When a doctor opened a plug-in

The case is not long.

Just a few words.

But a lot of information can be seen.

Doctors sometimes see only a few medical records.

The first is to find the cause based on the symptoms, and the second is to push the symptoms based on the cause.

The symptoms of the patient at this time do not seem to be difficult to have short legs.

In terms of symptoms, patients have sudden dizziness, weakness, etc. which should be manifestations of hypovolemia, but also have sudden abdominal pain, abdominal distension and other irritating symptoms of intra-abdominal bleeding!

Physical signs: pulse speed, low blood pressure, obvious peritoneal irritation, which should indicate intra-abdominal lesions.

The blood test showed that hemoglobin decreased progressively at the beginning of the onset, while MCV and MCH did not change significantly. Instead, Fib continued to be low and D-dimer increased significantly. These seemingly messy laboratory reports can clearly draw a conclusion. Meet the performance of acute blood loss!

So Chen Cang said directly: "Consider acute bleeding diseases!"

Chen Cang's diagnosis was almost immediately given after the case was finished.

Several directors looked sideways and admired them.

Although the diagnosis is not difficult, but... you need a certain level of acute bleeding so quickly.

But Chen Cang basically blurted it out, which shows the solid foundation of the other party!

Huang Qiuying couldn't help nodding: "Yes, since it is a bleeding disorder and pain in the lower abdomen, physical examination and imaging have found a solid mass in the pelvic cavity, and the patient has a history of gynecology, so I first consider Gynecological related diseases.

There are only a few diseases that can cause bleeding in gynecological diseases!

The first is pregnancy-related diseases: such as ectopic pregnancy, trophoblastic tumors, etc.;

The second is the rupture of ovarian or fallopian tube tumors;

Finally, the rupture of the ovarian endometriotic cyst."

Chen Cang nodded: "The patient has been menopausal for many years, and pregnancy-related diseases can be ruled out, and endometriotic cysts are also unlikely!"

Thinking of this, Chen Cang suddenly asked: "Did the patient fall?"

Cui Jisheng nodded: "Yes, but... it just slipped gently to the ground."

Sliding gently to the ground is not the same as a heavy fall.

Huang Qiuying said: "Before the diagnosis of bleeding caused by gynecological diseases is established, it is still necessary to rule out bleeding caused by other systems and other reasons."

As the director of general surgery, He Zhiqian said: "We have discussed before. Intra-abdominal bleeding in surgery is generally seen in organ damage."

"However, physical organ injuries such as liver, spleen, pancreas, etc., hollow organs such as stomach, intestine, and gall bile duct, etc.; in addition, vascular injuries such as abdominal aorta, inferior vena cava, etc. Generally these injuries are secondary In severe closed injuries or penetrating injuries, pelvic vascular injuries are mostly secondary to penetrating injuries, pelvic or lower limb fractures.

Therefore, the patient falls slowly to the ground after only minor activities, without obvious fractures, and generally does not cause damage to the above-mentioned organs and tissues."

He Zhiqian's words directly denied the possibility of the patient's organ damage.

Next, urology, hematology, endocrinology, and interventional departments began to discuss again.

Perhaps many people do not understand what a consultation is?

This is the consultation, where an inferential diagnosis is given, and then each department makes a diagnosis.

This is the advantage of division.

Every doctor is proficient in one field!

They are very good at diseases in their field.

Constantly reduce the possibility of patients.

An acute bleeding in the abdominal cavity may seem common, but now it is impossible to give a clear diagnosis.

In fact, this is medicine.

As one of the founders of Johns Hopkins School of Medicine, Sir William Osler said: "Medicine is an uncertain science!"

The discussion at this time became anxious again.

Urology rejected the possibility of damage to the bladder area of ​​the patient, and urology-related diseases are not considered for the time being.

The hematology department focuses on vascular damage. After all, long-term diabetes and other chronic diseases secondary to vascular disease can easily lead to bleeding.

Another round of discussions ended.

Everyone was silent again.

Generally speaking, the consultation is actually divided into steps.

If the situation is diagnosed, it is easy to say.

but……

If this is the case today, when everyone discusses it for a long time but cannot find the cause.

The consultation will not be wasted!

The consultation will gradually become a push-pot assembly.

After all, for such a difficult patient, the diagnosis is not clear now, let alone treatment.

In fact, it can only be said that the patient's condition is not bad.

If it is really critically ill, the first step may be a laparotomy.

Sometimes, imaging tests have limitations.

There must be bleeding, but the amount of bleeding is not great.

At this moment, the office fell into silence again.

Huang Qiuying was also decisive: "Notify the operating room to prepare for laparotomy!"

There is no point in dragging it down now.

At this time, Chen Cang was constantly thinking about various possibilities.

The routine diagnosis has been thought about completely, but...however, it doesn't match the patient's symptoms.

No wonder everyone had no results after an hour of consultation and discussion.

At this moment, Chen Cang suddenly said, "Can I go see the patient?"

Huang Qiuying turned and glanced at Chen Cang, only to realize that Chen Cang hadn't expressed any opinions since he came.

Everyone also thinks that this kid Chen Cang... won't come for a cutscene, right?!

But no one would force Chen Cang, after all, he was just a training doctor.

He is not responsible for giving or not.

but……

To be honest, these directors certainly do not believe that Chen Cang can give results.

Huang Qiuying saw that Chen Cang's serious look didn't seem to be pretentious, and she couldn't help but froze for a moment: "Okay!"

While talking, Huang Qiuying personally took Chen Cang to the ward.

An old lady in her sixties was lying on the bed, clutching her belly and moaning uncomfortably.

Seeing Huang Qiuying coming, and about to speak, suddenly saw Chen Cang!

Suddenly, the old lady's face flushed: "Professor Chen!"

The old lady's husband Cui Jisheng couldn't help but said, "My wife, don't worry, Professor Chen can definitely diagnose it!"

The old lady nodded and suddenly felt that her stomach no longer hurts so much: "Yes, yes! I believe Professor Chen!"

Chen Cang also sighed, the pressure is great!

Only love and trust cannot be disappointed!

The directors around had different expressions.

If Chen Cang really had a clear diagnosis, he would be really capable.

But... to be honest, if this disease is really so simple, it won't be so simple now.

This kind of bleeding is absolutely rare!

Sure enough, after Chen Cang palpated, he also fell into a deadlock, and he couldn't get an accurate answer for a long time!

However, Chen Cang's eyes are not perspective after all.

There is no way to see the situation in the abdominal cavity.

The patient's pelvic hematoma seems to be an unsolved mystery.

Time goes by every minute!

Chen Cang also racked his brains to think!

What are the acute abdomen?

His mind is like a search engine, constantly bringing in, thinking, and speculating.

Chen Cang suddenly thought of something, and said quickly: "Be a venous color Doppler ultrasound!"

Huang Qiuying frowned: "The upper and lower limbs? What's the point?"

After hearing Chen Cang's words, the doctor of the intervention department couldn't help but his eyelids twitched!

"Yes, be a color Doppler ultrasound!"

Hearing that the intervention doctor happened, Huang Qiuying was not blocking it either.

The gynecology department itself has ultrasound, and the results came out soon!

Color Doppler ultrasound of the upper and lower limbs also suggests thrombosis in the right femoral and popliteal veins!

Everyone who saw the result was a little at a loss.

But Chen Cang was scared and sweating!