This question is not difficult for Hu Dongsheng. Even if he has never seen a similar patient, he can try to guess according to the symptoms of the disease. And for Luo Tang and Qi Jing, it is even more of a piece of cake.

Interns have just entered the internship and will definitely not be able to achieve their level. Anyway, judging from Luo Tang's previous reaction, tension-induced pneumothorax encounters mechanical ventilation from the ventilator may accelerate the death of the patient.

"Actually, you can see the problem as soon as you get on the ventilator."

Qi Jing told all the symptoms as if he had known them: "Severe respiratory failure and further decrease in oxygen saturation. Pulmonary encephalopathy aggravated coma, and finally severe subcutaneous emphysema occurred."

If the ventilator is an air pump, the lungs and chest are like the inner and outer tires of a bicycle. The only difference is that the outer tire of the bicycle is a shell that can be peeled off at any time, while the outer tire of a human is completely closed like the inner tube.

Inflammation can cause some inner tubes to wear, the wear area will continue to thin, and finally pneumothorax will explode.

Since it is a tire blown from the inside to the outside, the original tire skin will be left on the break. This layer of tire skin is a one-way valve from the inside to the outside. Gas can flow out through it, but it is impossible to flow back to the inner tube in turn.

At this time, no matter how much air is injected into the inner tube, it will eventually flow from the damaged place to the intermediate area between the inner and outer tubes, that is, the pleural cavity. Because the air in the middle area cannot return in the same way, it can only accumulate more and more, thus causing the volume of the originally thin layer of the pleural cavity to continue to expand.

This made a strange phenomenon appear.

When the outer tire has sternum ribs for fixation and the volume does not change much, the infusion pump keeps injecting the inner tube, but the inner tube is pressed smaller and smaller due to the constantly expanding intermediate area, and finally cannot breathe.

"This metaphor is very interesting." A boy next to Song Yao should have been used to riding a bicycle. He saw someone replenishing his fertility. He agreed with the metaphor of the internal and external fertility and continued to ask, "Senior Qi, where is the subcutaneous edema?"

"The ventilator is a machine with good programming. There is no priority. Once you use too much force, the outer tire will break. There is air outside the outer tire of the bicycle, and there is a layer of skin outside the chest. If the air breaks, it will slip into the skin to form emphysema."

I have to say that Qi Jing’s metaphor is very vivid. Although it is somewhat unnecessary for Hu Dongsheng and Luo Tang, it has benefited a lot from the two interns.

They are in the transition period from theoretical knowledge to clinical practice. This kind of metaphor can greatly deepen their impression of knowledge and unconsciously remember all the knowledge points. When they test pneumothorax in the written test, they will think of bicycle tires, encounter pneumothorax patients in clinical practice, and also have memorable cases as templates. It is simply a pneumothorax teaching class.

Of course, it is impossible for only doctors to treat patients in clinical practice, but more so are family members and medical disputes.

"What if the patient didn't get through the ventilator just now?" The unknown boy suddenly asked the most deadly question, "Will the family make trouble?"

"Definitely." Qi Jing looked at Luo Tang with no concealment and said with a smile, "I will definitely come to the chief director every day to argue."

Luo Tang's chest was so shivered that his trachea was itchy. He started coughing. After coughing, he had no intention of showing weakness. He pointed at Qi Jing and immediately fought back: "What are you looking for me? You must go to the dean's office directly to ask his father to pay the money."

"Will the director compensate?" Song Yao obviously didn't know the hospital's attitude towards dealing with disputes and the general background in society. "How much does it have to be compensated?"

"It must be compensated. I was not rescued from pneumothorax in the hospital. It was just a problem for the doctor." Qi Jing did not think about it, and even thought of his father's apologetic look. "As for how much compensation is, it depends on whether it is settled privately or went to court."

"But......"

Song Yao knew very well the difficulty of this case. The sudden condition was not enough and there was no buffering time. She went straight into critical illness in one step. Most doctors could not think of the possibility of pneumothorax. Even Director Luo Tang might not be able to escape this hidden pit.

This is an almost inevitable situation. If the hospital pays the bill every time, then you will not be able to pay it to death?

Song Yao shook her head and said, "I think this is very unfair."

"Unfair? Ordinary pneumonia suddenly dies in the hospital. If you were you?" Hu Dongsheng has seen many such situations this year and has learned to think from the perspective of others. "After all, it is just a spontaneous tension pneumothorax after the rupture of the lung bulla. It is not a cancer or serious trauma. It is not obvious that it is a doctor's problem."

"But the patient develops too fast and can't react!"

"So you have to be clear-headed. No matter when you are treated, you have to do the same with the examination." Qi Jing explained, "Even if you look at the chest X-ray again, it's not better."

The two interns couldn't speak.

No matter why I had to take the medical school before, the doctor's appearance in the TV series is deeply rooted in people's hearts. I don't know that what doctors have to face is not only birth, old age, sickness and death, but also people's hearts beyond life and death.

"The hospital just compensates the money, but it's not the doctor who comes to compensate. Why are you nervous?"

Luo Tang is most annoyed by this kind of mother-in-law and mother: "If you think misdiagnosis is a terrible thing, then just try to avoid misdiagnosis. Other things are just experiences on the road to hard work."

"experience?"

Seeing that Song Yao was still a little confused, Qi Jing simply said it clearly: "Yes, dead people are the experience of doctors. Which famous doctors in the world don't bear their lives? Their glamorous names are piled up by dead people."

This sentence seems sensational, but it is not difficult to understand after thinking about it.

A doctor cannot know all the cases in the world. Sometimes, even the smartest doctor may fail. But those who can become famous doctors will dig deep into the cause of death and will also use it as nutrients in their minds.

Just like the few people present now, if they encounter such a patient next time, they will definitely check for pneumothorax first and then go to the ventilator.

Maybe the entire case will be written as a paper review and published in a magazine after screening. When this situation is widely spread among doctors and finally a consensus will be formed, the next step will be written into diagnostic and treatment guidelines and become an industry norm.

His death is the experience of the doctors.

It is cruel, but it is the only way for the development of medicine. Without these patients paying the price of death, medicine will only stop moving forward.

"Just like Director Luo, the director of the University of Respiratory Medicine, I'm afraid......" Although Qi Jing was brave, he didn't dare to say anything at this time, waiting for Luo Tang to answer. Luo Tang had no airs and did not hesitate at all when he was talking. He said directly: "73 deaths."

“So many?”

"Nonsense, I am the chief director, and the death of people in the ward is my problem."

"You actually remember the numbers."

Luo Tang sighed, not wanting to explain more, so he raised his hand and shook the record book in his hand: "I'm here to talk to you about 16 beds, hurry up."

"Was that patient moved in?" Hu Dongsheng turned around and looked at Qi Jing.

"Well, I came yesterday, you're just resting." Qi Jing replied, "You have the patient's medical records, so don't be too excited. Work well. If you have any new discoveries, you will tell you."

Hu Dongsheng nodded.

"You two will slowly digest the cases. If you are confused about your work, don't be afraid. Doctors have changed careers. There is a change in careers in Minghai as a host." Qi Jing stood up and patted the two on the shoulders, then walked to Luo Tang after warning, "Director Luo, let's go to the lounge?"

"Yes." Luo Tang nodded.

After all, the case Qi Jing mentioned is just a case. No matter how true it is, it is still fake. Now, the 16th bed is lying in the inpatient ward of the respiratory department upstairs. The 16-year recurrent pneumonia has stirred his lungs and damaged his respiratory function. Now, even after walking on the flat road for a short while, the patient can show you the patient.

The two discussed for two hours, talking about the process of respiratory decline from susceptibility factors of pneumonia. Unfortunately, although the patient suffered from pneumonia many times and involved many microorganisms, his family was not good, and he had never done a test that could objectively indicate that the lung function was tested before.

Even if there are various parameters of respiratory function now, it is difficult for doctors to diagnose without previous and later reference comparisons.

But one thing is certain, when the patient first got pneumonia, his lung function had some minor problems. As for what exactly affected the lung function, neither of them had any idea.

"Although the right heart is not uncommon, it can sometimes cause some pulmonary vascular malformations," said Qi Jing.

"There is such a possibility." Luo Tang opened his own record book, "I just found several colleagues in Cory and talked about this situation, and have already booked a picture for tomorrow."

"Do you have another bronchoscope?" Qi Jing asked.

Luo Tang glanced at him: "Do you suspect there is a foreign object inhalation?"

"This possibility cannot be ruled out." Qi Jing explained, "Maybe it was aborting by mistake when I was a child, and the foreign object was small in size and the situation was not serious, but it may cause pneumonia if it is stuck in the lungs for a long time."

This cause can explain all the symptoms of the patient, but Luo Tang still shook his head: "But the imaging examination is not supported, and no foreign object is seen in the chest radiograph or CT."

"Some foreign objects will degrade, and to a certain extent, they will not be able to capture when they are lower than the image resolution." Qi Jing retorted.

"Just the same fish bone you looked for before?"

Luo Tang knew Qi Jing's war history along the way. The fish bone of a Southeast Asian patient almost avoided the CT scan, but he still expressed a different idea: "Foreign objects can cause inflammation that is difficult to heal for a long time. Logically speaking, inflammation will only improve and cannot be cured. It is normal for a considerable part of the time between patients every time pneumonia, which means that pneumonia itself can be cured, but it is more susceptible to infection."

Qi Jing disagreed with this statement: "This is normal. Maybe the patient's health is good and it will really solve every inflammation."

"You're kidding." Luo Tang and he took a completely different second path. "He doesn't have pneumonia now, but his immunity is really not good."

"He has normal body temperature now, and although he has a lot of coughing and sputum, he is only white." Qi Jing said, "You can do an immunity test."

Although Luo Tang did not agree with his point of view, the tests that should be done must be done, and the immune ability test was originally in his notebook: "What do you think will be the cause?"

"Maybe the reason why the patient's bronchus changed," Qi Jing said, "I still feel like a foreign object is inhaled."

“So you want to check the bronchoscope.”

Qi Jing suddenly thought of another saying: "Some foreign objects stay in the patient's body for a long time, and may be mixed with the original tissue around the bronchial. The tissue will proliferate on the surface of the foreign objects and will not block the bronchial, but will change the structure of the bronchial."

"Make this section of bronchial more likely to accumulate bacteria?"

"Well, long-term coughing of phlegm may be because the bronchial has been changed shape." Qi Jing guessed.

Luo Tang nodded. This view was very novel. At least no one said it when the case was discussed just now. He looked at Qi Jing. This person had already started to show off a year ago. Luo Tang had not taken him seriously at the beginning, but now he has become the backbone of internal emergency forces in just one year.

Xiong Yong's pollen allergic patients, Ji Guanghao's liver flukes, dengue fever imported from abroad... Every case makes Qi Jing shine brightly.

How great would it be if I could come to the respiratory department...

Thinking of this, Luo Tang couldn't help coughing again and grabbed Qi Jing's sleeve: "The patient may not be able to withstand a bronchoscope. What if something goes wrong with the unit? I think it's only possible to judge by CT."

"What if the inhaled thing was similar to the body's tissue," Qi Jing said. "The development on the CT is similar to the normal tissue, but it is impossible to see."

Luo Tang was silent for a while and sighed: "Let's wait for the report of breathing function first."

Qi Jing nodded. The chronic disease is not urgent, so it has to be checked and diagnosed slowly. Moreover, there are other factors involved in this disease. Does the patient have a history of smoking, a history of pollution in his work environment, or a living environment that causes him to inhale some strange chemicals in daily life, or daily habits that cause him to intake toxins, and it may even be genetic reasons.

Luo Tang still needs to do a lot of inspections, while Qi Jing thinks to go home to check the information.

However, before returning home, Qi Jing stopped a car for rent and ran to a gymnasium in Shibei. There he made an appointment with an old friend, and he also made an appointment that he had made a year ago.

An old friend had been waiting at the entrance of the gymnasium and saw Qi Jing's taxi and came over: "You're here, I've been waiting for you for half an hour."

"There is a complicated patient who needs to be discussed. It's too late." Qi Jing paid the car and got out of the car and closed the car door. "Anyway, I'm going to have a fight with you. I'm not the one who broke the appointment."

"Haha, it's been a year..."

The person who came was Xu Jiakang. As soon as he met Qi Jing, he said that he could play badminton together to enhance his "feelings". Of course, he just wanted to contact him before and dig out the corners of the First Hospital. Later, when he found out that it was impossible, Qi Jing wanted to go back on his word.

After all, badminton is not his strength, and it will be embarrassing if he is beaten by the other party and tells it.

However, Xu Jiakang has been remembering this for the past year. After thinking about it, Qi Jing still has to be a gentleman: "What you promised me is to play your sports with you well, and you have to play with me next."

"Well, no problem." Xu Jiakang did not realize the seriousness of the problem and naturally agreed.

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Chapter completed!