Since 1981 Health School Chapter 617

   "There is really a possibility that we are not putting to death."

  When Chen Qi said this, the eyes of everyone at the scene lit up, including Li Huacheng, the director of the emergency department who was still arguing just now, and even Dean Bian, who had been calm all along, showed hope in his eyes.

  The big leader also sat up straight all of a sudden:

   "Dean Chen, what do you say?"

  Chen Qi took out the medical records, looked at the doctor in Ziguang Hospital and said:

   "When the patient came to the emergency department of the hospital, was it just abdominal pain, or was it accompanied by chest pain?"

  Everyone didn't know, so all eyes were on the emergency doctor of Ziguang Hospital.

  Li Huacheng thought for a while: "The main complaint is abdominal pain, and it is a sudden abdominal pain after overeating. It seems that there is no chest pain, right?"

   Li Huacheng said that he was not sure, and looked at the other doctors in the emergency department, which caused Chen Qi to frown again.

   At this time, a young doctor in the emergency department raised his hand weakly and said:

"When the patient came to the hospital, he was in extreme pain, and his speech was a bit slurred. At that time, he covered his stomach with his hands and said abdominal pain. He did mean abdominal pain, but I vaguely heard the patient still say Chestpain, which means chest pain. .”

  Foreigners can't speak Chinese, but there are many special terms in medicine, and ordinary small translations are not accurate at all.

  It was like when Chairman Chapman Webster had a sudden illness and was sent to the emergency department. A large group of people surrounded him in a mess, and Chapman Webster himself could not speak clearly because of the pain.

  So the translator only saw Chapman Webster clutching his stomach, and directly translated an abdominal pain, forgetting to turn over the chest pain.

  When the little doctor said that the foreigner patient mentioned "chest pain", there was another uproar at the scene.

  Because all the treatment measures targeted by Ziguang Hospital are based on "abdominal pain", but abdominal pain and chest pain are two completely different concepts, which shows that the emergency department may have mistaken the direction at the first time.

  Chen Qi thought that his guess might be accurate, so he continued to ask:

"Let me make a joke for everyone first. Listen to the symptoms I describe. A patient suddenly had severe pain in the chest, back or abdomen. The pain was like tearing, accompanied by dizziness, difficulty in moving, and slurred speech. He was rushed to the hospital. Admitted to the hospital, guess what went wrong?"

  A doctor was the first to speak: "First consider that there is a problem with the heart, such as myocardial infarction or angina pectoris."

   Another doctor also spoke: "Dizziness, difficulty in moving, slurred speech, and cerebrovascular stroke cannot be ruled out."

   "Severe abdominal pain, and a history of overeating, gastric perforation, acute pancreatitis and other digestive system diseases cannot be ruled out."

   All of a sudden, there was a lot of discussion in the meeting room, but no matter whether it was the big leader or Professor Cheng Bangwu, everyone had a carrot on their head and their minds were full of question marks.

  Professor Cheng could not help asking:

"President Xiao Chen, the symptoms you just mentioned are indeed the symptoms of this foreigner when he was admitted to the hospital, but as analyzed by so many colleagues, there are many reasons. Some say heart and brain stroke, some say digestive system. Yes, and the respiratory system cannot be ruled out.

  So many systems are possible, and now the deceased cannot undergo an autopsy. All speculation is actually useless. What we need is to produce solid evidence to prove that Chapman Webster's death has nothing to do with our Ziguang Hospital. "

   Chen Qi was there, shook his head slightly and said:

   "Professor Cheng and everyone, don't worry, I have listened to so many analyzes from you, and there is a disease that no one has thought of, and this is precisely one of the most common complications of gastroscopy."

   "What?" Everyone shouted.

   "Dissecting Aneurysm..."

   "Dissecting aneurysm?"

  Hearing this term, most of the doctors in the conference room were at a loss, and the doctors present were almost the most powerful group of doctors in Guangnan Province.

  Chen Qi blinked, eyes full of confusion, "Haven't you heard of dissection aneurysm? What about aortic dissection?"

   "Oh~~~It turned out to be aortic dissection~~~"

   At this time, a small number of doctors were suddenly enlightened. Obviously, they had heard of this disease and understood it.

  Why do most experts and professors not know about aortic dissection? In fact, this disease has not yet been included in textbooks, and everyone did not learn about it when they were in school.

   And this disease is very dependent on auxiliary examinations, such as intravascular ultrasound, enhanced CT, magnetic resonance imaging, etc., and there are few such advanced equipment in China.

  So even if doctors have encountered patients with aortic dissection in clinical practice, they often do not think of the existence of this disease because there is no auxiliary examination verification.

   Several doctors who knew about aortic dissection were a little complacent. After all, they only learned about this disease through foreign medical journals. Others did not know, but they knew. This is the gap.

  So he chatted and introduced to the colleagues next to him.

  The big leader also knocked on the table when he heard the messy meeting room:

   "Everyone be quiet, let's listen to what Dean Chen explained first. In addition, can this disease of dissection really save us?"

  Chen Qi is not polite, knowing that he has to start from the beginning.

  So he stood up and came to a white wall. Under the distressed eyes of the staff, he began to draw anatomical diagrams on the wall with a marker.

   "Look, this is the heart. The aorta is connected to the left ventricle. As the largest artery in the human body, the heart sends fresh oxygen, blood and nutrients to the whole body through the aorta to every organ in the body.

The aorta emanates from the left ventricle of the heart, arches upwards to the right and downwards, and then descends along the spine, branching out into many smaller arteries in the chest cavity and abdominal cavity, which can be divided into three parts according to their journey: ascending aorta arteries, aortic arch and descending aorta.

  The descending part of the aorta is bounded by the septal aortic hiatus. The section above the aortic hiatus is called the thoracic aorta, and the section below it is called the abdominal aorta. The disease I am going to talk about today arises from these two sections of the aorta. "

  The experts and professors in various subjects in the conference room, at this time, seemed to be back in their student days, with clear stupidity in their eyes, listening to Teacher Chen's lecture.

  Even the lay leaders listened very carefully.

  My good fellow, this is a major issue related to 100 million US dollars and the country's reputation, so they can't help but pay attention to it.

  Chen Qi said to a J-shaped blood vessel written upside down:

"The aorta, all the doctors here know, the leaders may not understand, this part is actually the yellow throat that we often order when we eat hot pot, it tastes crunchy, everyone must have noticed that the yellow throat is very thick and full of blood Elastic, this is because it has to bear the huge pressure of the blood.

The aorta is divided into three layers, which are adventitia, media, and intima. The three layers were originally closely connected. The elastic muscle medium can prevent the rupture of the vessel wall, but there are various reasons, such as high blood pressure. Blood pressure, aortic atherosclerosis, etc., often lead to destruction of the aortic stroma.

  The consequence of the destruction of the stromal layer is that the aortic wall becomes thinner and thinner, which will cause the blood in the aorta to flow into the media of the aorta from the weak or torn part of the aortic intima, causing the media to separate from the intima.

Then the blood will stretch the aortic wall along the direction of the long axis of the aorta, forming a state where the two chambers are separated, and the aorta will expand outward like a balloon, filled with blood, everyone thinks, this is a What kind of state? "

  The doctors are all professional, and they will move immediately after such an explanation.

  A doctor immediately exclaimed:

   "This is a time bomb. Once the adventitia of the aorta can't support the pressure, it will burst instantly and cause massive bleeding."

  Chen Qi clicked on the talking doctor:

   "Yes, you guessed it right, and because this is the aorta, once the dissection ruptures, the consequence is that the patient will die instantly."

  The little doctor in the emergency department couldn't wait to raise his hand and said: "At that time, this foreigner died instantly."

  Professor Cheng is quite rigorous and raised another question of his own:

"I heard that foreigners still pay attention to their own health and have regular physical examination reports. For example, the deceased had a physical examination in December last year, but there was no description of relevant vascular diseases in the physical examination report. It is difficult to convince the family members of patients.”

  The leader also nodded silently: "Yes, if there is such a big hidden danger, how could the physical examination not find it?"

"Not always!"

  Chen Qi returned to his seat and continued to analyze for everyone:

  "Physical examination is a routine examination, and everyone who is a doctor should know that the doctors in the physical examination department are often relatively poor in the hospital. They don't know whether they understand dissecting aneurysm or aortic dissection. How to distinguish it?

  Besides, the onset of this disease is very insidious and generally not felt. Some stable dissections may cause dyspnea or chest and abdominal pain, and most dissections will not burst into severe pain until they rupture and bleed. "

  In fact, aortic dissection is also one of the intractable diseases in later generations, because it is difficult to be diagnosed at once, especially in small hospitals or doctors with two knives, so the misdiagnosis rate is very high, which directly leads to a high mortality rate.

  Experienced doctors will ask them to scan enhanced CT when encountering patients with chest pain and abdominal pain, and CT doctors can identify the condition of the aorta.

   At this time, it can be detected and treated early to avoid the most serious consequences.

  However, in Huaguo in the 1980s, CT was not popular, or doctors themselves did not understand this aortic dissection, and there was no way to detect it in advance.

  Look, most experts and professors in the conference room don't know about this disease. When they encounter such a patient, they will just miss the best opportunity for early detection.

  The big leader listened for a long time and understood half of it, and asked again:

   "Then what Dean Chen means, the patient's clinical symptoms are also consistent with a dissecting aneurysm?"

  Chen Qi nodded solemnly:

"Yes, because the patient's main complaint was chest pain, but our doctor didn't hear it clearly or understood it. Chest pain, abdominal pain, difficulty in moving, and slurred speech are consistent with the performance of aortic miscellaneous layers. Blood pressure diabetes is also an important underlying disease.

   There is another fatal point, that is, when the gastroscopy is performed, the patient's discomfort with the gastroscope causes severe vomiting. At this time, the blood vessel pressure in the human body will instantly increase, which is fatal.

  Didn't the doctor just say that this dissecting aneurysm is now like a time bomb, ready to explode at any time. At this time, the blood vessel pressure suddenly increases, and the consequence is that the blood vessel pressure directly squeezes the aneurysm to burst.

  Once a dissecting aneurysm ruptures, there is only one consequence, which is death in an instant due to heavy bleeding. "

  Boom~~~ Everyone in the conference room exploded again.

   "This explanation seems to be the most reliable."

   "I also think that this is consistent from the mechanism to the clinical symptoms."

   "Ashamed, it seems that we have to learn foreign languages ​​well, and read more foreign medical journals."

  Chen Qi is like a policeman, slowly analyzing the case for everyone, trying to find out the possible cause of the disease, so that everyone can understand it immediately.

  Seeing that everyone started talking again, Chen Qi, who had been talking for a long time, picked up his thermos and took a sip of the Coke inside.

  The big leader knocked on the table and fell into deep thought. It took a long time before he opened his mouth and said:

   "Dean Chen, your analysis seems to be reasonable, but there is still a question, can you find evidence from so many inspection reports so that the family members accept this conclusion and stop causing trouble?"

  Chen Qi pretended to smile faintly at this time, and he was short of a feather fan:

   "It's not difficult to find evidence, Dean Bian, you did a CT scan after the deceased was admitted to the hospital, and now you send someone to pull out the CT film."

  When Dean Bian heard that things had turned around, he hurriedly shouted to the staff of the hospital office: "Hurry up!"

  The staff ran away after hearing this. About 10 minutes later, the staff rushed into the meeting room with a few CT films.

   "Dean Chen, here it is!"

  Chen Qi picked up the film, and a group of experts surrounded him with a whoosh from behind, and the dean, regardless of his demeanor, squeezed desperately towards Chen Qi.

  As for the two unlucky doctors Li Huacheng and Zuo Yongxin, they didn't care about it at this time, they stepped on the table and looked at the CT film.

  Although the big leader couldn't understand CT films, he was also anxious and ran to Chen Qi's side.

  The conference room, which was still sitting in an orderly manner, was already surrounded by a large group of doctors with Chen Qi as the center.

  Chen Qi quickly read the CT film as soon as he got it, and then tapped the film, making a soft and crisp sound:

   "Yes, it really is a dissecting aneurysm."

  The other doctors were anxious: "Where is it?"

  Chen Qi pointed to one of the places and said:

   "Look here, you see, is the aortic root here much thicker than usual, and you look here, there is obviously a crescent-like protrusion here, which is a dissecting aneurysm.

  Unfortunately, this is not enhanced CT. If enhanced CT can clearly see the true lumen, false lumen, as well as the delamination and dehiscence, as well as the entire part of the aorta passing through, the existence of this fissure can also be seen. "

  Most of the doctors present were not vascular surgeons. Most of them were gastroenterologists because of previous abdominal pain and misleading endoscopy.

  So the reading of vascular CT is not so professional, but this does not prevent them from suddenly realizing it, otherwise it is so embarrassing to say that they don't understand it.

   "Oh~~So that's how it is~~~"

   "Really, Dean Chen really has sharp eyes~~~"

   "Principal Chen, I am convinced~~~"

  The big leader laughed when he heard this:

   "Now it is confirmed that it is a dissecting aneurysm. Does this mean that there is no problem with our rescue? We don't have to bear too much responsibility? There is no basis for their compensation?"

  Principal Bian excitedly squeezed his fists, Li Huacheng and Zuo Yongxin were already hugging each other and crying bitterly.

   Having solved a big case, Chen Qi is also in a happy mood:

   "The most important thing now is to immediately revise the medical records and add the diagnosis of aortic dissection, followed by a question mark. In addition, the medical history should also reflect the text description of the doctor's suspicion of dissection."

  The family members of the deceased still lack experience, because the incident happened suddenly, and the family members did not bring a lawyer with them.

  In the event of a medical dispute, the original medical records should be sealed up immediately under the witness of the hospital, family members, and lawyers, but Americans did not do this.

   This left a chance for Ziguang Hospital to cheat.

  Once the original medical records were revised, even the CT conclusions were revised, with the emphasis on "aortic dissection" or "dissecting aneurysm", so that the hospital has almost no responsibility.

  I predicted in advance what disease you might have, and did corresponding examinations. In the end, the patient died unexpectedly because of this disease, and the hospital had nothing to do.

   After all, the mortality rate of this disease is so high, there is no time for rescue, and the blame can only be blamed on my own bad life.

  The doctors of Ziguang Hospital acted quickly, tampering with medical records is the basic skill of doctors, and everyone is familiar with it.

  In less than half an hour, a brand-new emergency medical record was released, and even the CT examination report was revised, printed, and inserted into the medical record.

  Everyone in the conference room was relieved, even the big leader laughed and joked with everyone.

   Just when everyone thought the matter would be settled like this, there was another accident in the communication with the family members the next day... (End of this chapter)

Chapter end