis, how can you treat the symptoms?

Modern medical treatment is based on evidence. You can put forward various hypotheses, but you must have auxiliary examinations to prove the correctness of your views.

Just like the police catching a thief, you know that the thief broke the law, and the police can't just convict you based on suspicion, so it is easy to catch and misjudge by mistake, leading to bad consequences (misdiagnosis in medicine)

So you have to find evidence to prove that the thief stole something, so that the thief can be convicted and the community can be restored to peace.

Thinking of this, Chen Qi was also helpless.

Jin Wenyao's illness was imminent, and they were not allowed to speculate like this.

According to Chen Qi's previous practice in Huangtan, that is, no matter what happens, he will be anesthetized first, and then he will have an incision, and see what's inside?

But it’s no longer possible. One is that he is the dean, and the dean will take the lead in standardizing diagnosis and treatment, and he can’t do whatever he wants like before.

The second family, the Jin family, is in bad shape, so keep an eye on it. If you are dissatisfied, you may have to walk through the gate of the county government again, so the advancement of the Fourth Hospital this year will not be mentioned.

What to do?

Chen Qi knocked on the table and came up with an idea. Anyway, the Jin family needed money for medical treatment, and it wasn't his Chen Qi's money, so why save for them?

So he looked at several subordinates in the office and had an idea in his mind:

"Yang Tihao, Zhang Xingshun, I entrust you two with a task. Send this Jin Wenyao to the First Affiliated Hospital of the Province. They have advanced equipment. Let them do a few tests for us. When the results come out, you will come back with the patient."

Chen Qi is now as close as a family to the Provincial First Affiliated Hospital, making the Fourth Provincial Affiliated Hospital like a branch of the Provincial First Affiliated Hospital, doing a few inspections, and it's not that they don't pay inspection fees.

"Okay Mr. Chen, what kind of tests are you doing?"

"CT, lung function, tumor indicators, a complete set of biochemical..."

Chen Qi counted with his fingers one by one. To say the same thing means that the Jin family's wallet will start to bleed again.

Although these inspections are very common in later generations, and the price is not expensive, but in the 1980s, these were all new gadgets, and the inspection fee was naturally not the whole family.

A CT scan alone costs several hundred yuan. These days, a farmer only earns a few hundred yuan a year? But there is no way, no matter how expensive it is, you have to do it, and you have to queue up to do it with the back door open.

Why do tens of millions of people in the province only have one CT? Why is the clinical value of CT so unique?

It is estimated that some people will question Chen Qi's medical ethics. Why do you have nothing to ask the Jin family to spend so much money? Are you not a miracle doctor? You know it by touching it twice.

Chen Qi will definitely pooh his face:

fine? It's okay, why did you come to the hospital? It's okay, you haven't been cured for 3 years? You need to make a clear diagnosis. These tests are mandatory. If you like to do it or not, don’t do it and get out.

When the Jin family heard that they were going to the provincial capital for a comprehensive inspection, the second daughter-in-law and the younger daughter-in-law twitched in distress, thinking that the family's brick and tile mansions would be lost.

So he looked at his old father pitifully.

In order to maintain the dignity of the Jin family in the village and the clan, the three sons did not separate their families, and the property was shared. The head of the family was Jin Kangsheng himself.

Luo Cuifeng was very happy, anyway, it wasn't her personal money that was spent, but the money in the family's account, which meant that their eldest family was taking advantage of other people's second and third bedrooms.

At this time, let alone go to the provincial capital, even if she went to the capital, she would not blink her eyes.

Jin Kangsheng is the head of the family, so he naturally knows his family's financial situation. A precious grandson has been sick for 3 years. After 3 years, it can only be described as the family has no money.

(Not to mention 1986, even if there is a three-year long-term illness in 2020, unless there is a mine at home, no one can stop it)

But the old man knew in his heart that this was also his grandson's last chance. After all, Chen Qi had cured almost 100% of the patients he had handled so far.

Thinking of this, Jin Kangsheng gritted his teeth:

"Boss, you go back to the village now and borrow money. Let's use our house as collateral. First borrow 2,000 yuan, oh no, 3,000 yuan. If you can't borrow that much, you can secretly withdraw it from the family's public account Part of it, don't let the villagers know."

The boss of the Jin family nodded and ran away.

The second daughter-in-law of the Jin family couldn't help it: "Father, we can't live without a house in the future?"

The youngest daughter-in-law's face was already full of frost, she didn't say a word, and she had already planned in her heart that the family would be divided sooner or later, the sooner the better, there is a saying that is good, the dog that bites does not bark...

Jin Kangsheng sighed, and comforted the two wives:

"Father, I can't help it. After all, Xiaoyao is the only boy in our family, but father promises that this is the last time. If Chen Qi is willing to take action, Xiaoyao's illness will definitely be cured, and there will be no need to spend such unreasonable money in the future." .”

The second daughter-in-law stomped her feet and left the ward with a straight face.

In this way, the Jin family prepared the money, and the doctors from the fourth hospital took Jin Wenyao to the provincial hospital for a walk.

Provincial Affiliated Hospital, Outpatient Building.

Director Xu Jinxing of the Department of Surgery saw all the patient's information, especially the X-rays several times, and then suspiciously drew Yang Tihao and Zhang Xingshun, two young doctors from the Fourth Hospital of Yuezhong Hospital who accompanied the patient, together.

"What are you, Dean Chen, doing? Such a simple tuberculosis patient has been sent up for CT?"

Yang Tihao and Zhang Xingshun looked at me and I looked at you, a little confused, why did the great expert and "teacher" in the provincial capital also diagnose tuberculosis?

Yang Tihao quickly reminded:

"But Director Xu, we have already treated for tuberculosis before, but it didn't work, so we ruled out tuberculosis when we discussed it in the hospital."

"You ruled out a diagnosis of tuberculosis?"

Director Xu was a little unconfident after being told, and went back to the film reader, looked through a few films carefully, and was full of question marks:

"No, whether it's the patient's clinical symptoms or the X-ray findings, do you think this thing looks like a tuberculosis? Well, it's a bit bigger, but it can't be ruled out that it's tuberculosis, right? By the way, you guys What does Dean Chen think?"

Yang Tihao replied with a little embarrassment: "Let's Chen Tou say that inflammation is more likely."

Xu Jinxing almost spit out a mouthful of tea, if Chen Qi hadn't said it, but if other doctors explained it like this, he would be scolding his mother.

"Inflammation? Inflammation that lasted for 3 years? Inflammation that is ineffective with anti-inflammatory treatment? Didn't Chen Qi miss it this time?"