Abdominal pain is a topic that can never be avoided by general surgery.

However, most patients with abdominal pain gather in the outpatient department, and there are not many abdominal pains in the ward. However, it is rare to have another recurrence of abdominal pain in the same position after more than a week after the operation, and even the wound is almost healed.

The nurse answered the bell, and the first thing that came to mind was naturally to go to the doctor's office to call out the doctor's on duty.

It is true that Qi Jing is a doctor in this hospital, but she is not a general surgery department. The patients in the department must be handled by the doctor in the department. This not only concerns the medical responsibility but also the face of a department in the hospital.

The visitor wore a pair of glasses, and a unified work sign hanging on his chest, without a photo or a work number. He looked very young and should be a graduate student under a deputy master, who was specially used to replace the hospitalized seat.

This is a trick that surgery has always used.

This situation is less common in internal medicine, but it is very common in surgery, and almost every department is like this. The method is to use cheap labor to minimize the denominator so that the doctors in this hospital can share more money.

In fact, graduate students are not much better than undergraduate interns. They are just a bit higher in status and have another year of clinical experience. To put it bluntly, they are just a higher-level cheap labor force.

The reason for the gap in employment between internal and surgical departments is actually the patients in the ward.

There will be some patients in all departments of the internal medicine department whose cause is unknown.

The patient's condition is unstable, and maybe he will give the doctor a big surprise in the middle of the night. If it is a headache and fever, it won't be fine. If it involves important organs such as the heart, lungs, and brain, the doctor on duty will have a big problem.

Therefore, the heart, breathing, diarrhea, and digestion of the junior high school will not let Shuoyan be on night shift alone.

If you can really take shifts in these departments during the graduate school stage, it means that this person usually shows the level of a resident doctor, otherwise the chief director of the department would not be relieved.

But the surgical ward has no such concerns, and there are only two types of patients living there.

One is before the operation, the diagnosis is clear and the examination is complete, and the operation will be carried out the next day. The patient's condition cannot deteriorate rapidly, and there are no serious underlying diseases. Because there are serious underlying diseases, you cannot go to the operating table, and people who can even withstand the surgery will not have any major problems in normal times.

The other is after surgery, which has eliminated the cause of the disease on the physical level. The only thing that needs to be monitored is a series of stress reactions and complications after the operation.

No matter which type of patient they are, they have already made a clear diagnosis and are unlikely to have any serious problems.

If malignant postoperative complications really occur, even if the director is on duty, the chance of rescue is very low. Therefore, it is enough to put a clear mind in the ward duty room and be able to judge the severity of the patient's current condition.

Anyway, there are also preparations behind the scenes.

Last summer vacation, the orthopedics checked rounds in the morning. Gao Jian found a patient a bit strange when he was changing the dressings.

Even if it was immediately discovered that it was a pulmonary infarction, he immediately called several doctors next door, but he could not save the patient's life. The two senior directors and four deputy seniors also had no choice but to deal with this postoperative complication, and Gao Jian's early prediction only increased the chance of survival by less than 5%.

The doctor on duty just entered the ward and focused on the patient: "What's wrong?"

"Wu Zhenggen has a abdominal pain again, old position."

Qi Jing made a simple description, hoping that he could attract attention. After all, he was not a surgeon and could not make decisions for surgical patients. However, the man's attention was immediately attracted by Qi Jing and the work number plate on his chest: "Yan Dingfei? I remember that Teacher Yan is not as much as you said."

Qi Jing blinked, nodded reluctantly and admitted: "Actually, I am his younger brother, and I borrowed the license plate from him."

"Who are you fooling about..."

"Okay, okay, actually the nurses in the emergency department say we look like each other." Qi Jing was too lazy to explain and suggested, "Let's stop worrying about the issue of 'who am I'. It's better to care more about the patient."

The graduate student on duty didn't have time to make jokes with Qi Jing. The patient in front of him was already complicated, and recurring severe abdominal pain was definitely not a good thing.

"It's the upper left abdomen again, and the pain is still under the suture." The more he thought about it, the more he became more and more panicked, "Can the thread inside collapse..."

"The spleen is so big, maybe it's cracked in other places." Qi Jing said, "Besides, Director Xin personally supervises it. No matter how bad the surgeon is, he will not make such a low-level mistake."

It is not a bad thing to be panicked at this time, it means that he has some experience and knows the dangers of night shifts. He will not foolishly think that the patient has just had a stomachache. However, seeing the problem, the reaction should be kept up. He just kept suspicious and did nothing, which is a bit unreasonable.

Seeing that he was just making an emergency checklist there, Qi Jing couldn't help asking, "Who are you preparing for the shift?"

"Teacher Li."

"Li Peide?"

"Yeah." The man hesitated for a while and frowned. "But he should still be undergoing emergency surgery. He had to watch it because he had acute intestinal perforation and peritonitis. He had to go there for more than half an hour."

"What are you waiting here?" Qi Jing looked at the nurse standing aside, "Go to the ECG monitoring first, and then take a large syringe."

As soon as the nurse pulled the screen on the patient, she saw that the doctor on duty had no reaction, so she nodded and immediately pushed the rescue vehicle out of the way: "Do you want to have an electrocardiogram?"

"Prepare pressure booster and volumetric drugs first, and the electrocardiogram is not used for the time being." Qi Jing took the syringe after hearing the patient's lungs and heart, and said, "The face is gone, blood pressure drops, heart rate rises, cold sweat on the forehead, and cold limbs. It is estimated that there is internal bleeding again."

"Director Xin Cheng repeatedly reminded him to stay in bed and avoid walking. Usually, he would go to the floor when he went to the toilet. With such a small amount of activity, how could he break it again?"

"What's impossible?" Qi Jing looked at the patient's slightly bulging abdomen, shook the syringe in his hand, and handed it to him, "You will know if the organs have been bleeding after an abdominal puncture."

Looking at the syringe, the doctor on duty hesitated for a while, but shook his head and said, "I'll call the liver and gallbladder preparation shift upstairs to see the situation."

"Hey, abdominal puncture is not difficult. Have you done it during your internship?"

Qi Jing looked at the blood pressure of 80/40 and heart rate of 110 on the electrocardiogram monitoring and continued: "This situation is undesirable."

"But..." The man stood there, struggling for a while, and took out the phone, "Don't worry about it, you an internal medicine doctor, the surgeon will make decisions on the surgical matters."

After saying that, he turned around and comforted his family, dialed the phone number.

After two strings of bells, a magnetic middle-aged man's voice came from the receiver: "Hey, what's wrong?"

"Is it Director Tong?"

"Say something."

"I am the doctor on duty for the anorectal cavity. I have abdominal pain again in bed 34. It looks like I'm not in good condition."

"Is there another abdominal pain?" Tong Miao stood up from the office seat and left the door of the director's office. "You are Li Peide preparing for the class today? Why did you come to me? Where are others?"

"There was an emergency surgery just now, and Teacher Li went to the operating room."

"Then you have an abdominal puncture first to see if there is no coagulation." Tong Miao immediately thought of the spleen rupture, because the previous spontaneous rupture had no signs, it was really suspicious, and there was a possibility of recurrence again.

"Abdominal puncture..."

The doctor on duty was obviously not confident about himself, so he couldn't help swallowing and looked back at Wu Zhenggen. Unexpectedly, Qi Jing, who was standing beside his bed, had pulled out the plastic protective cover on the syringe, wiped a clean area on the patient's skin with one hand, and pierced it in with a puff.

"You! What are you doing?"

"Director Tong said that he would have an abdominal puncture. You are still there. The patient will be unable to do it after you start."

After saying that, he slowly lifted the piston upwards, and the black and red non-coagulant blood was slowly poured into the syringe: "Is this enough to be evidence? If not enough, come another tube."

"you......"

The doctor on duty was so angry, but Qi Jing didn't give him time to continue to be angry, and directly raised his voice: "Director Tong, 40ml of non-coagulant blood was pumped into the abdominal cavity, and there was probably still some in his stomach."

Although Qi Jing's voice is not recognizable, he is probably the only one in the hospital who is confident and arrogant. Tong Miao and he have been together in the United States for a while and still have some understanding of this kid. As soon as he heard the sentence, the name popped up in his mind: "Qi Jing?"

"Yes, Director Tong, it's me." Qi Jing said, "The patient's spleen is probably broken again."

......

The bleeding rate varies depending on the size of the rupture.

The previous break was not big, so Wu Zhenggen could survive from home to the hospital and save his life through emergency surgery. This time, the amount of bleeding was obviously much higher than before. In just half an hour, he was in shock as soon as he was pushed onto the operating table.

"Blood transfusion and expansion!" Tong Miao washed his hands, put on his surgical gown, stood in front of the operating table that had just been disinfected and covered with towels, and looked at the anesthesiologist beside him, "Lao Ma, the patient's condition is not very good, the patient is looking at you."

"Don't worry."

Tong Miao nodded: "The operation must be completed as soon as possible. Some processes can be saved as much as possible. Cut a skin knife for me..."

Tong Miao has long been a famous director. He knows the organs in the abdominal cavity and has neat techniques.

The nurse on the stands on the night shift is also a senior. She has cooperated with Tong Miao several times, and after a few rounds of adjustment, she has followed his hand speed.

While using an electric knife to deal with the bleeding points of subcutaneous fat, Tong Miao asked, "Xiao Qi, if you don't stay in the house, why are you running to the surgery department so late?"

Qi Jing also put on the surgical gown and stood by watching the operation. The answer was very simple: "Isn't it going to have a big discussion tomorrow? I came here to see the patient again."

"This look made the patient see that his spleen had ruptured."

Qi Jing immediately smiled and said, "Director Tong, you can't talk nonsense. If Director Xin knows it tomorrow, he will not scold me to death."

"Come on, Old Xin praises you for being so good all day long, and can he scold you?"

When it came to this point, Qi Jing could only smile and no longer answer the conversation.

The doctor on duty really didn't expect that the person in front of him would be the son of the dean, and he didn't expect that an internal emergency doctor would be so familiar with the two directors of the U.S.A. The moment he handed the blood-free syringe to Tong Miao, he was slapping him in the face.

Since he is a patient in the anorectal department, the problem will naturally be solved by the anorectal department, so he naturally became Tong Miao's assistant. However, with his ability, he may be able to serve as a helper for the main treatment, but he cannot become Tong Miao's helper. Some operations that require cooperation with the main surgery cannot be completed at all, so he can only stand aside and do the most basic hook.

The patient's condition was not good, and Tong Miao was too lazy to talk nonsense. It was important to save people, so he simply took the lead in helping him and did it all by himself.

After a while, he cut his peritoneum and penetrated into his abdominal cavity. Seeing that he was full of blood-coagulation, Tong Miao frowned and picked up the suction device: "Prepare gauze, hemostatic forceps and stapler."

Qi Jing looked into the abdomen: "The amount of bleeding is quite large."

"It looks like it's at least 1200ml of base." Tong Miao looked at the blood that entered the liquid collecting bottle along the suction tube, and couldn't help but shake his head, "This spleen is too troublesome, and 2l of blood has been tossed out from the front and back."

After cleaning up the blood-coagulation in the vein, Tong Miao saw the rupture of the spleen and made a simple measurement: "The rupture is not deep, but the length is a bit large."

After the gauze was pressed, the wound stopped bleeding.

At this time, the spleen lost a lot of blood, and the focal ground became much smaller in size, which was just right for suture.

But Tong Miao hesitated.

Because from the perspective of the length and depth of the rupture, the spleen does not meet the indications for resection. However, from the perspective of spontaneous rupture, resection should be the best cure. However, losing the spleen will reduce the body's immunity by 20%.

Which one should I choose...

"Director Tong, let's cut it." Qi Jing looked at the shrinking spleen that was placed outside the body and said, "This spleen cannot be taken."
To be continued...