Zhou Litao still had questions to ask, but when he saw the patient's family looking at him, he held back and did not continue.
When they arrived at the CT room, they still had to wait for a while. The CT doctor explained the situation to the patient behind him and added the emergency patient into the room.
The other patients also understood. When they saw that the patient was lying on a stretcher trolley with three doctors and a nurse beside him, anyone would think that the patient was not going to make it.
There were also people who were unreasonable and didn't consider others, but they weren't common.
It was just that it had become normal for him to have more contact with them in front of the Emergency Department's window.
After sending the patient into the CT room, they went to the operating room.
Zheng Ren did not do it. After all, it wasn't good to always overstep one's authority. He stood quietly behind the doctor in the CT room and looked at the scan.
"Boss Zheng, the patient doesn't have a bloody stool. I'm thinking that if the diagnosis is an isolated superior mesenteric artery dissection, it's better to treat it conservatively." At this time, there were no family members of the patient, so Zhou Litao immediately expressed his thoughts.
Su Yun raised his eyebrows. Just as he was about to retort, Zheng Ren nudged him with his elbow and said with a smile, "If there are no thrombosis in the lumen, conservative methods should be fine. After all, the dissection pressure of the superior mesenteric artery is relatively low and incomparable to the aorta. "
Zhou Litao was also a little confused. Didn't Boss Zheng suggest surgery just now? Why did you change your tune so quickly?
"It's just a possibility. Cui Lao asked, so I told him." Zheng Ren smiled and said, "Each has its own advantages. As for surgery, it can avoid the possibility of undetected intestinal necrosis and other complications. If it's conservative, it can reduce the damage caused by the surgery and save money for the patient and the patient's family. "
These words were really smooth. Zhou Litao didn't know how to respond.
"Let's look at the diagnosis first. We'll listen to the patient's family on what to do," Zheng Ren said.
The 64-slice CT scan took a long time, and the patient's abdominal pain and agitation were obvious. Therefore, it took half an hour before the patient was wheeled out.
Then, Zheng Ren said, "Chief Zhou, you can push the patient back first. I'll see the results of the reconstruction."
Seeing that Zhou Litao had left, Su Yun asked in confusion, "Boss, this guy talks too much."
Zheng Ren felt that Su Yun had said the opposite. It was not that Zhou Litao was talkative, but that he was talkative. He smiled and said, "I'm telling the truth."
"Tsk." Su Yun said disdainfully, "The pain of the interlayer is not something an ordinary person can endure. I met a patient and asked him after the surgery. He said that the pain felt like there was a knife stirring in his chest. At that time, he didn't want to live anymore. If I could just die, I'd rather just die. "
"Yes, we still have to do the surgery if we can. I also don't agree with conservative treatment," Zheng Ren said.
"Then why didn't you attack him?" Su Yun expressed his disdain for Zheng Ren's good-natured attitude.
"It's meaningless. This kind of patient can't be accepted into our department. The General Surgery Department should be more experienced," Zheng Ren said. "If we need to go on stage, we'll do it. If there was no need, the vascular department could also do it. Arguing with the emergency department's chief resident in the CT room, do you have nothing better to do? "
"You're acting with your tail between your legs." Su Yun looked at Zheng Ren with a faint smile and said, "Is there a need to be so low-key?"
"This is what it means to keep a low profile. Didn't you say you didn't want to go to the emergency department? Why are you still so arrogant? "Zheng Ren asked.
"…" Su Yun was speechless.
This was really a dilemma. He thought about it carefully. Zheng Ren's words made sense, but he did not agree.
It was really suffocating.
"There are two views in the academic community, surgery and conservatism. However, I'm still inclined to surgery. The specific situation will be analyzed. If it's conservative treatment, there's a risk of recurrence, "Zheng Ren said." This point can only be determined after the CTA of the 64-row blood vessels is out. "
Su Yun nodded and quietly watched the doctor in the CT room perform the examination. The black hair on his forehead fluttered weakly.
Because it was an emergency, the 64-row CT three-position reconstruction was completed quickly.
The superior mesenteric artery had a true and false double lumen. There was no thrombosis in the true lumen, but thrombosis could be seen in the false lumen.
The false lumen was not big enough and compressed the blood vessels, causing the superior mesenteric artery to occlude.
The superior mesenteric artery supplied all the small intestine and two-thirds of the large intestine. Once it was ischemic, it would cause ischemic pain in the small intestine.
In Sea City, Zheng Ren had performed a case of intestinal bleeding in a patient. Part of the superior mesenteric artery was embolized, and the small intestine was necrotized and removed.
However, the patient in the past wanted intestinal necrosis and found the bleeding point to remove. The current patient was trying to avoid this situation.
Judging from the patient's condition, surgery or not was a choice.
If he was in the emergency department of Sea City General Hospital, Zheng Ren would definitely not hesitate to explain to the family and perform the surgery. However, this was the 912. Zheng Ren only gave opinions on ambiguous matters and was not responsible for making decisions.
After sending the radiographic films back, Zhou Litao had already sent the patient to the General Surgery Department and was not there. Cui Lao inserted the radiographic films into the radiographic film viewer, put on his reading glasses, and carefully looked at each frame.
More than ten minutes later, Cui Lao said, "Little Zheng, what do you think?"
"It can be conservative, or …"
"I'm asking for your opinion, not asking you to kick the ball." Cui Lao was unhappy and glanced at Zheng Ren.
His hair was as white as snow, and his eyes were as sharp as knives.
"I suggest surgery," Zheng Ren immediately replied. "I observed on the way. The patient's pain threshold is relatively low, and his blood pressure control is not good. Although there is no thrombosis in the true lumen of the superior mesenteric artery in this kind of patient, the possibility of recovery will be further reduced if he is treated conservatively. "
Cui Lao did not say anything. He sat down and looked at Zheng Ren quietly.
"The surgery is also relatively simple. Just a stent will do. Superior mesenteric arteriography, PTA, and stenting. If the patient's family has no financial problems, he can be discharged after three days of observation after the surgery. "
"Yes, that's more like it," Cui Lao said. "Young people should be energetic. Don't pretend to be old and profound."
"…" This was the first time Zheng Ren had heard someone evaluate him like this.
Cui Lao was really different.
However, the difficulty of practicing medicine in his era could not be compared to now. The conflict between doctors and patients became more and more acute as medical treatment was pushed to the market.
"The patient has a history of smoking and high blood pressure. His blood pressure is not well controlled. Based on my experience, patients with a history of smoking basically can't be kept. Now, he has given low-molecular-weight heparin anticoagulation, prostodyl dilates blood vessels, and papaverine spasmolysis. Go to the General Surgery Department and prepare for surgery, "Cui Lao said.
Not only did he give a diagnosis, but he also determined the following treatment.
To Zheng Ren, it was very difficult to keep a history of smoking. This sentence was worth a lot of money. Such certainty did not sound like something a doctor would say.
However, Cui Lao said so.
This was a summary of his experience. Although this sentence was not rigorous, it was precisely because of this that it could not appear in the journal articles.
This was just a summary of Cui Lao's lifetime experience. It could not be learned anywhere else.
Zheng Ren's heart trembled. He nodded and bowed deeply.
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