Different from inpatient consultations, the outpatient and emergency department is not just the troublesome patients who keep pouring into the clinic.

Once the time for the consultation is extended, the patients who have left for the examination will come back one after another. It is impossible to get them back and forth after re-queuing. Even if the patients are still retained, the doctor's thinking still needs to be able to switch back and forth between new and old patients. If there are more patients who have just entered the clinic, their minds will be confused, and even patients who have seen the disease before will not remember them.

Therefore, every doctor will learn some tips to remember the patient's condition when he enters the clinical stage. As for how to deal with the conditions of two patients at the same time and not interfere with each other, it will take some time.

This is not a skill learned with a purpose, but a passive practice during long-term work.

Qi Jing looked at the chest radiograph of patient No. 151 on the reader and said, "There is an infection in the lungs, and the range is not small. I contacted the respiratory department to see if there is an empty bed and let you be hospitalized as soon as possible."

"Hosted?" Hearing the hospitalization, the patient shook his head repeatedly, "Doctor, don't be so troublesome, just prescribe some antipyretics for me."

"You should not take antipyretic drugs indiscriminately." Qi Jing explained simply, "You have a fever of 38.8 degrees and there are still large areas of inflammation in your lungs. You need to use antibiotics to suppress the infection under the guidance of a doctor..."

The patient touched his forehead and interrupted him: "Actually, I don't even want to use antipyretics. I used to endure it and then pass it. Besides, you told the female patient just now that if the body temperature is a little high, the body can handle it by itself, and there is no need to be hospitalized."

Qi Jing's eyes lit up. What a good guy, he has begun to learn to use geology and question the doctor's medication. The patients this year are very strong.

Logically speaking, if you write a paragraph that refuses to be hospitalized, you can finish it by signing a word. Qi Jing will never spend too much time with such a patient. However, as soon as he said he wanted to sign, the patient immediately realized the weight of this sentence and immediately changed his mind: "Doctor, hospitalization is just about using antipyretics and antibiotics. What is the difference between this and going home? If you don't explain it clearly, you can't blame me."

A very plain sentence actually pushed all the blame to Qi Jing, which made him feel very reasonable after hearing this.

Stop the blame!

Explain and explain again, Qi Jing sighed and asked, "Have you burned hot water?"

The patient frowned, but he didn't expect the doctor to suddenly ask: "What's wrong with the fever?"

A normal person is a pot of cold water. When the gas is turned on or the electric kettle is turned on, it means that he is infected. The result of infection is a fever, that is, the cold water turns into hot water or even boiling water.

"When the water boils, should you turn off the fire and unplug the power supply, or put the cold water in it?" Qi Jing asked a simple question, which made the patient answer very simply: "Of course, turn off the fire and unplug the power supply."

Qi Jing explained: "Switching off the fire and removing the power supply is an antibiotic, pouring cold water into it is an antipyretic. If you don't turn off the fire, it will be useless even if you pour more cold water into it. It's not the following, right?"

The patient raised his eyebrows, and if he couldn't understand it, there would be a problem: "Then prescribe some antibiotics for me and I'll go back and take it."

Qi Jing sighed helplessly: "Don't turn off the fire and remove the power supply, are you going to do it by your child who has not yet gone to school or do it yourself?"

"It's so dangerous to turn off the fire, of course I did it myself."

"So..." Qi Jing continued to follow his words, "Your pneumonia is very serious now. If you ask you to go back and take antibiotics yourself, it is like letting a three-year-old child turn off gas, which is so dangerous. Of course, it's okay if you insist on doing this, just sign it."

Speaking of this, it is so clear that it is no longer clear.

Looking at the medical record book in front of him, the patient hesitated for a while, until the other patients waiting behind him spoke to him, he nodded and agreed to be hospitalized. However, whether he could be hospitalized depends on the tension in the respiratory department bed. If it doesn't work, maybe he has to stay in the observation room for one night.

If he keeps entangled like this, there are people who are relatively obedient.

After the liver and gallbladder ultrasound, I found that there were multiple stones in the gallbladder. After listening to Qi Jing's advice, I went to the general surgery clinic number very obediently. The chest radiograph of No. 158 looked even more serious than that of 151, and I also handed over the decision-making power to Qi Jing.

In the chest radiograph, his left lung was completely filled with white, and even the female doctor sitting opposite Qi Jing had never seen this situation.

She was afraid that Qi Jing would judge the problem, so she looked up and looked at the patient a few more times. But from the surface, he didn't have much problem, just because he coughed harder and breathed a little faster.

For her, her first intuition is the white lung caused by infection. The specific situation in the "white lung" must be judged by the respiratory department.

This type of patient is relatively serious, and the best choice for consultation from the respiratory department is to consult. As for whether to treat directly in the observation room or accept it into the ward, it must be judged by the consultation doctor.

Qi Jing really didn't delay time, so he called the respiratory department with a phone call: "Hey, it's Director Luo."

"What's wrong?"

Qi Jing directly stated the preliminary diagnosis: "There is suspected pneumonia here. The chest x-ray found that it was effusion in the left pleural cavity, and the amount should be quite large."

The female doctor was stunned: Is this pleural effusion?

Luo Tang also asked the same question like her: "Pleucorrhea?"

"Well, the left side is completely filled, and the pressing mediastinum has moved right." Qi Jing looked at the chest radiograph and said all the important key points. "The patient's condition is OK now, but he has a little difficulty breathing. I'll let him sit in the door and inhale oxygen first, and wait until you come down to see it."

Luo Tang trusted him very much. Qi Jing chose what he wanted to hear, and there was no need to ask any more questions: "I'll let the consultation come down."

"Um."

Patients with a large amount of pleural effusion are generally admitted to the hospital urgently.

Even if the inpatient department has no bed and cannot be hospitalized for a while, the respiratory doctor will temporarily occupy the debridement room or gastric lavage room and directly perform breast puncture and pleural effusion in the emergency room.

First, we can check the source of pleural effusion, whether it is common pneumonia or tuberculosis, and sometimes it may be a tumor. Second, after removing pleural effusion, it can relieve the pressure on the lungs on the same side and temporarily improve the patient's breathing. It is also a symptomatic treatment method.

Five minutes later, the consultant doctor from the respiratory department appeared in the emergency room.

After a brief physical examination, I took a look at the chest radiograph and immediately issued an inpatient form. No. 158 and No. 151 joined hands to enter the respiratory department, and the bed was also set by the nurse, one corridor 6 and the other corridor 11.

......

Ever since the old man with an aortic aneurysm was sent away, the intern called by Qi Jing became his temporary follower.

According to others' eyes, the female doctor's title and qualifications are higher than those of Qi Jing, so the intern should help her. But in fact, it doesn't matter who the intern has the strength and the doctor's level or the professional title.

In the outpatient department, interns need to copy prescriptions to further learn clinical knowledge, so generally those who teach interns are instructors.

Even if doctors with higher qualifications in the same clinic, they usually refuse the interns’ help. After all, taking interns is a job, and it is not smooth to complete.

It seems that interns can help share some of the copying work, and the speed will be faster than before. But the fast processing speed means that the doctors in the clinic have to deal with more patients within a unit time, which will lead to greater pressure.

Moreover, the interns at the end of June are all freshmen who have just come to the internship. Not recognizing words is the norm, and you must ask if you don’t understand them. Generally, a prescription requires an average of three or four times to complete, and sometimes you even write incorrectly and rework. Therefore, the female doctor who was in the clinic with Qi Jing rejected the intern’s “good intention” and would rather watch it slowly alone than take on this tiring job.

This boy just came to the internship for an internship for a few days and his experience was almost 0.

Fortunately, Qi Jing's calligraphy is quite reasonable, and there is no conjoined cursive script, so it is not difficult to copy it. With more hands, his reception speed has been further accelerated. After dealing with several patients who came back to report the examination, he finally met the patient who was about to go to the lineup before.

"Oh, it's really... "My mother looked at the wall clock at more than two o'clock and felt uncomfortable, so she could only complain, "I can't even go to the cram school, I'm unlucky."

This kind of family member is the norm in emergency rooms. Qi Jing didn't say much and asked her son: "Where is uncomfortable?"

"The mosquito bite." The senior high school student showed his right arm and said lightly, "I was bitten at the breakfast stall in the morning, and I still feel a little itchy now."

Was the mosquito stuttered?

What is the reason for this?

Qi Jing has seen many strange patients, some have strange conditions, and some have strange ones. It is just that people are more demanding, speaking more vigorously, and having stronger medical theory knowledge. Qi Jing has been used to it.

It can be said that I came to the emergency room after being bitten by a mosquito. What is this? It wasn't when dengue fever appeared last year, so it was so strange.

Could it be that the bag is swollen because of the mosquito bite?

Looking at the child's raised arms, Qi Jing checked it carefully and found that the lump had actually receded a lot. The original lump only left a circle of light red marks, and there were only some fine scratches after the nail was scratched. From this, it can be inferred that the mosquito bites out before was an ordinary lump, the size of the thumb, the skin on the surface was raised, and the boundaries were irregular, nothing special.

Of course, you have to be careful when doing everything in the emergency room. It is not uncommon for accidents after worm bites. You should be more careful.

"The body temperature is normal..." Qi Jing looked at the nurse at the door at the door and asked seriously, "Do you feel uncomfortable? Dizziness? Vomiting? Chest tightness and breathing?"

"No." The child was very honest and shook his head repeatedly.

No matter how normal the patient is, since he has a urgency number, he must test his blood pressure and heart rate. After the intern took the test, he immediately gave the result. 125/70mmhg, heart rate 70, breathing 20, and a very healthy number.

No fever or other symptoms, isn't this just messing around?

"You were bitten by a mosquito and ran to the emergency department?" Qi Jing asked the child, but his eyes were looking at his mother standing behind him.

The child didn't say much, and then looked at his mother, and his face became very strange. The mother finally spoke at this time, with a sarcastic look on her face, but her voice was suppressed very low: "We want to do an AIDS test."

AIDS?hiv?

Qi Jing turned his attention back to the child, a very ordinary and shy boy. He looked average, but because of his age, he covered up many shortcomings. At first glance, he looked quite pretty.

In order to protect the patient, Qi Jing did not immediately ask the reason, but went to look for it as much as possible. Judging from the child's previous movements and expressions, he seemed to be very careful by his mother. Now that he is in the college entrance examination, it is probably impossible to have an early love relationship.

So what else can be the reason?

I was vengeful on the road? There are some cases, but I was accompanied by police, and it was impossible to be so calm.

At least there is a reason to test a person for HV, and it must be stated in the medical record book. Otherwise, the family will bite you and say that if you give a test for no reason, the problem will be yourself. You should not be harmful to others, and you must be careful. Many doctors who have just started working will end up in the pit because they have not done a good job of self-protection.

Of course, when encountering this situation in the emergency department, old doctors often use one trick, that is, there is no such test in the emergency department, so if you want to do it, go to other departments.

This can avoid many unnecessary troubles, but the reason for this child to see a doctor has successfully aroused Qi Jing's interest. Qi Jing would not let him go until the question was asked.

"Can you tell me the reason?" Qi Jing said, "I can't issue a checklist if I don't tell me the reason."

"Reason?" the mother thought for a while and said, "When he bought breakfast in the morning, he met an AIDS patient in the community, who was that kind of person."

Qi Jing didn't know what kind of person she was talking about, but her face was full of recognition and nodded repeatedly: "What about?"

"There is a green belt next to the breakfast stall. As soon as he passed, he was bitten by a mosquito." The mother became more and more angry. "The problem is that the AIDS patient was also bitten, and it was on his arm! Isn't this abusive person!"

"oh......"

Qi Jing couldn't hear the relevance of the whole story. After thinking for a while, he realized her brain circuit. His voice lowered and tried his best to restrain his urge to smile: "You mean, your son might have contracted AIDS because he was bitten by a mosquito?"

"Yes, I've seen the publicity on TV, blood spreads!" The mother pointed to her long sleeves and trousers, "It's really scary to think about it now. There are so many mosquitoes outside. What if I get infected with it after being bitten?"

Qi Jing looked at the patient and his mother, not knowing where to start complaining, so he could only say: "If it is transmitted by mosquitoes, it is called insect-media transmission."

As he said that, he pulled out a checklist and wrote the word "insect vector": "Blood transmission is direct blood transfusion, and it has nothing to do with insect vector."

"It's okay?" The mother still didn't understand, "Don't the mosquito suck blood and then sucked the blood into the next person's body? How come it doesn't matter?"
Chapter completed!