Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

The people next to him who had never seen this technique were of course moved by it.

After all, everyone knew that there would be bleeding after the knife was cut, but Dr. Lin hardly saw any bleeding when the knife was cut.

This situation is indeed rare!

As for the surgical plan for this case, Lin Yi already had a well-thought-out plan.

Subarachnoid hemorrhage has a high disability rate and mortality rate, and its surgical treatment mainly includes craniotomy clipping and endovascular embolization.

Compared with traditional craniotomy and clipping, Lin Yi's treatment option this time is endovascular embolization.

This treatment plan has the advantages of high success rate, less trauma, short operation time and quick recovery of patients.

Before the operation, in order to ensure the smooth progress of the operation and avoid spasm of the cerebral vessels in the child, Lin Yi first used the calcium channel blockers nimodipine and fasudil to relieve the cardiovascular system of the patient with aneurysmal subarachnoid hemorrhage.

After doing this, Lin Yi turned around and asked.

"Anaesthetist, how is the patient's condition now?
Is it ready for surgery? "

The anesthesiologist glanced at the ECG monitor and said.

"no problem!

The child is now in stable condition and you can start the operation! "

Afterwards, Lin Yi routinely disinfected and spread drape on the right groin of the child, performed local infiltration anesthesia on the puncture site, and then inserted a 6F arterial sheath into the right femoral artery with a puncture needle.

Then he spoke to the anesthesiologist.

"The whole body of the patient is heparinized, the first dose is 1000U, and then an additional 500U of heparin is added every hour to prevent thrombosis, and the pressure drip is continued.

The anesthetist nodded understandingly and said.

"No problem! Dr. Lin!"

After that, he will use the 6F guiding catheter wire to pass through the incision just now, send the clipper to the child's medial carotid artery, and then perform the clipping operation.

The operating room was so quiet that even a needle could be heard falling.

Lin Yi took a deep breath and prepared to insert the wire into the incision.

At this time, I heard someone next to me saying.

"Please wait!"

Lin Yi was taken aback, then turned around and asked.

"What's wrong?
The person who spoke was Liu Tianning, the deputy director of brain surgery in the operating room who had just arrived.

"Dr. Lin, why didn't you wait for the brain surgeon to come to start the operation? You're just fooling around to operate on the patient like this!"

Lin Yi looked at Deputy Director Liu and said.

"The reason why I chose such a surgical plan is also because the patient is too young to be able to afford the general surgical plan."

Director Liu sneered and said:

"Then your plan must be reliable!"

After hearing Director Liu's words, the other doctors were all shocked.

Could it be that the surgical plan used by Lin Yi was wrong?
The patient's condition was urgent, and the anesthesiologist had a hard time stabilizing the patient's signs.

In the end, unexpectedly, Cheng Yaojin came out halfway, and Director Liu of the brain surgery actually called to stop the operation at a critical moment.

Rather than saying that Lin Yi carelessly disregards human life, it is better to say that Director Liu is arrogant.

If Lin Yi didn't have such confidence, he would never have taken this operation hastily.

However, Director Liu's attitude is very firm now. He thinks that Lin Yi's actions are harming others and delaying the patient's condition.

After all, in traditional medicine, a patient with such a condition must have a craniotomy!

And regardless of age, even a child who is waiting to be fed will have to have a craniotomy when encountering such a disease.

This is the standard protocol for treating this condition.

And this young doctor in front of him, and a doctor in the emergency department, what qualifications does he have to perform surgery here?

In terms of orthodoxy, he, the deputy director of brain surgery, is a professional doctor and a professional doctor.

And what about the doctors in the emergency department?

Generally speaking, don't doctors in the emergency department just hang the patient's life, and then transfer to other specialties for treatment?

So, what is the situation now?
This is not a disregard for human life, what else can it be?
Even though he had heard of Lin Yi's name before, he didn't take it seriously.

Therefore, he insisted on changing to another doctor from their department to perform the operation.

Deputy Director Liu's attitude surprised the other doctors in the operating room.

Perhaps, what Director Liu said is also correct?

Because according to common sense, it seems safer to switch to a specialist doctor for surgery than Lin Yi.

Moreover, I feel that the specialist doctor mentioned by Director Liu is indeed more suitable for this kind of operation than the emergency doctor, and it is indeed dangerous for the emergency doctor to perform this operation.

After all, the patient is already on the verge of death in this state, and switching to the emergency department to perform this operation is like playing with fire, which can easily cause unknown accidents and lead to the failure of the operation.

If Lin Yi is really desperate, this kind of operation is really dangerous.

But this danger did not affect Lin Yi.

On the contrary, Director Liu's words just now made Lin Yi speechless.

He asked back:

"Director Liu, why are you so sure that my surgery is wrong!

Medicine is also constantly advancing, and traditional treatment options also need to be continuously improved and evolved.

You will not always stick to the original surgical plan and rigidly apply it to patients, right?

Director Liu, why are you so sure that my operation was wrong!

Medicine is also constantly advancing, and traditional treatment options also need to be continuously improved and evolved.

You will not always stick to the original surgical plan and rigidly apply it to patients, right?

Such an approach is useless. Not only will it not save lives, but it will only treat patients as repeated products in your hands.

On the other hand, the surgical plan I proposed seems to be somewhat different from the traditional surgical plan, but this plan not only has a small wound, quick recovery, and more importantly, there are almost no complications.

Isn't such a surgical plan more suitable for children?

Do you want the child to face the future life with huge wounds for the rest of his life? "

Doctor Liu on the side persuaded:
"Director Liu, don't get excited!
I think Dr. Lin is right. After all, he has done so many operations before without any problems.

Moreover, the procedures of his operations are very surprising.

Therefore, I think at this time, it is indeed time to consider accepting new technologies and new solutions. "

After listening to Dr. Liu, Director Liu snorted coldly.

"The hospital has its rules and regulations. This is a brain surgery patient, so it has to be handled according to the rules of the brain surgery!"

Director Liu said coldly.

"Now these young people just don't have any discipline and dare to do anything. They are really a bunch of lunatics.

It is because he is not a doctor in our department, otherwise, I must deal with it seriously. "
In this regard, Lin Yi felt that it was meaningless to continue to entangle with Director Liu.

So, he said to Director Liu.

"Director Liu, here, I am the chief surgeon, and I also take full responsibility for this operation.

As for the surgical plan, it was decided by me, and the responsibility was also borne by me.

Now, the operation is about to begin, please leave the operating room immediately for irrelevant personnel. "

Lin Yi's words were very decisive.

Director Liu didn't expect Lin Yi to be so strong for a while, and he was stunned speechless in front of everyone.

He stretched out a finger, pointed at Lin Yi and said.

"you are vicious!"

After Director Liu finished speaking, he turned and left.

In the operating room, after Director Liu left, Lin Yi immediately began to operate on the child.

First suture the damaged blood vessel gap, and then use a 6F guiding catheter to the internal carotid artery on the affected side with the cooperation of the guide wire, as close to the lesion as possible.

Then, in parallel with [-]D reconstruction, the diameter, size, width of the artery and the positional relationship of the surrounding collateral vessels were measured again.

Then, based on the measurement data, a covered stent was first selected and placed in the distal neck of the child's arterial damage point, and the balloon was slowly inflated for about 10 seconds to keep the stent fully expanded and released.

Then, angiography after deflation of the balloon showed that the intracranial aneurysm completely disappeared and the artery was unobstructed.

In this way, the operation ended smoothly and the child was safe.

Everyone was amazed!

Still have to trust Dr. Lin!

After returning to the consultation room, Lin Yi asked Wang Qiaoya and Chen Qiang to come too.

The door was opened, and a middle-aged man in his 40s came in pushing a wheelchair.

A middle-aged woman about his age was sitting in the wheelchair.

However, the woman had a thin face, and her legs slumped in the wheelchair had obvious muscle atrophy.

This is caused by not walking for many years and not exercising the calf muscles.

So immediately, several people in the consultation room could tell that this patient should be a paralyzed patient.

However, when Lin Yi looked at the patient's abdomen, he couldn't help frowning.

"Doctor... Please help me, my wife said she has an upset stomach."

As soon as Wu Jiang heard this, he put on gloves and prepared to palpate.

Lin Yi turned to look at Chen Qiang and Wang Qiaoya and said:

"You two also wear gloves and observe with Dr. Wu."

"Ok."

The two stood up and followed Wu Jiang to palpate the patient's abdomen.

"What have you eaten recently? Have you had diarrhea? Have you had X life?"

Wu Jiang asked while palpating.

When female patients are not clear about the abdominal pain point, they should consider whether it is the problem of the uterus and its appendages.

If it is a problem with the uterus and its appendages, then a woman who is paralyzed and has her husband to take care of her should ask if she has an X life.

**Abdominal pain may also occur with ascending infection.

If it is not the problem of the uterus and its appendages, the stomach or appendix, liver and gallbladder should be considered.

When the family members heard Wu Jiang's question, they felt a little embarrassed.

"She ate normal meals, three meals a day, and didn't eat too spicy food... She didn't have diarrhea, but she didn't poop for several days. If she lived in X... this... Yes, but this is the same as Is it related to her abdominal pain?"

Wu Jiang nodded:

"Maybe, women have a little more abdominal pain than men, sex life is the only way to cause women's genital infection to cause pain, so I'm asking.

And you said she hasn't had a bowel movement for several days?Specifically how many days? "

Haven't had a bowel movement for several days?

Then it may not be a problem with the uterine appendages, but a problem with the intestines.

The family members were thinking carefully, and the patient in the wheelchair said slowly:

"I... I haven't stretched for seven days... for seven days."

Wu Jiang was taken aback: "Seven days?"

As he spoke, he stretched out his hand and pressed a few times on the patient's abdominal intestine.

It's really tough!

And the patient also feels pain when pressing.

"The abdomen is bloated and still very hard. Go find a CT first to see if it is blocked by feces. If it is, I will prescribe two bottles of Kaiserutone for you and you will be fine."

If it is constipation, it can be cured a little bit, but if it is constipation caused by intestinal obstruction, it will be troublesome.

Unexpectedly, the family members immediately said:

"No, doctor..."

Wu Jiang raised his head: "What's wrong? Kai Sailu?"

The family members nodded: "She has been paralyzed for more than ten years. I know all about Kaisailu. Since she was paralyzed, she can't move her lower body. She lacks exercise for a long time, and she often can't poop for two or three days.

So there are a lot of Kaiserol at home, but after I used two for her last night, she only pulled out a little bit, which was about the size of sheep droppings.

I didn't believe in evil and used two more this morning, but I still didn't get much out, so I pulled out the length of my little finger.

In addition, she started complaining about her stomach ache yesterday, so I thought about taking her to the hospital. "

Lin Yi nodded in understanding at this moment.

No wonder I saw a stomach full of excrement when I came in...

Dare it be that Kaiseru is not working well and wants to go to the hospital for an enema? ?

"Okay, it might be constipation, but let's do a CT scan to find out the specific cause of the pain. It's safer." Wu Jiang said.

The family members also nodded: "Okay, let's have a CT scan."

Soon, the family members pushed the patient outside for an examination.

After the two left, Wu Jiang said with emotion:
"Oh, let me go, this woman's stomach is so hard! There must be a lot of shit!"

"So the stomach with seven days of constipation is this kind of touch?" Chen Qiang looked at his hands and said softly.

Lin Yi glanced at the two interns and asked:

"Chen Qiang, let me ask you, what diseases are most common in abdominal palpation with hard lumps or plate-shaped abdomens?"

Chen Qiang's face froze!
I just touched my belly and I will be questioned, right? !

"Um……"

After thinking about it, Chen Qiang replied:

"A hard lump on palpation may be constipation. Of course, if it is a plate-shaped abdomen, it means that the rectus abdominis is in a state of tension. Generally, the tension of the rectus abdominis is usually caused by inflammation, peritonitis, perforation of the digestive tract or simple gastroduodenal perforation. , are all possible.”

Lin Yi nodded with satisfaction.

Not bad, can answer up.

After a while, another middle-aged woman with a child came in. As soon as she came in, she said nervously:
"Doctor, my child has a fever! Prescribe some antipyretics, doctor!"

Lin Yi frowned. The child looked like he was only over one year old, and he could only consider taking medicine if he had a particularly severe fever.

Generally, if the temperature is below 38.5, physical cooling can be tried, and if physical cooling fails, then medication can be considered.

Lin Yi asked Wang Qiaoya to take the child's temperature.

"Don't use a temperature gun, use the amount of mercury."

"Ok."

5 minute later.

The child's body temperature was 38.3°C.

Lin Yi: "Cough? No runny nose?"

Family member: "I have a little cough and a little runny nose, but the fever is the most serious. I started to have a fever yesterday. I used the child's fever-reducing patch at home, but it didn't work."

After thinking about it, Lin Yi said: "Your child's body temperature is 38.3, and generally below 38.5 we suggest trying physical cooling.

How about this, I will teach you a method of physical cooling, and then I will prescribe you acetaminophen drops and cough syrup.

If physical cooling is really ineffective, then take this medicine again. "