From 9:00 to 11:00, it is the time when breakfast is gradually digested and decomposed. However, because the blood sugar level in the body is maintained at a relatively high level, the body does not feel much hungry. During this period, people are more likely to concentrate and do things well.

There are not many patients with external emergency patients, which is much easier than those with internal emergency patients, but sometimes a single doctor is too busy to get busy when attending the clinic. Of course, Gu Liang also hopes that fewer patients can be relaxed by himself, but the rare patient waste actually appears on the morning when he has the best energy, which always makes people feel like they are wasted.

He was sitting by the window now, looking at the abortion outside with his head laterally, in a daze.

"You are very idle." Qi Jing pressed the back of his head and frowned and walked in from outside the door.

"There is no patient, of course I'm bored." Gu Liang knew it was Qi Jing when he heard the voice, and he didn't look at him. He just continued to look out the window and asked, "Is there anything fun here?"

"Yes, I brought three students." Qi Jing pulled down a chair and sat down, then smiled and said the point, "It's an intern."

"Hmm? Intern?" Gu Liang immediately sat upright after hearing this, and looked over, "I remember Director Xin did not allow the intern to come to the surgery department, saying that the surgical operating room was already crowded... What's wrong with you?"

The pain of migraine is very sensitive to the strength of surrounding pressure, and any additional muscle pull will aggravate the headache. To reduce the intensity of the pain, you have to maintain the muscles on the face in a very strange position.

"Migraine." Qi Jing endured the pain again and smiled, "I've taken Shumatriptan."

"It's better to take this for a long time." Gu Liang sighed, took out a box of aspirin from the drawer and placed it in front of him, "It's better to take aspirin preventively than to eat tritaned in an emergency. Anyway, it can also prevent cardiovascular and cerebrovascular diseases... By the way, you have no problem with your stomach, right?"

Qi Jing smiled and pushed the medicine back: "Forget it, my stomach is not good."

"Okay." Gu Liang took back the medicine and remembered the topic just now, "You just said the interns? Do you mean to take them to the debugging room to have a look?"

Qi Jing only thought about internal medicine consultations and physical examinations, but she didn't expect to have a debridement room.

As the first line of emergency trauma treatment, the debridement room is sometimes more terrifying than the operating room after covering the surgical towel. Since the trauma area is often treated roughly, it is not comparable to the wounds created by surgeons after carefulness.

He still remembers the first time he saw the injured person in a car accident.

The man's back muscles and ribs were cut open, and the entire lung lobe was exposed, opening and closing. What was even more shocking was the avulsion of the scalp on the top of his head, and he could clearly see the part where the blood flowed out and the white skull under the skin.

From the moment the eyeballs caught the picture, Qi Jing's stomach and intestines were in a state of churning back and forth. If it weren't for the strong adjustment ability, he might have been unable to help vomiting.

Of course, after being baptized, Qi Jing gradually got used to that kind of scene.

Large-scale burns after the fire, car accidents with broken hands and feet, chopping injuries after fighting weapons, even firecracker explosions during the Chinese New Year, etc. No matter which of them is, once it becomes serious, its tragic level is not something that ordinary people can bear. No matter how realistic the film and television games are, they cannot completely restore the real visual impact.

Qi Jing looked back at the debugging room that closed the door, and couldn't help asking: "Is there a patient inside?

"Yes, yes, but it's just a simple stitch." Gu Liang made a simple long incision on his arm with his fingers and said, "Originally, Xiao Yang is shy enough, and his skills are not too good. Don't you be nervous to death when you go in?"

"Then don't see the treasure room clearly."

Qi Jing was a little girl named Yang, but she was quite shy. He immediately said, "If there is really trouble with the patient, three or four doctors will be saturated in the place in the debunking room, and it is not appropriate to ask the intern to enter."

Gu Liang does like students, and he likes the feeling of watching them grow up step by step under his cultivation. On the other hand, he also likes to bully these children from time to time. This is a very strange feeling, just like playing a stand-alone game in cultivation.

"If you don't go to the debunking room, what else can you see?" He was very worried about not having a patient at hand: "There are no patients now."

"It's okay, the patient will arrive soon." Qi Jingdai Xiaomei sent a message, "The emergency center just called. She is about 40 years old. The abdominal pain has not been relieved for three hours. Now her vital signs are not stable."

"Oh? Someone is really here?" Gu Liang raised his eyebrows.

"For us, we can quickly find the key points of differential diagnosis, but it is a big challenge for these children who have never learned from inside and outside the country." Qi Jing made the statement clear, "This is a perfect case template for "bullying children", and it is just right for you."

.........

Five minutes later, the 120 ambulance brought the patient. After a simple handover with the emergency doctor in the car, Gu Liang signed the patient's first doctor. But he did not plan to take over the patient directly, but handed the patient over to Guo Yan, who had not been in a hurry yet.

Guo Yan and ABC formed a temporary treatment team, while Gu Liang stood aside and guarded him. Qi Jing, who gave him a "big gift", sat alone at the desk due to migraine.

Consultation and physical examination are very important components of diagnosis. Although Guo Yan is one year older than the three people around him, there is actually not much difference in these two aspects.

In the early years, consultations and physical examinations required memorization and memory to do it. However, in the past two years, the menu-style admission record format has gradually been popularized in China, and doctors in the inpatient department are not so troublesome when accepting patients. In addition to the necessary first-time illnesses, a large number of full-body examination items seem to have become menu items, and you only need to check it, saving a lot of writing procedures.

However, in the emergency department, any situation may occur. Without such treatment, it is estimated that there will not be any future.

Therefore, this has become the best "test point" to test students to master consultation and physical examination.

Judging from the values ​​shown on ECG monitoring, the immobility of vital signs mentioned by the emergency center is not obvious. The blood pressure re-measurement of the intern was only a little lower than that of normal people, and fell within the normal lower limit range. The heart rate was around 95, which was not too fast.

"Let's get started."

After all, Guo Yan was a senior, so he was the first to be affected. As soon as he opened his mouth, he highlighted the difference from other interns. He started with "discomfort" and never mentioned "pain", for fear that someone would mix up the discomfort and pain.

"Here!" said the female patient, covering her stomach with one hand, "This piece hurts so much."

After confirming that the symptoms were abdominal pain, Guo Yan began to dig down. While arching the patient's legs, he asked, "Have you eaten anything dirty?"

"No."

“Do you have vomiting and diarrhea?”

"No."

As Guo Yan's hand kept pressing his abdomen, the female patient frowned slightly and said, "Doctor, I always feel that it hurts a little anywhere, and I can't explain the specific area."

"oh......"

Physical examination is the basis for differential diagnosis and diagnosis. The patient's pain rating is not very strong, far from the level of peritonitis. However, the only pain area he can rely on is told that there is no difference. The pain area extends from under the sternum to the lower abdomen, almost covering the entire belly.

If there is pain in a specific location, Guo Yan can make a general judgment, but this total abdominal pain...

"Hmm? Don't ask?"

Gu Liang felt a little strange. How could the intern who was pulled by Qi Jing to set role models for the three interns be at this level? It is far from Hu Dong, who stood out last year.

He couldn't help but look back at Qi Jing, but Qi Jing seemed a little helpless. Guo Yan's foundation is indeed not good. Although he has tried hard, medicine depends not only on memory and practice, but also on more comprehension and logical thinking skills.

In these two aspects, Guo Yan is indeed not as good as some top students.

Seeing that he was stuck, Gu Liang could only look at the three ABCs and the other two: "Don't be stupid, ask."

I didn't know if I didn't ask this, but when I asked, I was startled, the three of them took turns to fight, but none of them got the point. Intestinal obstruction, cholecystitis, and gallbladder stones were reasonable, but as they asked, the direction of their question was in a strange direction.

b: "Did you eat too much in the morning?"

The female patient shook her head: "It's just an egg cake and a cup of soy milk, I usually eat it like this."

c: "The intestinal rumbling sound is a little weak."

a: "Is it the intestinal perforation that Teacher Yu said?"

c: "It is possible..."

b: "It may also be a mesenteric torsion. I also said this in class before, I think..."

"Stop." Gu Liang saw their typical behavior of a layman, and immediately called for a stop.

It happened that at this moment, a doctor from the electrocardiogram room came outside the door. He quickly asked his background to welcome both the person and the electrocardiogram: "The first lesson of the internship is also a supplementary lesson for Guo Yan. The first thing you need to learn is this. What is the first priority for patients coming to the emergency department? "

When Guo Yan saw the electrocardiogram, he knew where he was wrong: "Excluding myocardial infarction, look at my brain."

"Don't the patient have abdominal pain?"

"Stomach pain also has something to do with the heart?"

Gu Liang slapped them on the forehead, but none of them pulled down: "Have you learned the pain of pulling in the nervous system physical examination? The pain of myocardial infarction may occur from head to toe, so no matter what the patient sent to 120 will first pull the electrocardiogram and then talk about it."

"Is this what I called before?"

"Of course." Gu Liang said with a smile, "For your internship, Teacher Qi and I have spent a lot of effort to lay the groundwork."

In fact, when Qi Jing received the news about the patient, she had already made some necessary preparations. After all, it was an emergency department. While doing consultation exercises for the interns, she also had to protect the rights and interests of the patient, and it was impossible to delay her diagnosis and treatment time.

As soon as the patient entered the external emergency room, Gu Liang sought the consent of the patient and the electrocardiogram monitoring around her. If there was a conflict between doctor and patient, it would be not good to make a fuss. After all, medical trouble was not included in the content list of this internship.

While a few people were talking, the electrocardiogram showed results: normal sinus rhythm

Gu Liang said to the female patient, and thanked her again: "The teaching hospital must take students, so I'm sorry. You can rest assured that we are already doing what we should do and will not delay your diagnosis and treatment process."

"It's okay, I'm much better off lying down now." The female patient was open-minded and said with a hurried smile, "What are you afraid of when you are looked at by so many doctors? As long as it can be cured."

Gu Liang was very pleased to encounter such a patient and would never miss this excellent opportunity.

"I've already started, what should I ask next?" He pushed the four students at hand over again, looked down at the watch, and continued, "Time doesn't wait for anyone, at most 10 minutes. Your consultation and physical examination must be over and enter the laboratory examination stage."

After this mistake, Guo Yan's thinking was gradually opened up, and he gradually jumped out of the limitations brought by abdominal pain and relaxed his vision.

After sorting out his thoughts, he found that he had indeed asked one less big question. As he thought about it, Guo Yan's face suddenly turned red: "Sorry, I want to ask if you have stopped your menstruation?"

After all, it’s a boy, so it’s embarrassing to have no experience in this area.

"Oh, are you still asking this?" The female patient didn't think anything was there and quickly replied, "I haven't stopped."

"Oh..." Guo Yan quickly wrote down the answer, feeling that he had passed the level and stopped asking.

But at this time Gu Liang sighed, and couldn't help but shake his head. The kid found the siege brick, so why did he just knock on the door? Shouldn't this be smashed hard?

"You don't ask clearly, it's over?" Gu Liang said quickly, "What's the use of stopping your menstrual cycle?"

"Doesn't the book just ask about menstruation? Shouldn't this situation stop menstruation?"

"Of course not!" Gu Liang wanted to beat him up, but he still held back when he thought of his internship. "The situation you mentioned will cause a small amount of bleeding, and the patient will mistakenly think that it is menstruation. Do you think it is useful to just ask and stop menstruation?"

Guo Yan suddenly realized and immediately looked at the patient: "Yes, yes, yes, I forgot this important symptom. At this time, I have to ask whether it is normal or not!"

When the female patient heard this, she finally hesitated. She didn't know if she was counting the time, but after thinking for a while, she said: "It's really not accurate. Especially these days I often see bleeding."

"really!"

Only then did the three interns realize the art of consultation, but they would definitely not be able to ask so carefully when asked according to the book. But the next question arises again. Is it necessary that the inaccurate menstruation is the ectopic pregnancy they think of? Will there be no other situation?

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