When doctors have a simulated operating room

In addition to large amounts of fluid and electrolyte supplementation, the treatment of rhabdomyolysis also requires infusion of mannitol. Mannitol is used to dilate blood vessels. A large amount of protein accumulates in the renal tubules, and mannitol can play a certain dilating role. In this way, protein can be discharged from the kidneys in time. In addition, alkaline urine must be corrected. Each hospital has different rescue indicators for rhabdomyolysis. Some hospitals will choose to do blood exchange once the creatine kinase is higher than 300,000. That is, hemodialysis. Why? Because the creatine kinase is too high, it proves that there are too many protein substances in the blood. Blood exchange can quickly purify and filter out impurities in the blood. Prevent patients from sudden acute renal failure. Renal failure is very dangerous and can easily lead to death.

So some doctors will perform blood exchange for safety reasons or to prevent medical accidents.

But Zhang Yi took into account that the child was still a high school student.

And the urine volume had not yet reached the point of oliguria or anuria.

(Protein accumulation in the renal tubules will cause urine to be unable to be discharged. The more protein accumulation, the less urine.)

So active fluid replacement treatment, a few days in the hospital will almost restore the patient to normal.

Chen Fang wrote an infusion order and also arranged for him to be hospitalized in the Department of Nephrology.

Call the number, next one.

Knock knock knock.

The door of the clinic was knocked.

I thought it was a patient who came in, but it turned out to be Dean Qian.

Dean Qian walked in with an excited look on his face.

The two greeted Qian Zhenggang.

Qian Zhenggang walked directly to Zhang Yi and asked him:

"Zhang Yi, I just came back today and heard that you had an operation in the Imperial Capital Ping An Hospital! Is this true?!"

Zhang Yi nodded:

"It's true."

The muscles on Qian Zhenggang's face trembled slightly.

Good guy!

Awesome!

He actually went to the Imperial Capital for an operation!

"Haha! Great, great!"

Qian Zhenggang praised Zhang Yi for a few words and then left the clinic thoughtfully.

Hmm!

It seems that it's time...

The second patient.

It's a little boy about ten years old.

There are two old people following behind him, who should be his grandparents.

They look very simple in their clothes.

A pair of very old-fashioned dark cloth shoes, with some mud on the edges of the shoes.

The little boy walked in with his hands on his stomach and a painful look on his face.

There are still traces of tears on his young face.

"What's wrong, kid? Are you feeling uncomfortable in the stomach?" Zhang Yi asked softly.

The little boy nodded: "My stomach hurts..."

Zhang Yi glanced at him.

There are roundworms in the little guy's gallbladder! !

Zhang Yi put on a pair of gloves and gave the little boy a physical examination.

While pressing the abdomen, he asked:

"Little boy, when did you start having stomach pain?"

"It's been a few days... It's been a dull pain... It suddenly hurt a lot this morning..."

As he spoke, the little boy couldn't help crying.

Gallbladder roundworms are a kind of abdominal pain similar to a drilling-like pain.

It's hard for adults to bear, let alone children.

Zhang Yi took the boy's temperature, 38.4℃.

A little fever.

Then he reached out and gently pressed the little boy's gallbladder area.

The little boy screamed in pain immediately.

"Woo... It hurts..."

The tenderness of the gallbladder area and pancreas in the abdomen is obvious.

"Diarrhea? Have you eaten anything recently?"

The boy nodded: "A little diarrhea..."

Take off the gloves, Zhang Yi glanced at Chen Fang and said:

"The tenderness is near the gallbladder. The initial estimate is that the gallbladder should be inflamed, but it may not be gallbladder inflammation. Let's do a B-ultrasound first."

Chen Fang was puzzled, but did it.

Write a prescription and give the doctor's instructions for examination.

However, if the gallbladder is inflamed, what else can it be but cholecystitis?

Behind the boy.

The two old men didn't quite understand, so they asked:

"Doctor, can you please tell me what's wrong with my grandson?"

Zhang Yi didn't answer directly, but continued to ask about the medical history:

"Does this child usually drink raw water or eat raw food?"

The two old men thought for a while and said:

"We country people drink natural water from the mountains. Does this have anything to do with stomachache? The water in our place is pure and natural, very clean."

Zhang Yi shook his head and said:

"Let's do this, you go get a B-ultrasound and then draw a blood test. If you have a stomachache, kid, this

There is a wheelchair for you to sit in, okay? "

The little boy was about to nod, but asked cautiously:

"Doctor...does this wheelchair cost money?"

Zhang Yi smiled lightly:

"Silly child, it's just a wheelchair, it's free, if you feel uncomfortable, just sit and go for the check-up."

"Okay, thank you doctor. "

The two old men helped the boy to the wheelchair and went out for the checkup.

Half an hour later, the boy was sent back.

He was holding several checkup sheets in his arms.

Zhang Yi picked up the B-ultrasound sheet and took a look.

The top was a black shadow image, and the bottom was the diagnosis of the B-ultrasound doctor:

Strong rope-like echoes were seen in the gallbladder area.

Diagnosis: Gallbladder ascariasis.

On the side, Chen Fang was also shocked!

Damn!

No wonder Zhang Yi said that the gallbladder was inflamed but not necessarily cholecystitis!

It turned out to be gallbladder ascariasis!

Hey!

Chen Fang slapped his thigh!

Why didn't he think of this disease?

Gallbladder ascariasis is more common in children and adolescents.

And the reason why ascariasis is more common in the gallbladder is because ascariasis prefers alkali but not acid.

Bile The juice is alkaline, so it always likes to drill into the gallbladder.

It is easy to treat.

Antibiotic treatment, plus deworming.

If the disease does not improve after a set of treatments, surgery to remove the worms can be considered.

Zhang Yi looked at the black picture on the B-ultrasound report.

Not to mention, he suddenly found that he could not understand the B-ultrasound report and CT film of some diseases.

It seems that I have to draw relevant knowledge about auxiliary treatment and examination.

While doing a good job in surgery, you must also be able to read all the auxiliary examinations.

What if it is useful in the future?

Zhang Yi prescribed the little boy with infusion medicine, deworming medicine, and painkillers.

And told them:

"Remember, child, you must drink boiled water at home in the future.

All vegetables must be washed and fried before eating.

Otherwise, your gallbladder will grow worms again, you know, child?

At that time, it may not be necessary to take medicine and infusion, but surgery may be required to cure it, understand? "

Zhang Yi glanced at the two old men, worried that they didn't understand this, so he asked:

"Where are the child's parents?"

He thought that the child's parents were younger and would definitely be easier to communicate with.

The old man smiled and said:

"He is working outside and can't come back for a while. Just tell us, I will definitely tell him well when I go back."

Zhang Yi sighed.

Okay, this child is a left-behind child.

"Okay, then you remember this, you can take one pill of this medicine now, and take this infusion form to the infusion room next door and ask the nurse to give you an infusion. The fever will subside in a few hours.

And this medicine is for maggots, take it for two days first, and come back for a B-ultrasound and stool test two days later. Remember not to eat in the morning and come on an empty stomach.

Try to wait until you come to the hospital for examination before defecation."

"Remember, kid? "

The little boy nodded.

The two old men behind him also nodded.

Zhang Yi tore off a medical prescription sheet next to him, wrote his phone number on it and said:

"This is my phone number. If you don't understand anything after you go back, you can ask me at any time."