Wu Yushu was soon received 19 beds in cardiac surgery. The doctor in charge of the bed was Zhang Wenfu, a senior attending physician.
Tao Mi intends to take the patient as a case to teach everyone.
Constrictive pericarditis is not well understood by many students. Most patients in cardiac surgery are cardiovascular diseases, and most of them are heart valve diseases. This chronic persistent pericarditis is still relatively rare.
Therefore, Tao Mi thought about it as a teaching ward round.
……
Qian Lin followed the graduate students around him, looked at the patient curiously, took out paper and pen, and began to take notes.
Clinical teaching is to cultivate a clinical thinking ability for the diagnosis and treatment of diseases.
Other doctors and students gathered behind, while Zhang Wenfu stood in front and asked about the medical history.
Zhang Wenfu is a little nervous!
After all, there was a script for teaching ward rounds in the past, and the situation of patients was memorized and kept in mind.
And this time it''s real.
I''m a little flustered for everyone.
What''s more, it is a rare patient with constrictive pericarditis in clinic!
At the thought of this, Zhang Wenfu muttered, don''t be ashamed
Behind him are the doctors in the whole department and a group of students... The most important thing is that director Tao MI is still staring behind him.
It would be a tragedy if!
Thinking of this, Zhang Wenfu began to collect detailed medical history.
I have to say that Zhang Wenfu is indeed an experienced old doctor. He collected patient information very comprehensively and soon got some meaningful clues.
But!
After asking about the medical history, Zhang Wenfu became more worried
Because this symptom is more like COPD! (chronic obstructive pulmonary disease).
Zhang Wenfu is a little flustered. It is very difficult to detect constrictive pericarditis by simple physical examination. It is a great test for a clinical doctor to grasp the signs of this disease.
Could it be... That the emergency physician made a wrong diagnosis?
At the thought of this, Zhang Wenfu''s eyes brightened. After all, there are many such cases in clinical practice. After all, the emergency department is a transit department. It is not rare to have an unclear diagnosis.
However, if you call the director in person, you should be diagnosed with constrictive pericarditis!
Forget it, just push it according to constrictive pericarditis.
All the signs of constrictive pericarditis kept coming up in his mind. He made up his mind and carried on step by step.
He can''t push back, can''t he retreat?
At the thought of this, Zhang Wenfu picked up the stethoscope and listened. This time, uh, the heart sound was indeed abnormal,
Then there is the percussion of the heart, which seems wrong. Well, the voiced world is a little big!
Then there is the physical examination
Until the end, Zhang Wenfu suddenly realized that this should be a constrictive pericarditis!
At this moment, Zhang Wenfu had to admire the doctor in the emergency department.
It is difficult for him to push down this constrictive pericarditis, but how difficult is it for others to diagnose it?
Thinking of this, Zhang Wenfu couldn''t help being curious. Who is it?
Is it director Li Baoshan?
Zhang Wenfu asked curiously, "do you know what disease you had before?"
Wu Yushu shook his head: "I don''t know. As Dr. Chen said, I may have had this old problem before, but I didn''t pay attention until Dr. Chen diagnosed me as constrictive pericarditis."
Tao MI is curious. How did Xiao Chen diagnose it?
Thinking of this, Tao Mi asked, "how did the emergency doctor diagnose you?"
Wu Yushu thought: "in the morning, there are many patients. Dr. Chen listened to his heart, checked his blood pressure, touched his stomach and said I might be constrictive pericarditis... Less than five or six minutes."
The people around were blindfolded.
Tao Mi swallowed her mouth. What can Meng Xi do to make a person progress so fast?
Tao Mi: "didn''t you do an ECG?"
Wu Yushu nodded: "well, no, Dr. Chen said he asked me to come and have a comprehensive examination after hospitalization."
Tao Mi said, "Xiao Zhang, please give me the doctor''s advice, improve the relevant examination as soon as possible, and continue to discuss this case tomorrow morning."
Zhang Wenfu nodded and gave the patient relevant examinations, including chest film, cardiac color Doppler ultrasound, abdominal B-ultrasound, ECG... And various physiological and biochemical examinations.
……
……
When he handed over his shift the next day, Tao Mi looked at Wu Yushu''s examination reports. All the signs showed that the patient was a constrictive pericarditis.
Tao Mi sighed with emotion, looked at the crowd and said, "Wu Yushu in bed 19 has been diagnosed with constrictive pericarditis, but... This has sounded an alarm for us."
"People''s emergency doctors can make a clear diagnosis of patients without passing the auxiliary examination, and let''s ask ourselves, Wu Yushu, can you be sure by physical examination and consultation alone?"
In a word, everyone was silent.
Zhang Wenfu couldn''t help blushing. To tell the truth, if he didn''t know in advance that it was constrictive pericarditis, could he diagnose it himself?
Not only Zhang Wenfu, but also the people around him couldn''t help reflecting.
Maybe?
Tao Mi looked serious and said seriously, "as a clinical doctor, if you go to the grass-roots level and go to the countryside, not to mention CT, MRI, even if you don''t have B-ultrasound, X-ray or even ECG machine, you come to a patient. You only have a sphygmomanometer stethoscope. Can you make a judgment? Can you give a relatively accurate answer to the patient?"
Speaking of this, Tao Mi even felt a little disappointed.
Now many doctors have lost the ability to think independently and rely on instruments and examinations to see a doctor. Who can''t see a doctor like this?
"I''m not saying that everyone is not good enough. I think every doctor, since you have clinical practice, you must improve yourself. Instrument examination is a good thing and can help us make a better diagnosis. However, you must not forget some basic clinical operations."
"Otherwise, other patients will laugh at us and leave the instrument. Will you see a doctor?"
Tao Mi''s voice improved a little when he said the last sentence!
This sentence echoed in everyone''s mind for a long time.
"Will you see a doctor when you leave the instrument?"
Doctors can''t help clenching their fists. This sentence is really like a needle penetrating into their hearts.
The whole office was silent.
Tao Mi looked around and suddenly said loudly, "starting next week, a small ward round will be held once a week, starting from the auscultation of the heart. I need you to remember the auscultation sound of each disease!
A stethoscope can tell us a lot of clues. This is all experience. Now look at yourself. How many of you wear a stethoscope every day? Some people don''t wear a ward round stethoscope. Do you look like an extracardiac doctor? "
After that, Tao Mi said with a black face, "OK, break up!"
Regardless of the crowd, get up and go.