Everyone discussed for a long time, and then all looked at Chen Qi, wanting to hear the dean’s opinion.

Bian Meng was a quick-tempered person and was a close confidant of Chen Qi, so he was the first to ask:

"Tou Chen, what do you think this patient's condition is like?"

Chen Qi stood in front of several X-ray films lined up and thought for a while, and then said something that surprised everyone:

"I think this is inflammation."

"Ah???"

Everyone in the office was surprised. If Chen Qi hadn't been the dean, many people would have booed.

Are you kidding about inflammation? Have you ever had inflammation that lasted for 3 years?

How is that possible?

The surgical director couldn't bear it anymore and asked:

"If it is inflammation, anti-infection treatment has been repeated for 2 weeks, and the best antibacterial drugs in the provincial capital have been used. How come it is not absorbed at all?"

"Yes, if it is inflammation, why has the patient's lung shadow not changed much in the past three years?"

"Yes, look at this film, the border of this shadow is not very clear. If it is inflammation, the border should be very clear."

After Director Bian started the conversation, everyone started to refute it. Anyway, it was you, Chen Qi, who said it. Don’t be afraid of saying the wrong thing during the discussion.

Only Yan Shifan was thoughtful and continued to look back at the film.

Seeing that everyone didn't believe it, Chen Qi patiently explained:

"Then let's take stock. First of all, everyone thinks that lung abscess can be ruled out by occupying space in the lungs. The diagnosis of pulmonary tuberculosis is generally recognized as the most consistent, but anti-tuberculosis treatment is ineffective, so only inflammation is the most likely, right?

”

When everyone was about to say something, Director Bian made a silent gesture.

"But inflammation is the diagnosis that everyone thinks is the most unlikely. Because the time is wrong, it has been 3 years. Also because anti-infective treatment has been given, but the effect is not very effective, so everyone does not even dare to think about this possibility, but everyone

Thinking about it on the other hand, without looking at the time, just looking at this film and the clinical symptoms, does it look like inflammation?"

Zhang Xingshun interjected at this time: "But looking at the film and clinical symptoms, it is similar to tuberculosis."

Shh~~~~

Everyone in the office laughed wildly and booed Chen Qi one after another.

Chen Qi didn't take it too seriously, and was sincerely happy that everyone had such a relaxed atmosphere that did not worship authority.

"When I say it's inflammation, the first thing that everyone thinks of must be lung infection, or pneumonia, right?"

Everyone nodded. What else does a lung infection focus mean?

"Okay, let's review the X-rays of pneumonia first. The first and most common type is Streptococcus pneumoniae pneumonia. Patients may show thickened lung markings in the early stages. As the disease progresses, shadows of realignment may appear.

Right?

Attention, everyone, you can see the airway sign of the bronchus in this kind of consolidation shadow. In some patients, due to inflammation spreading to the pleura, causing an inflammatory reaction in the pleura, a small amount of pleural effusion may occur. Have you seen this patient?"
p>

Everyone shook their heads again.

What Chen Qi talked about was all about internal medicine, which was relatively unfamiliar to surgeons, so everyone listened very carefully.

"Then let's look at a very common clinical staphylococcal pneumonia, which is an acute suppurative lung inflammation caused by Staphylococcus aureus invasion. Through X-ray examination, it can show consolidation of lung segments and lobes, or

It is a lobular-like infiltration with single or multiple fluid-air cysts...

Pay attention to the fluid-air sac cavity. Everyone has seen the film. Patients don’t have this characteristic symptom, so staphylococcal pneumonia can also be ruled out. It’s no problem, right?

There are other types of pneumonia, such as mycoplasma pneumonia, which can show various forms of infiltration, which are segmentally distributed. They are more common in the lower lobes of the lungs and sometimes extend outward from the hilus.

If it is pneumonia caused by viral infection, the lungs may show ground glass-like shadows, which may appear in both lungs. In addition, patients with new coronavirus pneumonia may also show patchy shadows. The shadows are mainly distributed in the outer belt of the lungs and are very easy to <

/p>

It is easy to develop into white lung..."

Director Bian suddenly raised his hand and interrupted:

"Wait a minute, I know about other types of pneumonia. What is the new type of coronavirus pneumonia? Why haven't I heard of this disease?"

Chen Qi was shocked, wondering why he had let the news out of his past life about COVID-19, a disease that was prevalent around the world.

"Well, don't worry about these details. This is a type of pneumonia just discovered by the United States. It has not been officially used in clinical practice. It is normal for you surgeons not to know. Ahem, where did I go?"

Wang Yuelei reminded: "Tou Chen, you talked about the different imaging manifestations of pneumonia."

"Oh, yes, you see, we have gone through the elimination methods one by one. Isn't there a kind of pneumonia that matches Jin Wenyao's film? So we can also rule out the diagnosis of pneumonia."

Now everyone was confused and couldn't understand. I thought you said it was lung infection and inflammation, and then said it wasn't pneumonia. What kind of trouble is this?

You are the dean and you have the final say?

When Chen Qi saw everyone's confused, questioning, and surprised expressions, he burst into anger:

"It's true that you are surgical experts. Is there only one type of lung inflammation? Pneumonia? Don't you think about the surrounding infection caused by a foreign body entering the lungs?"

Zhang Xingshun was dissatisfied:

"Tou Chen, you said it was a foreign body in the bronchus, which is clinically common, but you said it was a foreign body in the lungs, and it was located in the patient's right middle lung. How could there be a foreign body in this place? How did the foreign body fall into the right lobe of the lung?

”

"That's it!"

There was another burst of doubts from everyone.

Why do they doubt it? It is precisely because they are doctors that they directly doubt Chen Qi's statement.

Foreign bodies may be inhaled into the lungs through the mouth and trachea, especially some relatively small foreign bodies.

For example, some rice grains, small plastic pellets, small screws or small beans such as mung beans may pass through the trachea and enter the lungs.

Then infection and inflammation may occur in the lungs, or long-term irritating cough, fever, chest pain, and sometimes asthma attacks may occur.

In acute cases, dyspnea, cyanosis, etc. may occur. In severe cases, it may lead to hypoxia and respiratory failure.

From this point of view, Jin Wenyao's symptoms are indeed similar, and the symptoms can be explained.

However, the prerequisite for this to be inhaled into the lungs is a small foreign body, at most the size of a mung bean.

Some relatively large foreign bodies, such as coins and larger toys, usually cannot enter the lungs through the bronchus. In most cases, they will enter the gastrointestinal tract through the throat and esophagus...

Let’s take a look at the shadow of Jin Wenyao’s right lung. It is an oval-shaped high-density shadow. The longest diameter reaches 1. So even if there is a foreign body in the shadow, it must be at least 6.

This is obviously illogical.

In this way, in the case discussion meeting, everyone talks about your opinions, and I talk about my observations, but no one can convince anyone.

This brings the problem back to its original point. If you can’t make a clear diagnosis, how can you treat it symptomatically?

Modern medical treatment requires evidence. You can put forward various hypotheses, but you must have auxiliary examinations to prove that your opinions are correct.

Just like the police arresting a thief, you know that the thief has broken the law, but the police cannot convict based on suspicion alone. This will easily lead to mistaken arrest and misjudgment, leading to adverse consequences (in medical terms, it is misdiagnosis)

So you must find evidence to prove that the thief stole something, so that you can convict the thief and restore peace to the community.

Thinking of this, Chen Qi was helpless.

Jin Wenyao's condition is imminent and they are not allowed to speculate like this.

According to Chen Qi's previous practice in Huang Tan, that is, regardless of the situation, he first anesthetized and directly opened the knife to see what was inside?

But it doesn't work anymore. One is that he is the dean, and the dean must take the lead in standardizing diagnosis and treatment. He can't do whatever he wants like before.

The second person

The Jin family is in bad shape and is keeping a close eye on them. Anyone who is dissatisfied will probably come to the door of the county government again. Then let’s not mention the progress of the fourth hospital this year.

What to do?

Chen Qi knocked on the table and came up with an idea. After all, the Jin family's medical treatment costs money, and it's not Chen Qi's money spent, so why save it for them?

So he looked at his subordinates in the office and had an idea in his mind:

"Yang Tihao and Zhang Xingshun, I will give you two a task. Send this Jin Wenyao to the First Affiliated Hospital of the Province. They have advanced equipment and let them do a few tests for us. When the results are out, you can follow the patient back."<

/p>

Chen Qi is now as close as a family to the First Affiliated Hospital of the Province, making the Fourth Hospital like a branch of the First Affiliated Hospital of the Province, doing a few trivial inspections, and besides, the inspection fees are not waived.

"Okay Mr. Chen, what tests should be done?"

"CT, pulmonary function, tumor indicators, a complete set of biochemistry..."

Chen Qi counted them one by one. If he said the same thing again, it would mean that the Jin family's wallet would start to bleed again.

Although these examinations were very common in later generations and were not expensive, in the 1980s, these were all new gadgets, and the cost of examinations was naturally not high.

Just a CT examination costs hundreds of yuan per time. These days, a farmer only earns a few hundred yuan a year? There is no way. No matter how expensive it is, you have to do it, and you have to queue up to do it with the back door open.
p>
To be continued...