Chapter 1329: : The significance of consultation?

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The case is not long.
Just a few words.
But a lot of information can be seen.
Doctors sometimes just see a few medical records.
The first is to find the cause according to the symptoms, and the second is to push the symptoms according to the cause.
At this time the patient's symptoms do not seem to be difficult for short legs.
In terms of symptoms, the patient's sudden dizziness, weakness, etc. should be manifested by low blood volume, and there are also sudden irritation symptoms such as sudden abdominal pain and bloating!
Signs: There is pulse rate, low blood pressure, and obvious signs of peritoneal irritation, which should indicate intra-abdominal lesions.
Blood routine showed that hemoglobin gradually decreased in the early stage of the disease, but MCV and MCH did not change significantly. Instead, Fib continued to be low and D-dimer increased significantly. These seemingly messy laboratory test reports can obviously draw a conclusion. Meet the performance of acute blood loss!
So Chen Cang directly said: "Consider acute hemorrhagic disease!"
Chen Cang's diagnosis was almost directly given after the case was finished.
Several directors looked frequently, full of appreciation.
Although this diagnosis is not difficult, but... you need a certain level to get acute bleeding so quickly.
And Chen Cang basically blurted out, which shows the solid foundation of the other party!
Huang Qiuying couldn't help but nod: "Yes, since it is a bleeding disease and it is pain in the lower abdomen, physical examination and imaging have found that the solid mass is accessible in the pelvis, and the patient has a history of gynecology, so I first consider Gynecological related diseases.
There are only a few diseases that can cause bleeding in gynecological diseases!
The first is pregnancy-related diseases: such as ectopic pregnancy, trophoblastic tumors, etc.;
The second is the rupture of ovarian or fallopian tube tumors;
Finally, the ovarian endometriotic cyst ruptures. "
Chen Cang nodded: "Patients with menopause for many years can completely rule out pregnancy-related diseases, and endometriotic cysts are also unlikely!"
Thinking of this, Chen Cang suddenly asked: "Has the patient fallen?"
Cui Jisheng nodded: "Yes, but... it just slipped gently to the ground."
Sliding gently to the ground is not the same as thinking hard.
Huang Qiuying said: "Before the diagnosis of bleeding caused by gynecological diseases is established, it is necessary to rule out bleeding caused by other systems and other causes."
As the director of general surgery, He Zhiqian said: "We have discussed before, surgical abdominal bleeding disease is generally seen in organ injuries."
"But damage to parenchymal organs such as liver, spleen, pancreas, etc., and hollow organs such as stomach, intestine, and gallbladder bile duct; in addition to vascular damage such as abdominal aorta, inferior vena cava, etc. Generally these injuries are secondary Due to severe closed injuries or penetrating injuries, pelvic vascular injuries are mostly secondary to penetrating injuries, pelvic or lower limb fractures.
Therefore, the patient fell slowly to the ground after only slight activity, without obvious fractures, and generally did not cause damage to the above organs and tissues. "
He Zhiqian's remarks directly denied the possibility of the patient's organ damage.
Next, urology, hematology, endocrinology, and interventional departments began to discuss again.
Perhaps many people do not understand what a consultation is?
This is a consultation, giving an inferred diagnosis, and then the various departments to diagnose.
This is the benefit of branching.
Every doctor is proficient in one field!
They are very good at diseases in their field.
Continuously reduce the possibility of patients.
An acute hemorrhage in the abdominal cavity may seem ordinary, but now a clear diagnosis cannot be given.
In fact, this is medicine.
As one of the founders of Johns Hopkins Medical School, Sir William Osler said: "Medical science is an uncertain science!"
The discussion at this time was anxious again.
Urology has rejected the possibility of bladder area damage in patients, and temporarily does not consider urology-related diseases.
The inference of the hematology department focuses on vascular injury. After all, chronic vascular diseases such as long-term diabetes and secondary vascular disease can easily lead to bleeding.
Another round of discussions ended.
Everyone was silent again.
In general, consultation is actually a step-by-step process.
If the situation is diagnosed, this is easy to say.
but……
If this is the case today, when everyone discusses for half a day but cannot find the cause.
Consultation will not be wasted!
The consultation will gradually become a push pot conference.
After all, such a difficult patient, the diagnosis is now unclear, let alone treatment.
In fact, it can only be said that the patient's condition is okay.
If it is really critical, the first step may be to perform a laparotomy.
Sometimes, imaging studies have limitations.
There must be some bleeding, but the amount of bleeding is not very large.
At this moment, there was silence again in the office.
Huang Qiuying was also decisive: "Notify the operating room and prepare for laparotomy!"
Now it makes no sense to drag on.
At this time, Chen Cang is constantly thinking about various possibilities.
The routine diagnosis has been completely thought through, but... but it does not meet the patient's symptoms.
No wonder everyone has consulted and discussed for an hour without results.
At this moment, Chen Cang suddenly said: "Can I go to see the patient?"
Huang Qiuying turned to look at Chen Cang, only to realize that Chen Cang had not expressed any opinions since he came.
Everyone also thinks that this kid Chen Cang... will not come to the stage? !
But no one will force Chen Cang, after all, they are just a training doctor.
If you don't give it, he is not responsible.
but……
To be honest, these directors certainly do not believe that Chen Cang can give the result.
Huang Qiuying saw that Chen Cang's serious look did not seem to be pretending, she couldn't help but stunned for a while: "Okay!"
During the speech, Huang Qiuying personally took Chen Cang to the ward.
An old lady in her sixties was lying in bed, moaning uncomfortably over her stomach.
Seeing Huang Qiuying coming, was about to speak, and suddenly saw Chen Cang!
Suddenly, the old lady blushed: "Professor Chen!"
The old lady's husband Cui Jisheng couldn't help but say: "Wife, don't worry, Professor Chen can definitely diagnose it!"
The old lady nodded, and suddenly felt that her stomach did not hurt so much: "Yes, yes! I believe Professor Chen!"
Chen Cang also sighed, the pressure is great!
Only love and trust cannot be let down!
The directors around have different expressions.
If Chen Cang really had a clear diagnosis, then he really had the ability.
But... to be honest, this disease really needs to be so simple, and it won't be until now.
This kind of bleeding is absolutely rare!
As expected, Chen Cang was in a stalemate after palpation, and he could not get an accurate answer for a long time!
However, Chen Cang's eyes are not perspective after all.
There is no way to see the situation in the abdominal cavity.
The patient's pelvic hematoma seems to be an unsolved mystery.
Time goes by one minute and one second!
Chen Cang also racked his brain to think about it!
What are the acute abdomen?
His mind is like a search engine, constantly brought in, thinking, repeatedly speculating.
Chen Cang suddenly thought of something, UU reading www.uukanshu.com quickly said: "Be a vein ultrasound of upper and lower extremities!"
Huang Qiuying frowned: "The upper and lower limbs? What's the point?"
The doctor in the intervention department heard Chen Cang's words and couldn't help but jump in the eyelids!
"Yes, be a color doppler!"
Hearing the intervention of the doctor, Huang Qiuying was not blocking.
Gynecology itself has ultrasound, and soon the results came out!
Color Doppler ultrasound of upper and lower extremity blood vessels also prompts thrombosis of the right femoral and popliteal veins!
Everyone who saw the result was a little dazed.
And Chen Cang was scared and sweating!
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