When doctors have a simulated operating room

The patient was so tired that he had to wait for the patient to recover.

"Leg? Where does your leg hurt?"

Chen Fang stood up and walked to the male patient.

The patient was grimacing in pain and couldn't speak clearly.

It was his wife who introduced the condition to him.

"It started to hurt at midnight last night, at the heel."

In Zhang Yi's sight.

Some urate crystals appeared behind the Achilles tendon of the patient's right lower limb and deposited around the joint.

It was gout, no doubt about it.

The primary pain location of gout is on the foot, at the big toe or the heel.

Because urate crystals have weight, they will sink.

Chen Fang also guessed that it was gout after taking a look.

"Zhang Yi, write a checkup sheet. Check the uric acid first."

"Take another X-ray to see if there are any tophi on the heels."

"Okay."

Zhang Yi did as he was told and typed on the computer.

Two sheets came out soon.

"Doctor, what's wrong with me? Baidu said it's gouty arthritis? Is that it?"

Chen Fang nodded: "It's probably this. Do you drink a lot?"

The patient's wife immediately showed a disgusted look and complained:

"More than that! You can tell by looking at his belly. He used to be very thin! He's fat now because of drinking!"

"How long have you had this foot pain?"

"Well... I started to feel vaguely uncomfortable a month ago, and it hurt the most at midnight yesterday." The patient replied while enduring the severe pain.

Chen Fang glanced at them and said, "Okay, I understand. You go check it out first. If the uric acid level is high, it can be diagnosed as gouty arthritis, and then you have to be hospitalized."

The patient and his family nodded repeatedly and took the list to get checked.

After washing his hands and disinfecting them, Zhang Yi was about to call the second patient.

He heard a nurse outside the clinic shouting:

"Emergency room, hurry up! A patient has fainted!"

Zhang Yi and Chen Fang looked at each other and hurried out of the clinic.

"What's wrong? What's the situation?" Chen Fang asked.

"Hurry up and come to the outpatient clinic to pick up the patient. A patient is receiving an infusion in the outpatient clinic and fainted just after the infusion. Hurry up and rescue him!"

The two walked quickly to the outpatient infusion room.

Only a middle-aged woman in her forties was lying on the flatbed.

The patient was semi-conscious and restless, and two nurses were trying to hold her restless hands.

"What's going on?"

"The patient came for infusion with abdominal pain and fever at first, and just after infusion of a bag of clindamycin, he suddenly became like this. The fever is up to 40℃, you should take him to the emergency room for rescue."

Outpatient clinics usually only see patients with mild symptoms.

So this kind of rescue patient still has to be taken to the emergency room.

The two of them took the patient back to the emergency room one after the other.

The doctors and nurses in the emergency room received advance notice and had prepared the beds, ECG monitors and oxygen.

"First draw blood, check blood gas, blood routine, liver and kidney function, PCT, then do a blood culture, and do an abdominal CT as well, it's an emergency check!"

As soon as he lay down, Zhang Yi hurriedly instructed the nurse.

This patient is not just suffering from ordinary abdominal pain and fever.

In Zhang Yi's sight, the man's abdominal cavity is already full of black water.

A closer look shows that the bile duct is blocked by gallbladder and common bile duct stones.

Induced cholangitis and acute pancreatitis!

It seems that it has been a few days, otherwise there would be no abdominal effusion.

The gallbladder, liver and pancreas are all next to each other.

If one has an accident, the other two will not be able to escape.

Stones grow in the bile duct, and bile cannot flow out, blocking and inducing inflammation.

Then the bile with bacteria will accumulate and flow back into the liver and pancreas, thereby inducing acute pancreatitis and liver damage.

Acute pancreatitis will cause pancreatic juice to reflux into the abdominal cavity.

If it is delayed further, the abdominal effusion will infect the peritoneum and cause peritonitis.

If it is delayed further, bacteria will enter several arteries in the abdominal cavity, which is acute sepsis.

If it is delayed further...

No, if it is delayed further, the person will die.

So the first rescue method at the moment is to drain the abdominal effusion first.

Take the effusion for culture to see what bacteria are infected, and then prescribe the right medicine.

However, Zhang Yi could see it, but no one else at the scene could.

So Zhang Yi could only wait for the test results.

Chen Fang examined the patient and said, "It should be acute cholecystitis? Let's give him Supushen and Colebitol first."

Zhang Yi nodded. Using antibiotics first can indeed relieve the symptoms a little.

Soon, the blood test results came back.

Liver

Function:

Total bilirubin: 84 (0-21).

Direct bilirubin: 51.30 (0-4).

Alanine aminotransferase: 86.71 (7-45).

All of them were over the limit.

PCT:

PT international standardized value: 1.26 (0.8-1.2).

Fibrinogen: 4.96 (2-4).

D-dimer quantitative: 5.31 (0-0.5).

Another row of red!

Blood gas, lactic acid increased to 4.9!

Chen Fang took a look and diagnosed it as biliary pancreatitis.

But Zhang Yi shook his head: "No, not necessarily. I think it is bile duct stones combined with cholangitis, and sepsis is not ruled out."

"Because biliary pancreatitis is not that serious."

Clinically, many diseases have many similarities.

As a doctor, you must find the differences in these similarities and then accurately determine the cause.

After saying that, Zhang Yi walked to the patient's bedside.

The fluid had been transfused, but the patient was still agitated.

Blood pressure 94/62mmhg.

Respiration 34 times/min.

Heart rate 113 times/min.

Vital signs were very abnormal.

"Teacher Chen, I suspect she is in shock! It's septic shock!"

Chen Fang was stunned: "Shock?!"

Good man, this is not a joke.

Several other doctors in training were also shocked!

Then, Zhang Yi reached out and pressed the patient's abdomen.

The tension was very high.

"Hurry up and arrange a puncture, Teacher Chen, I feel he has abdominal effusion."

Coincidentally, the results of the abdominal CT scan came out.

A few people saw that there were really stones in the gallbladder and bile duct.

And there were a lot of free dark areas in the abdominal cavity.

If this is not effusion, what is it?

Chen Fang glanced at Zhang Yi calmly.

Awesome!

Other trainees cast admiring eyes at Zhang Yi~~

Big brother is awesome! ~~

Zhang Yi was able to accurately identify such a difficult disease!

Soon, the patient was taken to the treatment room for puncture and fluid extraction.

As a result, the patient's family members just came over.

Zhang Yi informed the family members that the patient was in critical condition.

The family members did not react for a while and squatted at the door of the emergency room crying.

"My mother just has a stomachache and fever? Why does she have to sign this critical illness notice? Woohoo... What happened to my mother? Nothing will happen, right?"

The family members were very anxious.

She was fine a few days ago, but today she suddenly went to the hospital for a major rescue.

Zhang Yi had to comfort them and said that she would be fine after the ascites was drained.

Fortunately, the patient came in time. If it was delayed until the late stage of sepsis, it would be more difficult to treat.

In the treatment room, Chen Fang was preparing to wear gloves for puncture.

Zhang Yi walked in: "Let me do it, Mr. Chen?"

Chen Fang glanced at him.

Okay...

You come if you want...

Who makes you so awesome...

Chen Fang felt more and more that he was just a little follower who signed for Zhang Yi everywhere...

Put on gloves and a mask.

Zhang Yi inserted a 50 ml empty needle into the right abdomen of the patient.

Pull hard.

Swish!

A stream of dark liquid was drawn out.

The nurse next to him frowned and hurried over with the drainage bag to connect.

In less than half an hour, more than 1,000 ml of effusion was drained.

The patient's stomach was also visibly deflated.

Take samples for bacterial culture and make the following diagnosis:

"1. Bile duct stones combined with acute cholangitis 2. Acute pancreatitis 3. Gallbladder stones 4. Sepsis."