Qingping continued to introduce the condition: "After discussions in the local hospital, the cause of the fever was not clear. A CT scan of the chest and abdomen was repeated, and no obvious fever lesions were found. As of yesterday, five days later, the patient's high fever persisted, and his family asked to be transferred to our hospital. He was admitted to our hospital in the afternoon.

.So I invite you all to come over and discuss the condition together."

After Qingping finished speaking, he started to make suggestions:

"Let me tell you my opinion. Based on the abdominal cavity exploration and the ileocecal area, appendix, and peritoneal exudation shown in the picture, I think the appendix is ​​not the cause of the patient's high fever and abnormal blood routine. The patient has no history of chronic disease and his stool condition is normal.

, first rule out intestinal disease and abdominal infection caused by perforation caused by intestinal tuberculosis. Looking at these films, the patient's ileocecal tumor may also be ruled out..."

After analyzing his own opinions, Qingping ruled out some possible causes, but could not make a diagnosis. After speaking, he sat down.

After hearing this, Cheng Jian nodded and looked at Song Yang, the other chief of the general surgery department.

Song Yang is a little man of 1.6 meters, and has a pair of big earlobes, which look like Buddha statues.

Song Yang walked to the laptop and began to slide the profile pictures on the screen:

"Based on the current information, I can't diagnose the cause of high fever during appendicitis surgery. There are many possible situations. I would like to put forward some of my humble opinions for your reference."

"I wonder if other parts of the digestive tract were carefully explored during the operation? Was there any pus culture? Were any abnormal changes in the ileocecal bowel such as thickening, stiffness, etc. checked? Was it flushed during the operation? How were the antibiotics selected for the operation?

, is there any lung infection? Is it possible that it is a fungal infection? What is the erythrocyte sedimentation rate, and whether there is any incision or abdominal wall infection. The shape of the appendix and terminal intestine cannot be clearly seen in the intraoperative photos."

Song Yang raised some of his doubts and provided some directions for follow-up inspections.

After listening to some of Song Yang's questions and suggestions, Qingping, as the organizer, naturally responded immediately:

"I can answer some of the questions Dr. Song asked immediately, but some do require re-examination. First of all, based on what I know about the situation, I can rule out abnormality of the ileocecal bowel. There is no problem with intraoperative flushing. As for the erythrocyte sedimentation rate, further examination is needed.

..”

After Qingping answered, Song Yang revised it again, temporarily considering the direction of lung infection and fungal infection.

After Song Yang, it was the turn of Fang Qing, a senior physician in internal medicine. Fang Qing was in his forties, had short hair, dark complexion, and liked to carry a wolfberry cup with him.

After taking a sip of tea, Fang Qing steadily opened his notebook to the first page of records, walked to the computer, and slid the information picture to the page he needed.

"You see, the patient's blood picture is abnormally elevated and PCT is high. I suspect sepsis. During the operation, the appendix was slightly swollen and there was no purulent coating. So Dr. Qing and I agreed to rule out appendicitis. First of all, after Qing

The doctor's discussion preliminarily rules out infection caused by surgical complications. Then I would like to suggest whether the patient has other systemic infections and whether the patient is immune deficient? Third, abdominal CT shows that the patient's ileocecal intestinal wall is thickened and the mesenteric lymph nodes are thickened.

Is the swelling possibly caused by inflammatory bowel disease, non-specific intestinal infection, or blood system diseases such as lymphoma?"

After Fang Qing finished his analysis, he walked back to his seat and continued to drink tea.

"The reverse provided by Dr. Fang is also very possible. I will arrange a physical examination later."

Qingping nodded in agreement.

After the other speakers finished their presentations, Cheng Jian, as the director, naturally made the final appearance.

After looking through the information Qingping gave him and combining it with the analysis of the three previous people, Cheng Jian added:

"Dr. Qing, in addition to the screening items listed by Dr. Fang and Dr. Song, I personally recommend additional examination of the gastroduodenum, ileum 1cm, and ascending colon. At the same time, the patient's abdomen should be flushed and a drainage tube should be placed. As for antibiotics, antibiotics should be given during the process.

Treatment: cefoperazone, sulbactam + metronidazole for two days, then Taineng, and add Levoxan after Taineng for two days.”

Cheng Jian said while Qing Ping took notes. Although it could not be determined immediately after the consultation, there were already several directions, and the next step was to investigate one by one.

After the big guys finished speaking, Qingping summarized a few more words and announced the end of the consultation. As for Ma En Tanglou and others, they were naturally not qualified to speak at the meeting.

After deciding on the next treatment and investigation policy, Song Yang and Fang Qing left first.

Cheng Jian called Qingping into the corridor and asked, "How is the recent appendicitis plan going?"

Qingping reported truthfully, and especially put forward an amazing plan for the subsequent training of Tanglou.

"Are you sure? Tanglou can do the job?"

Although Cheng Jian admired Tang Lou, he did not expect that Qing Ping would approve of it so much that he would choose Tang Lou as the future chief surgeon of the navel cavity technique.

"Tanglou's talent, potential, and learning ability are the best I have ever seen in my career. Appendicitis surgery is not a difficult surgery. As long as you train for a period of time, you can be competent. But..."

Qingping paused and hesitated.

"But what? If you fart quickly, is it the Qingping I know who is squirming?"

Cheng Jian said politely.

Qingping said somewhat depressedly: "This little guy is smart, but he is a little disobedient. The first time I performed an appendicitis operation, I happened to encounter a case of appendix perforation, which shocked me. Although the operation was completed successfully in the end, there was a problem.

I'm still a little scared when I think of that reckless energy."

Qingping looked at Cheng Jian with a wry smile.

After Cheng Jian listened, he recalled the first time he saw Tang Lou in the operating room of the county hospital. No one would have thought that he was an intern. It was the first time he had performed those surgeries...

Cheng Jian patted Qingping on the shoulder: "This boy is indeed a bit arrogant, and his arrogant look makes people hate him. But that's why I fell in love with him in the first place. Not everyone can be so bold in the operating room.

Be calm and adapt to circumstances.”

"So, please pay more attention."

Cheng Jian looked at Qing Ping, who nodded and smiled: "Isn't this a punishment for him to have performed ten appendicitis surgeries?"

"But don't be too intense."

Cheng Jian gave another instruction.

Qingping thought of the gossip and rumors in that department, and asked curiously: "I know, teacher, are you starting to feel sorry for your son-in-law?"

"roll!"

Cheng Jian cursed, and after Qingping walked away, he touched his chin: "Would you like to go back and ask the girl? If it's true... this brat from Tanglou can do it..."

...

...

After Qingping returned to the office, he called Ma En over.

"Ma En, you will be mainly responsible for various examinations of this patient today. You will report to me as soon as each examination comes out, and check the vital signs every three hours until the condition is diagnosed."

Ma En nodded quickly. Qingping was in charge of the treatment anyway, and he was just doing some routine examinations. He was following the patient's condition, so there was naturally no pressure.

There are too many patients who cannot find the cause of the disease through examination. After all, the human body is too complex and the causative factors are also all kinds of strange. Two people with the same symptoms may have completely different causes.

"Dr. Qing, can I share the responsibility with Dr. Ma? Maybe we can help."

Tang Lou said on the side that although through various examinations, he could not draw any conclusions based on the photo data, but if he could see the patient with his own eyes, he might be able to diagnose it, so Tang Lou could not bear to be "greedy".

After hearing what Tanglou said, Wang Daquan and Tian Linsheng on the side were naturally a little dissatisfied. Why did this Tanglou have to get involved in everything?

Qing Ping was also a little angry. Thinking about Cheng Jian's instructions, he said earnestly: "Tanglou, you don't have much to do now? You still have three dressing-changing patients on hand, and there will be ten appendicitis surgeries in the future. You

Where do you get the time and energy? Don’t think you’re just smart enough to try everything. Just calm down and study appendicitis surgery seriously.”

"Oh." Tanglou had no choice but to agree. After all, he couldn't explain the fact that he had diagnostic skills. He could only find an opportunity to take a look at the patient. Of course, it was also possible that the cause of the disease could be found out immediately through department consultation.

"Wang Daquan, your burn patients are still being screened. If there is no rush, you and Ma En will be mainly responsible for this patient."

"Tian Linsheng, in addition to daily ward rounds, you will also cooperate seriously with Tanglou's appendicitis surgery."

"good!"

"Um."

Wang Daquan glanced at Tanglou proudly, "It's impossible that all the good things will be yours."
Chapter completed!