Chapter 915: Hidden Meaning
Zhou Litao still had some questions to ask, but when he saw the patient’s family members looking over, he held back and did not continue.
When he came to the CT room, he waited for a while. The CT doctor explained the situation to the patient behind him and added in the emergency patient.
The other patients also understood. When they saw that the patient was lying on a stretcher trolley with three doctors and a nurse by his side, everyone felt that the patient was going to die.
There were also people who were unreasonable and inconsiderate, but they were not common.
It was just that in front of this window in the Emergency Department, they had a lot of contact, so it became normal.
After sending the patient into the CT room, a few of them came to change shifts for the operation.
Zheng Ren also did not get the hang of it. It was not good to always overstep one’s authority. He stood quietly behind the doctor in Room C and looked at the radiographic films.
“Boss Zheng, the patient has no bloody stool. I’m thinking that if the diagnosis is an isolated superior mesenteric artery dissection, conservative treatment is better.” At this time, there were no family members of the patient around, so Zhou Litao immediately voiced his thoughts.
Su Yun’s eyebrows shot up. Just as he was about to retort, Zheng Ren’s elbow gently touched him and he said with a smile, “If there is no blood clot in the lumen, conservative treatment is not a problem. After all, the pressure of the superior mesenteric artery dissection is relatively low. It can’t be compared to the aorta.”
Zhou Litao was also a little puzzled. Boss Zheng suggested surgery just now, right? Why did he change his mind so quickly?
“It’s just a possibility. Cui Lao asked, so I said it.” Zheng Ren smiled and said, “Each has its own advantages. As for the surgery, it can avoid the possibility of the patient’s large intestine necrosis and other complications that cannot be detected. If it is conservative, it can reduce the damage of the surgery and save money for the patient and the patient’s family.”
These words were really tactful. Zhou Litao did not even know how to respond.
“Let’s look at the diagnosis first. We still have to listen to the patient’s family about how to do it,” Zheng Ren said.
64-slice CT scans took a long time. In addition to the patient’s abdominal pain and obvious restlessness, it took half an hour before the patient was pushed out.
Then, Zheng Ren said, “Chief Zhou, you can push the patient back first. I’ll look at the reconstruction results here.”
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 talked too much, but that he talked too much. He smiled and said, “What he said is true.”
“Tsk.” Su Yun looked down on him. “The pain in the interlayer is not something that an ordinary person can endure. I once met a patient. After the surgery, I asked him, and he said that the pain was like a knife stirring in his chest. At that time, he did not want to live anymore. If he could die directly, it would be better to die.”
“Yes. If we can do the surgery, we still have to do it. I don’t agree with conservative treatment either,” Zheng Ren said.
“Then why don’t you go against him?” Su Yun expressed his disdain for Zheng Ren’s kind attitude.
“It’s meaningless. This kind of patient can’t be accepted into our department. He should be more experienced in general surgery,” Zheng Ren said. “If we need to go on stage, we can do it. If we don’t need to, the Vascular Department can do it too. In the CT room, fighting against the chief resident of the Emergency Department? Don’t you have nothing better to do?”
“You’re hiding your tail between your legs.” Su Yun looked at Zheng Ren with a faint smile and said, “Is there a need to keep such a low profile?”
“This is a hidden low profile. Besides, didn’t you say that you don’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 were very reasonable, but he did not agree with it.
He was really holding his breath.
“There are two views in the academic world, surgery and conservatism. I prefer surgery. I will analyze the specific situation. If the treatment is conservative, there is a risk of recurrence,” Zheng Ren said. “This can only be determined after the CT is done.”
Su Yun nodded and quietly watched the doctor in the CT room do a check-up. The black hair over his forehead fluttered weakly.
Because it was an emergency, the three-person reconstruction of 64-slice CT was completed very quickly.
The superior mesenteric artery could be seen as a true and false double lumen. There was no thrombus in the true lumen, and thrombosis could be seen in the false lumen.
The false lumen was not large enough to compress the blood vessels, causing the superior mesenteric artery to be occluded.
The superior mesenteric artery supplied blood to all the small intestine and two-thirds of the large intestine. Once there was ischemia, it would cause ischemic pain in the small intestine.
Zheng Ren had done a case of intestinal bleeding in Sea City. He embolized part of the superior mesenteric artery and took the initiative to let the small intestine die and be excised. This was the reason.
However, the former patient wanted the intestine to die and find the bleeding point to be excised. Now, the patient wanted to avoid this kind of situation.
Judging from the patient’s condition, to do surgery or not was depended on two different things.
If this was the Emergency Department of Sea City General Hospital, Zheng Ren would definitely tell the family members without hesitation and go on stage for the surgery. However, this was the 912. Zheng Ren only gave his opinions 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, but he 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 one by one.
After more than ten minutes, Cui Lao said, “Little Zheng, what do you think?”
“It can be conservative, or it can be…”
“I’m asking for your opinion. I’m not asking you to play football.” Cui Lao was displeased. He glanced at Zheng Ren.
His hair was as white as snow, and his gaze was as sharp as a knife.
“I recommend surgery,” Zheng Ren immediately replied. “On the way, I observed the patient. The patient’s pain threshold is relatively low, and the blood pressure is not well controlled. Although there are no thrombi in the true lumen of the superior mesenteric artery in this patient, conservative treatment will further reduce the probability of a good recovery.”
Cui Lao did not say anything. He sat down and looked at Zheng Ren quietly.
“The surgery is also relatively simple. The next stent will do. Superior mesenteric arteriography plus PTA plus stenting. If the patient’s family finances are fine, the patient 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 heard someone criticize him like this.
Cui Lao was really different from the rest.
However, the difficulty of practicing medicine in his era could not be compared with the current situation. The conflict between doctors and patients became more acute as medical treatment was pushed into the market.
“Patients who have a history of smoking and high blood pressure have blood pressure control that is not good. Based on my experience, patients who have a history of smoking basically can not be saved. Now that we have given low-molecular-weight heparin as an anticoagulant, Alprostadil as a vasodilator, and papaverine as an antispasmodic, you should go to the General Surgery Department and prepare for the surgery,” Cui Lao said.
Not only did he give a diagnosis, but he also confirmed the following treatment.
To Zheng Ren, the phrase ‘It’s hard to be conservative and successful if you have a history of smoking’ was worth a lot of money. It did not sound like something a doctor would say with such certainty.
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.
This was only a summary of Cui Lao’s life experience. He could not learn anything else from it.
Zheng Ren’s heart skipped a beat. He nodded and bowed deeply.