EFB Chapter 125 Offense is Defense!
Chapter 125 Offense is Defense!
Chapter 125 Offense is Defense!
There weren't many patients in the emergency room.
One in the internal medicine group and one in the surgery group.
There was a cacophony of footsteps, equipment, and carts near the patient's resuscitation bed, and a cacophony of voices from nurses and doctors.
The computer area where Guo Ziyuan and Ding Xianqi were sitting was neat and tidy.
Ding Xianqi understood Guo Ziyuan's meaning, but he still asked curiously, "Does this patient have any other special circumstances?"
Guo Ziyuan could see the arterial source of the pelvic hematoma, and Ding Xianqi could also see it.
Ding Xianqi felt that Guo Ziyuan was better and could probably see more.
Guo Ziyuan shook his head: "Master, special cases certainly exist, and there are definitely patients who are 'unexpected,' but not every patient will be like that."
"If there are more patients like this, the mortality rate in the emergency room will be much higher than the current figures suggest."
"No one would dare to falsify this number, would they?"
If every patient is considered a special case, how can the emergency department function properly?
What is called "unexpected" is actually "lesion" that is not diagnosed.
For example, before surgery, you only diagnose the patient with a fracture, but when you are about to perform the fracture surgery, you discover that the patient also has a severed nerve.
This was unexpected, "beyond the diagnosis."
Ding Xianqi nodded slightly, feeling as if he could do it too.
Soon, Peng Jingye stepped off the control panel.
He immediately called for a consultation, and doctors from various surgical departments arrived. As long as he completed the emergency hemostasis procedure, he would have completed the emergency rescue mission.
The task of treating diseases by specialists is a matter for specialists.
"Brother Ding, Xiao Guo, you've worked hard."
"The location was found very accurately, saving us time from blind exploration."
"Otherwise, there would still be some risks for the patient," Peng Jingye said with a forced smile as he washed his hands.
What are the benefits of accurate diagnosis of open wounds?
There are too many.
For patients with typical open wounds, you can only perform exploratory laparotomy.
Which blood vessels were damaged?
do not know.
Therefore, once you have located the hematoma, you should examine all the surrounding blood vessels as much as possible.
It's like comparing it to police officers handling a case.
Someone with supernatural abilities can tell you the killer's ID card!
The eyewitnesses only saw his back or the information that his left index finger was half broken.
The difficulty of handling these two cases is vastly different.
The more accurate the diagnosis, the more directly the operator can probe in the direction of the target. If it is found, the bleeding can be stopped immediately, reducing operation time and the amount of bleeding!
At this point, you're not worried about not knowing where to explore; your only concern is whether you're capable enough!
The probe wasn't fast enough, and the hemostasis wasn't precise or effective enough.
Instead of being completely lost and wandering around like a headless fly—
Guo Ziyuan's phone rang at just the right moment: "Teacher Peng, a patient has arrived at the control room, I have to go there—"
"Master, please continue your conversation with Teacher Peng."
After finishing his sentence, Guo Ziyuan strode away.
This was the first lesson Ding Xianqi taught Guo Ziyuan when he enrolled for his master's degree.
Once you're in clinical practice or in the hospital, the mission comes first!
It means that as long as you're on duty, even if I call you for help, you have to refuse!
Even if a family member is sick or elderly, or if it's an unexpected accident.
You also need to report first and ask your superiors to adjust the on-call doctor for you. You can only leave your post after the on-call doctor has arrived at the ward!
Don't gamble!
Don't gamble that everything is stable in the ward while you're away. Don't take that gamble!
Because you are alive, even if you have tried your best, but it is beyond your power, it is a matter of ability and fate.
You weren't there, something happened.
That was an absolute accident!
It's a matter of attitude and character, which could potentially ruin your career. No matter how much you've read, it could all be for naught.
"Brother Ding, you've taught this student really well." Peng Jingye looked at Guo Ziyuan's back and gave him a thumbs up.
Ding Xianqi shook his head: "Ordinary people can only absolutely abide by the rules and act within the rules."
"The mistakes our predecessors made have shaped our current need for caution."
Ding Xianqi continued, "Old Peng, let's get this straight up from the start."
"You can ask Guo Ziyuan for help, but that's just helping. If you dare to shift the blame onto him when it comes to dividing the responsibility, I'll risk losing this shirt."
"I have to put on a tough front too."
Ding Xianqi hadn't been in contact with any patients, so he wasn't wearing a mask. He twitched his tongue and pushed his cheeks up, saying, "I'm not saying this to you, I'm saying it to your director."
"Because I know my student, he wouldn't have come if you hadn't called him."
Ding Xianqi came to Yishi this time only to find Guo Ziyuan, not to support Guo Ziyuan.
Ding Xianqi now knows Guo Ziyuan's feelings and doesn't need to worry about Guo Ziyuan being abducted.
Ding Xianqi also learned along the way that the emergency room here was asking Guo Ziyuan to help look at the X-rays and assist in the diagnosis, so he had to go out.
You can shout as you please, but helping is helping.
Don't tell him that he made a misdiagnosis again—that's utter nonsense!
Peng Jingye frowned: "My goodness, Brother Ding, are you treating me like I'm not even human?"
"This Xiao Guo is, by all accounts, my junior apprentice. How could I let him suffer such a loss?"
"I know the principle that helping is a favor, and not helping is one's right."
After Peng Jingye finished speaking, he nudged Ding Xianqi again: "What's more, Xiao Guo helped me a lot."
"Brother Ding, you're also my good brother."
Ding Xianqi emphasized again: "I'm not saying this to you, I'm saying it to your director. Please remember to pass it on."
"Honest advice is hard to hear, so I won't go looking for trouble."
"If a real problem arises, then we'll have to escalate it to a much higher level —"
"Okay, okay—I know—" Peng Jingye knew that Ding Xianqi must really like his students, and he understood that even better.
"But to be fair, if Xiao Guo can't diagnose it, or if the diagnosis is wrong."
"And who in our entire city can point out this mistake?"
"Isn't it still the most authoritative diagnosis?"
"Even if we bring in people from the provincial level, what difference will it make?"
"Brother Ding, I personally witnessed the scene of all the directors of our hospital's radiology department shaking their heads."
Ding Xianqi said, "I'm just stating the facts."
Whether others can discern the additional diagnoses is a matter of their ability.
"Assigning blame is a systemic problem."
"If Xiao Guo is in the control room and something goes wrong with his operation, our Provincial People's Hospital will be responsible for explaining everything."
"We haven't said that on other levels, have we?"
Ding Xianqi really said some very ugly things, because he was saying them to Peng Jingye.
"Alright, alright—Brother Ding, that's enough."
"It's impossible for Xiao Guo to have an accident while he's in the control room—" Peng Jingye hadn't even finished speaking.
Guo Ziyuan's call came through.
Peng Jingye picked up the phone and turned on the speakerphone: "Xiao Guo, what's up?"
Guo Ziyuan's voice was urgent: "Teacher Peng, I don't think the patient who was just brought to our operating room is suitable for direct debridement."
"Why don't you contact the doctor in the emergency room, or come over and get another CTA scan for the patient?"
'
Peng Jingye had always known that Guo Ziyuan spoke in a rather tactful manner.
"Is there a problem?" Peng Jingye asked.
"I personally think there's a problem. This patient's abdominal trauma is only a minor issue!"
"It's best to have a bilateral lower extremity CTA scan."
Guo Ziyuan continued, "Or, Professor Peng, could you personally perform the wound cleaning?"
Peng Jingye glanced at Ding Xianqi a few times and cursed, "Even your master wouldn't dare to cheat me, and you dare to talk to me like that?"
"I'll call someone over right away."
After hanging up the phone, Peng Jingye called out to Qian Shuhang, "Director Qian, Xiao Guo called from the control room."
"A patient was sent to the wrong place and needs a CTA!"
Qian Shuhang, who was in charge of the rescue, immediately switched roles with Peng Jingye, who was rushing to operate the bed, upon hearing this.
As he ran out, he instructed, "Peng Jingye, take the patient directly to the emergency operating room."
"We have no other procedures to perform in the emergency room."
"Professor Ding, why don't you come with me?" Qian Shuhang thought for a moment and then invited Ding Xianqi to walk with him.
Once Qian Shuhang arrived at the control room, he immediately used his identity to his advantage.
After explaining the decision to continue the examination to the patient, he added, "Yes, I am the deputy director of the emergency department, and I am also an associate chief physician."
"Your current condition isn't suitable for direct debridement and suturing. Let's get a CTA scan!"
"I made the arrangements for you on my way here."
The patient was a young man in his early twenties. Upon hearing this, he instantly tensed up. Being so inexperienced, he even forgot his own identity: "Uncle, don't scare me!"
"I'm not kidding you!"
"Be a good boy and listen to me, we won't pay the fees yet—I'll take you to get a CTA—" Qian Shuhang said, leading the nurse to push the young man out of the operating room along with the bed.
Qian Shuhang didn't doubt Guo Ziyuan's words at all, nor did he ask any further questions.
We obeyed the order immediately.
Guo Ziyuan's record is "unbeatable"; so far, he has made zero mistakes.
Guo Ziyuan also spoke very little.
I'm never the kind of person who just raises questions but doesn't take responsibility for solving them.
Ding Xianqi didn't follow, but watched as Qian Shuhang and the others hurriedly led the patient out.
Ding Xianqi didn't notice An Yue's surprised, astonished, and puzzled look: "Do they usually do it this way?"
"If you discover a problem, are they the first to take over?"
This is what Ding Xianqi cares about.
Peng Jingye's agreement was just that—an agreement; time will tell.
Their behavior and response truly represent the attitude of the emergency department here.
Guo Ziyuan knew what Ding Xianqi was worried about, and slowly nodded: "Master, Director Qian and the others are usually like this."
"Even if they have other ideas, I won't agree."
Who is Guo Ziyuan?
He's an old man from Yicheng Central Hospital. He's been running around doing emergency consultations for ten years in his previous life. How could he possibly be tricked by the people here?
An Yue couldn't help but ask, "Dr. Guo, why does this patient need a CTA?"
Guo Ziyuan shook his head: "Everything is just speculation now, it's useless, let's wait for the results."
"So what's your guess about the diagnosis?"
"It seems you didn't explain things clearly to Director Qian and the others." An Yue is very good at studying.
To learn something, you have to keep asking questions until you get to the bottom of it.
Guo Ziyuan looked at An Yue, then at his teacher, and seeing that Ding Xianqi was also curious, he said, "Master, some things cannot be delayed."
"If I explain for too long, the situation might change."
"I suspect it might be a femoral artery dissection—"
"Of course, it could also be abdominal aortic dissection."
One of the most familiar and dangerous types of aortic dissection is aortic dissection.
In fact, besides aortic dissection at the heart, there are other types of arterial dissection.
These dissections are certainly not as dangerous as aortic dissections.
However, this is a disease that must be treated promptly.
Before the patient's films were taken away, Ding Xianqi and An Yue went to the patient's films upon hearing the sound.
Guo Ziyuan has already said it's femoral artery dissection, so they don't need to search extensively anymore; they just need to do confirmatory imaging to find a diagnosis!
Generally speaking, arterial dissection is diagnosed using more direct examination methods such as magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and arteriography.
However, an X-ray is usually taken before any aortic dissection is suspected.
A chest X-ray of aortic dissection may only reveal an enlarged mediastinal or aortic arch shadow, an irregular aortic shape, and localized bulges, which is very difficult to detect.
No one would use a chest X-ray to diagnose aortic dissection.
Of course, since it is one of the diagnostic imaging evidences, there are clues in Guo Ziyuan's case.
Guo Ziyuan didn't pretend to be profound, but said, "Fortunately, it's an anterior-posterior compartment, so there's some imaging on the abdominal X-ray."
"If it's a tear in the sagittal plane, then it's completely obscured!"
"In this situation, unless you can distinguish between three layers of artifacts and two layers, it's very difficult to find any signs!"
The information that a flat film can provide is very, very limited.
"Here, on the inner side of the artery, the shadow is separated."
"There wasn't much blood injected into the interstitial space either —"
"But this is a film from an hour ago —" Guo Ziyuan explained carefully.
After this explanation, Ding Xianqi did discover a faint artifact, but in An Yue's field of vision, it was still a blurry blur with no specific direction.
The patient never came back!
About twenty minutes later, an emergency room nurse came to the operating room and took away the patient's X-rays and medical record, which meant that Anyue no longer had the opportunity to complete the diagnostic verification.
Guo Ziyuan's main attention was on Ding Xianqi, and he didn't pay any attention to An Yue's confused expression.
Instead, they said, "Master, if we encounter this situation in the future, we should also pay attention to it."
"Otherwise, if we only discover it after the procedure, the patient might be gone."
"This patient simply doesn't have fractures or limb injuries. If it were just fractures or limb injuries, our trauma surgery department would be in trouble."
Ding Xianqi nodded, but his tone was relaxed: "What does the consultation with vascular surgeons have to do with our trauma surgery?"
Guo Ziyuan was speechless for a moment. After a brief hesitation, he finally said, "Master, wouldn't it be better if we could find it ourselves?"
"Although it has nothing to do with our department."
Sometimes, offense is the best defense.
Ding Xianqi suddenly felt a shiver run through his body.