Free Web NovelChapter 1038: Chapter 1038: Teaching Reception
"Call over the other interns. This patient has significant teaching value; let them learn from this too," Liu Banxia said.
"Alright." fгeewёbnoѵel.cσm
Xu Yino responded and put her thoughts aside, deciding not to think about the girl who was abused for the moment.
"What’s going on now? I see Xu Yino is bouncing around," Wei Yuan came over.
"We admitted a patient who might have pancreatitis. We’re planning a teaching session for the consultation which got her quite excited," Liu Banxia said. freёwebnoѵel.com
"I heard the case review you did yesterday was excellent; the kids even had a small meeting last night to continue the discussion," Wei Yuan said.
"Really? I didn’t know that," Liu Banxia said with a smile.
"It’s essentially a reminder for them. They’re just starting their path in medicine, and if they stay on the right track, things will be much smoother in the future."
"There are too many entangled interests involved, which can often affect our subjective judgment and lead us astray."
"I never used to think this way, but recently, with more cases and experiences, I’ve felt a lot more."
"I used to think I was too naive, believing everything was simple. But it’s just like life, far more challenging than imagined."
"Wow, a soon-to-be dad surely has a different perspective. Keep it up, we rely on you," Wei Yuan joked.
"Don’t put so much pressure on me. I can fool those kids, but fooling you guys? I’d blow my cover instantly, not happening," Liu Banxia laughed.
"Yesterday we admitted a rectal cancer patient. The family is considering it, and if they opt for surgery, your NOSES procedure is recommended for the low position. Good luck," Wei Yuan said.
"Alright, no need for formalities," Liu Banxia said.
"Recently, it feels jinxed. The more you want to do a certain surgery, the fewer patients meet the criteria. I wonder if this is a test from above, only managed to do it once."
"Haha, there’s plenty of time. They’re all gathered now, so the rest is up to you guys," Wei Yuan said with a smile.
"Wow, why so many?" Liu Banxia asked.
"When I mentioned it, they were all very interested," Xu Yino said.
"Okay, Xu Yino, present the patient’s admission details," Liu Banxia said.
"The patient is a 36-year-old male who came on his own, suffering from abdominal pain and vomiting. Physical examination revealed abdominal tenderness and slightly elevated body temperature. There is some rigidity in the abdominal muscles, and bowel sounds are normal," Xu Yino said.
"Okay, this is a common case of acute abdominal pain. Zhang Hongfei, what judgment should you make after admission? Cui Jia, since you participated in the admission, you can only listen, not speak," Liu Banxia said.
"First, a rapid test for appendicitis and cholecystitis can be done," Zhang Hongfei said.
"Anyone else? Now’s the time to refute. Whether it’s right or wrong, you must challenge his view. A friendly reminder, Xu Yino is actually a very cunning person," Liu Banxia said.
"Teacher Liu, it’s a teaching consultation," Xu Yino reminded.
"Shouldn’t we also consider intestinal obstruction? The patient has tense abdominal muscles, indicating the condition has been developing for some time," Xu Zhenkai said.
"In discussions, don’t be afraid to refute others. This is a discussion, like a debate, where arguments are about the issue, not the person," Liu Banxia continued.
"The purpose of a teaching consultation is to help you clarify some things during the admission process. Xu Zhenkai’s statement just now is a supplementary explanation. Is anyone brave enough to challenge Zhang Hongfei’s argument?"
The interns remained silent, generally agreeing with the previous statements, since these three symptoms are the most common in acute abdominal pain cases.
"Okay, what kind of examination is needed next? Who wants to answer?" Liu Banxia asked again.
"An ultrasound should be done,"
This answer was from Wang Zhaoping, an internal medicine intern.
"Any additions? No one thought of doing a CT, just scanning it thoroughly? Or an X-ray?" Liu Banxia asked with a smile.
"The current symptoms are not very clear, so we should follow the principle from low to high," responded Peng Peng, a cardiothoracic intern.
"From your expressions, it’s clear that your opinions are currently quite unified," Liu Banxia said.
"However, you’ve all overlooked one issue, which is what I just mentioned. Xu Yino is very cunning. By ignoring the cunning Xu Yino, you are likely to make biased judgments."
"When we receive a patient, we should not only focus on the patient’s approximate age and gender, but also their basic physical indicators. For example, blood pressure and body temperature all need attention."
"But the cunning Xu Yino didn’t mention these just now, so you all assumed there might not be a problem because she didn’t say it."
"But I must solemnly remind you, including with emergency patients brought in the future. Whether or not the paramedics mention it, you should keep this in mind."
"Because during the process of admitting patients, there’s a principle of using instruments from low to high complexity. But this principle is determined by the patient’s physical condition. What if this patient has severe abdominal pain and a temperature of 39 degrees? Shouldn’t we just proceed directly to a CT scan?"
Hearing Liu Banxia say this, everyone felt a sudden realization. Had the patient had such a high fever at the time, they might have gone straight to a CT, but judging by their previous reaction, they did indeed overlook this.
"Why are you all looking at me? I just forgot to mention it," Xu Yino hurriedly said.
"Tsk tsk, you said it, whether you believe it yourself or not, I’ll just assume I believe it," Liu Banxia said with a smile.
"Let’s get back to this patient. Although I haven’t seen the patient, I think the patient’s self-diagnosis after visiting was gastroenteritis. Abdominal pain plus vomiting is quite consistent from a patient’s perspective."
"However, we must remain vigilant. While gallbladder inflammation, appendicitis, and intestinal obstruction are common in patients with acute abdominal pain, we can’t ignore other possibilities."
"For instance, kidney stones. Someone might ask, shouldn’t kidney stones cause back pain? The patient says it’s abdominal pain. Some patients don’t describe their symptoms accurately because pain can radiate."
"For example, other organs in the patient’s body like the liver, stomach, bile duct, pancreas, spleen, duodenum, jejunum, ileum, colon, rectum, ureters, and bladder are all possible sources."
"If the patient is female, it could also be an issue with the uterus or appendages. It could also be a heart attack or an aortic dissection."
"Doesn’t this seem daunting? What could have been mere gastroenteritis suddenly involves so much. The treatment cost could range from a few hundred to twenty or thirty thousand — quite a jump!"
"While the patient might not think of all this, we need to consider everything during a consultation, and then rule out accordingly."
"That was a bit of a digression, so let’s get back. The primary consideration for this patient was correct, but Xu Yino needs to provide all the supplementary information."
"If the patient’s temperature is high, we need to consider whether the inflammation has developed severely. Would doing an ultrasound first and then a CT delay things?"
"There’s also the issue of performing an ultrasound. Do we do a bedside ultrasound or send them to the ultrasound room? These are all things we need to consider, and the choice can only be made based on the patient’s overall situation at the time."
"That’s about all there is to say. Patients with acute abdominal pain constitute a high percentage in our emergency center. In the process of admitting patients, we face many situations and must make a comprehensive judgment."
"The standard practice of instrument checks from low to high is merely a conventional standard. The decision for different patients ultimately lies in our hands."
"For this patient, our cunning Doctor Xu judged through the ultrasound report that it might be pancreatitis, so she sent the patient for an abdominal CT."
"Before the patient returns, you can review your knowledge on pancreatitis, and those interested can participate in the diagnosis."
"Judging by the number of people today, if it really is pancreatitis, a call should’ve been made to get the images from the computer directly. Zhang Libo, can you explain why not?"
"Uh... is it because surgery might be needed?" Zhang Libo hesitated for a moment before hastily adding.
Liu Banxia laughed, "We can’t rush. The pancreas is not just any organ; it’s a critical digestive organ that also secretes insulin. It shouldn’t be cut lightly."
Zhang Libo smiled awkwardly, recalling the recent total pancreatectomy that Liu Banxia performed, which made him nervous earlier.
"If it’s not a case of the whole pancreas being affected, we should leave the pancreas intact; conservative treatment is better, unlike the appendix, which holds a different status."
"The CT room is on edge because if it really is pancreatitis, it progresses rapidly, making it a very dangerous disease."
"Today, I also have to commend Xu Yino. There’s one more thing she didn’t mention, which is that during the patient’s examination, she checked for back pain, and it wasn’t obvious."
"That’s why she did the ultrasound. If back pain had been significant, she probably would’ve gone directly for a CT. Her overall assessment of the patient was quite good."
At this time, Xu Yino’s phone rang. She glanced at it and nodded towards Liu Banxia.
"OK, let’s proceed with the diagnosis. Pancreatitis can be confirmed," Liu Banxia said.
