Chapter 261: The relationship between acupuncture and puncture, it is not easy to be a special needs expert
Based on Zhou Can's experience, this patient is most likely suffering from sepsis.
"The patient is in extremely poor physical condition. The risk of liver puncture is very high and the puncture technique is very demanding. It must be successful in one go and there cannot be any mistakes. I'm afraid we need to ask Director Tan from our internal medicine department to do it personally."
Director Luo has some concerns about this.
Liver puncture is essentially a thoracotomy, and patients in good physical condition can certainly withstand it. But this patient is already dying, like a candle swaying in the wind. Any slight wind or wave could cause the patient's life to be extinguished.
Zhou Can was originally planning to seize the opportunity for puncture, but after hearing what Director Luo said, he stopped talking.
If something goes wrong and the patient dies, he will die with him.
Director Luo called Director Tan on the spot.
After hanging up the phone, Director Luo said with a relaxed look, "Director Tan agreed to come and help right away."
Zhou Can felt a little curious. Was Director Tan's puncture technique really that powerful?
To put it simply, the four major puncture medical techniques are injection techniques.
When doctors perform punctures, their skills are pretty much the same as long as they have practiced.
Nurses are very good at giving injections, but they are not familiar with punctures. Therefore, even the head nurse who is very good at giving injections cannot do punctures.
Not long after, Director Tan arrived in a hurry.
After not seeing him for nearly a year, Director Tan still looks rosy-cheeked, with clear eyes, and in excellent mental and physical condition.
"Hey, Xiao Zhou is here too!"
As soon as Director Tan entered the consultation room and saw Zhou Can was there, he was the first to greet Zhou Can.
His heartfelt love for Zhou Can made other doctors envious.
"My teaching teacher was busy, so he sent me here for the consultation. I haven't seen you for nearly a year, and you seem to have become younger than before." Zhou Can was not flattering him, but speaking the truth.
Director Tan must have taken very good care of his body.
"Haha, really! It seems that the little bit of Chinese medicine I learned has some effect." Director Tan replied with a happy smile.
The chief physicians of the Department of Cardiology did not show much expression after hearing this, but Zhou Can said with a surprised look on his face, "From what you said, it seems that you have studied and researched Chinese medicine quite deeply! It's really surprising!"
"What? Do you think that those of us who study Western medicine cannot study Chinese medicine? Foreigners are deliberately suppressing Chinese medicine, and we cannot be fooled. Western medicine and Chinese medicine each have their own methods, and there are things worth learning. In my opinion, Chinese medicine is more profound, and its discussion of pathology and pharmacology is more in-depth and extensive. It's a pity that we, the descendants, are not talented enough, and we can only learn the basics after all our efforts."
Director Tan actually publicly promoted the benefits of traditional Chinese medicine in such a public occasion.
This really surprised Zhou Can.
It is true that there are very few truly talented traditional Chinese medicine practitioners these days.
There is a huge difference between internal medicine and surgery.
Surgeons have great admiration for Western medicine. Whether it is the instruments and equipment used in surgery, the use of drugs, or some knowledge such as surgical standards, they all learn from Western medicine.
Unexpectedly, when internal medicine developed to a certain extent, traditional Chinese medicine became more valued.
"Doctor Zhou, you may not know that Director Tan's acupuncture skills have been commended by the Chinese Medicine Association! This time, we asked Director Tan to come and do the thoracentesis for the patient personally because we considered that this is a high-risk task and only Director Tan can do it."
When Director Luo saw how cordial Director Tan was to Zhou Can, he also became more enthusiastic and friendly towards Zhou Can.
"I heard that acupuncture is very difficult to learn, but I didn't expect that Director Tan has made great achievements in many fields." Zhou Can suddenly realized it. No wonder Director Tan's puncture technique is so amazing.
Acupuncture is more advanced than general injections.
Especially for its acupuncture points, I heard that the shortest silver needle is one inch long, and the longest gold needle is nine inches long.
One inch is equal to 3.3cm, and nine inches is about 20cm long.
It’s terrifying to think about inserting such a long needle into the human body, leaving only the tail of the needle outside.
At least even though Zhou Can now has level five injection skills and has reached the level of deputy director, he still has no confidence in inserting a silver needle as thin as a cow hair and more than ten centimeters long into the patient's body.
But some good Chinese medicine practitioners can do it.
Whether it is using silver needles to prick the acupuncture points or to dredge the meridians, they can do it easily.
This is also the mystery of traditional Chinese medicine and acupuncture.
"Hey, my skills are not worth mentioning. I remember that Xiao Zhou's puncture skills are also very good, right? It shouldn't be difficult for you to puncture this patient. How about you do the puncture later?"
Director Tan actually knew Zhou Can's strength very clearly.
It seems that he pays a lot of attention to Zhou Can.
"Director Tan, this patient is in a critical condition and cannot stand the torture! Can you let Doctor Zhou do the exercise later?"
Director Jiang became anxious when he heard this.
He actually didn't know much about Zhou Can's level.
"You still don't understand Zhou Can's ability! I can guarantee that he is absolutely capable of completing this level of puncture. And as far as I know, he has performed more difficult punctures in the surgery department, and more than once."
Director Tan, however, was confident.
Director Tan really knew everything about Zhou Can's affairs in the surgery department.
"Is he... really that good? Puncture is easy to learn but hard to master. There are many doctors who can do the four major punctures, but there are very few who are proficient in them. Doctor Zhou is so young, and puncture is an unpopular medical skill. I'm afraid he is not as good as you say!"
Director Jiang did not dare to be disrespectful when speaking to Director Tan.
But this patient is his primary care patient, and if something unexpected happens, he will have a hard time explaining himself.
That's why I said something that might displease Director Tan.
"Hearing is believing, seeing is believing. Won't it be clear after watching him operate it?"
Director Tan is very confident.
Just then, a young intern rushed into the consultation room with a test report.
"Director Jiang, Director Jiang, the patient's sputum culture results are out! It indicates that the patient's lungs are infected with Klebsiella... Uh, hello, Director Tan."
The intern entered the consultation room and realized that the atmosphere was a little off.
Looking closely, Director Tan from the Department of Internal Medicine was there.
He was so scared that he quickly greeted Tan Liuren.
"The young man has a positive work attitude, good!"
Director Tan praised with a smile.
"It turns out to be a Klebsiella infection. It seems that Dr. Zhou's diagnosis is correct. The patient is very likely to have sepsis." Director Jiang felt mixed emotions when he heard the test results reported by the intern.
The cause of the disease has basically been determined.
The subsequent thoracentesis is only to further clarify the cause of the disease.
What he needs to consider now is the treatment issue.
"From what Director Jiang said, it seems that Zhou Can made a significant contribution to this diagnosis!"
Director Tan was not surprised by this.
He was just very curious about Zhou Can's diagnostic process and thinking.
Director Luo took the initiative to recount Zhou Can's performance during the consultation. After hearing this, Director Tan's smile deepened a little, and he looked at Zhou Can with a friendlier look.
"Let's go to the ward and do a liver puncture first!"
After Director Tan learned about Zhou Can's contribution to diagnosis, he valued Zhou Can even more.
When they arrived at the ward, the patient's condition was already quite serious and it was distressing to see.
Since this puncture needed to be done under the guidance of B-ultrasound, the patient was taken into a special operating room.
"Xiao Zhou, are you sure you can complete the puncture?"
"have!"
Zhou Can answered briefly and forcefully with one word.
At this time, the nurse had already taken the initiative to undress the patient and disinfected the surface of the patient.
Zhou Can began to perform liver puncture on the patient.
He first found the right spot, then inserted the needle directly into the enlarged area of the right lobe of the liver. He successfully took out the biopsy specimen and sent it for examination.
He also gained 101 injection experience points.
One hundred points are awarded as rewards.
It takes some time for the biopsy material to be sent for pathological histological examination and bacterial culture to produce results.
Zhou Can was ordered to attend a consultation at the Department of Cardiovascular Medicine. Not only did he not bring discredit to Director Shang, he also earned face for the Department of Gastroenterology.
Before leaving, Director Jiang apologized to him three times in a row.
He kept praising Zhou Can for his diagnostic ability and puncture skills, which amazed him.
"Thank you, Dr. Zhou, for your contribution to our Department of Cardiovascular Medicine. I'll see you off." Director Luo felt relieved when he saw that the cause of the patient's illness had been successfully diagnosed.
Next, as long as the symptoms are treated, I believe the patient will get better soon.
The key to sepsis is early detection and early treatment.
It's not too late now.
When passing by the nurses' station, the three young nurses all widened their eyes in disbelief.
"This, this...isn't this the resident doctor sent by the Department of Gastroenterology to participate in the consultation? Why did Director Luo personally send him off?"
"Are you going to follow him to the gastroenterology department to question him?"
"I'm really impressed by you. Director Luo had a smile on his face, and he was chatting and laughing with the young doctor. How could he look like someone who was going to accuse him of something?"
"Hey, hey, did you see the expression on Director Hong's face when he left the endocrinology department not long ago? He also came to participate in the consultation, but not only did he leave early, but no one saw him off. Do you think Director Hong didn't make any contribution to this consultation?"
"It must be. Otherwise, why would Director Luo personally send a resident doctor away but not Director Hong? That young resident doctor is really handsome. I wonder if he has a girlfriend?"
"You're being a fangirl again. You're setting your sights on a handsome young doctor with a bright future. I really admire you."
Zhou Can heard a lot of the nurses' whispered discussions.
He shook his head secretly, thinking that the doctor's efforts were not as good as the nurse's words.
These gossipy women.
…
After returning to the Department of Gastroenterology, he checked the patients under his care and found no problems. He then hurried to the outpatient department to see Director Shang.
I can learn more by following Director Shang's practice.
I was delayed by many things today.
It is almost eleven o'clock now, and I can only sit with Director Shang for an hour at most.
Zhou Can knocked on the door and walked into the clinic.
Three graduate students and Dr. Huang Xinggui were all there.
Huang Xinggui should be one of the key training targets selected by Director Shang, so whether he is performing surgery or seeing patients, he can be seen learning behind Director Shang.
"Dr. Zhou is back from !"
Director Shang greeted him with a friendly smile.
"The consultation went smoothly, so it didn't take long to finish. The patient has been basically diagnosed with sepsis. The preliminary diagnosis is that the cause is a bacterial infection caused by the infusion. After the sepsis occurred, he did not receive effective treatment in time, and eventually developed sepsis. Abscesses have formed in the liver and lungs."
Zhou Can reported the consultation results to Director Shang.
“Who diagnosed it?”
Director Shang asked.
"Need I say more? I guess it must be Dr. Zhou who made the diagnosis."
Xie Lin interrupted with a smile.
"Haha, Dr. Xie thinks too highly of me! When I went there, they had already done a sputum culture test. But the diagnosis I gave was of some use."
Zhou Can played a role in this diagnosis, but to say that the diagnosis was entirely made by him would be underestimating the chief physicians of the cardiovascular department.
They were simply confused by the sterile results of previous blood culture and infusion fluid culture.
This is why the cause of the patient's illness could not be diagnosed in time.
However, as the results of sputum culture come out, they will definitely consider sepsis.
"You are always too modest. If you say it has a certain effect, then it must have a significant effect. It's OK as long as you didn't embarrass me or the Department of Gastroenterology. Next time a department asks me to consult, you should go instead of me."
Director Shang tasted the sweetness and couldn't stop.
He said that in the future he would let Zhou Can continue to consult other departments on his behalf.
"Aren't you afraid that I might discredit you and ruin your reputation?"
Zhou Can has followed so many teachers, but he has never seen such an "irresponsible" senior doctor.
He is now equivalent to a disciple on the mountain who has not yet completed his studies, but the headmaster keeps urging him down the mountain to handle various important matters, treating him as a disciple who has just finished his master's training. He is really generous.
"I believe you have the ability to bring honor to me, not to discredit me. Besides, everyone grows up step by step. Even if there are one or two mistakes occasionally, isn't that normal? Go ahead and feel free and don't have any psychological burden."
Director Shang covered him up.
Even if something goes wrong, I won't blame him.
"You're back just in time. This patient's condition is quite complicated, with an enlarged spleen, long-term irregular fever, and night sweats. Treatment at two hospitals has been ineffective, and the true cause of the disease is still unclear. Please help with the consultation."
When Zhou Can came in, he saw the patient and his family.
It seemed like he talked a lot with Director Shang and others, but in fact, it was just a few short sentences.
During this period, the patients and their families looked at Zhou Can curiously.
They were not stupid. They had heard something from Director Shang and Xie Lin. They knew that the young doctor who had just come in was very capable and could replace Director Shang to participate in consultations with other departments.
The level must not be too low.
Zhou Can picked up the patient's examination results from other hospitals and the copied medical records for review.
The first hospital was a county-level hospital. They did a blood test on the patient and the white blood cell count was normal. They used a variety of antibiotics to treat the patient but none of them worked. The patient's systemic poisoning symptoms were mild, and the possibility of bacterial infection could be basically ruled out.
Seeing that the patient's condition was getting worse, the family members began to question the medical level of the county-level hospital. They asked to be discharged and went to a larger hospital for treatment.
The second hospital performed a chest X-ray on the patient , which showed that the chest image was normal.
The patient complained of fatigue, night sweats, weight loss, and long-term irregular fever.
When the doctor performed a physical examination on the patient, he found a bean-sized lymph node at the base of the patient's left neck. The hardness was medium and the patient had no obvious pain.
B-ultrasound showed an enlarged spleen.
The patient's ESR was 50ml/at the end of the first hour, which is quite fast.
Blood test data showed that globulin was significantly elevated.
After comprehensive diagnosis, the doctors at this large hospital diagnosed that the probability of tuberculosis was high.
The patient was then treated with a triple anti-tuberculosis drug combination of isoniazid, rifampicin and streptomycin.
After more than a month of treatment, the patient went to the hospital for a follow-up ultrasound examination and found multiple solid masses in the spleen and enlarged abdominal lymph nodes. The hospital's follow-up result was complicated with splenic tuberculosis.
The family members saw that the patient’s condition was getting worse and worse. Instead of being brought under control, many new problems arose and they also lost contact with the second hospital.
Finally, he took the patient to Tuya Hospital for treatment.
After all, it is a famous hospital among the provincial tertiary hospitals with high popularity, and patients come here with great hopes.
When Zhou Can saw this, he finally understood why even Director Shang had to frown because of this disease.
Patients like this who have been treated in two or three hospitals with no effect are generally very difficult to deal with.
It’s really not easy to be an expert.
The opening of special expert outpatient clinics means that at least 40% of the patients seen every day are those who have not been effectively treated in other hospitals.
