Chapter 325: Perfectly cured one, neurofibroma and café au lait spots
"Doctor Zhou, what kind of cold does my granddaughter have? Why doesn't the medicine work?"
She asked Zhou Can who was measuring the little girl's vital signs.
As she spoke, she took out the cold medicine and showed it to Zhou Can.
"You don't think this is fake medicine? My granddaughter fell ill at night, and I bought the medicine at the nearest small clinic."
When patients find that medicine does not work, they tend to doubt whether the medicine they bought is fake.
There is indeed a probability of 'winning the lottery'.
Especially now, many pharmacies choose to buy drugs from small manufacturers to increase profits. In terms of quality, they are not as guaranteed as drugs from large manufacturers.
After all, it is not easy to build a brand, and the cost of making mistakes for large companies is high, so they dare not take risks.
In order to survive, small manufacturers sometimes act carelessly and do some stupid things.
Zhou Can took the cold medicine the patient had taken and examined it carefully.
"There is nothing wrong with the medicines. They are all produced by regular manufacturers and are suitable for the symptoms."
If the owner of the small clinic heard what he said, he would definitely thank him.
Some small clinic owners and pharmacists are basically medical students who have studied pharmacy or even clinical medicine. Or they desire freedom and do not want to stay in the big system of hospitals, where there are intrigues and bullying, so they choose to work on their own.
Therefore, these people have certain professional knowledge.
It is even less likely to sell medicine randomly.
If something happens to the patient after taking the medicine, the clinic or pharmacy will be in trouble.
"Your granddaughter has a fever and a fast heart rate. Judging from the symptoms, it does look like a cold, but it could also be something else. Has her bowel movements been normal over the past two days?"
"I really don't know about that." The old lady shook her head.
My granddaughter is already eight years old, and adults rarely pay attention to things like urination and defecation.
The little girl felt the eyes of her grandmother and the doctor on her face, and said embarrassedly, "It's just a little diarrhea, everything else is fine!"
Diarrhea is also one of the most common symptoms of a cold.
Zhou Can had almost understood the patient's basic information, and the next step was to think about which tests to order.
In her case, routine blood and urine tests are very necessary.
There was no need to do a chest X-ray for the time being. We could wait for the blood and urine test results to come out before further checking the relevant biochemical items. Zhou Can quickly sorted out his diagnostic ideas in his mind.
He now finally understood why the Ministry of Health had to stipulate the number of patients that outpatient and emergency doctors could see per day.
Because there are too many patients, the doctor's mind will be confused.
If you see more than a hundred patients a day, you will definitely not be able to remember their information and conditions. Even many patients will be sent away after a brief chat after seeing them once and giving them a checkup.
In this case, the quality of diagnosis and treatment can be imagined.
It is almost an open secret that doctors in hospital inpatient departments and operating rooms are seriously overloaded with work, especially interns and trainees, who are the hardest hit.
I just didn't expect that the outpatient clinic also had an overload of work.
This is definitely not a good thing.
Doctors and nurses are suffering, patients are not getting high-quality medical services, they spend money and time, but the disease is not cured.
When doctors are too tired, the probability of misdiagnosis or missed diagnosis will also increase greatly.
Zhou Can dares to assert that if a hospital can come up with a proper solution to these problems, the competitiveness of that hospital will instantly surpass that of other hospitals.
"Go get a blood and urine test first! I'll see what happens."
After checking the patient's basic condition, Zhou Can issued an application for examination.
"Okay! Now that we're here, we'll definitely listen to you."
The old lady agreed readily.
Holding the prescription written by Zhou Can, the old lady took her granddaughter out.
This is also the first difficult case Zhou Can has encountered since he started seeing patients today.
Before he had time to drink some water and rest, the door of the clinic was pushed open again and a new patient came in.
He could only cheer himself up and deal with it.
This is the fifth patient I have seen today, and less than an hour has passed.
The momentum is encouraging!
It seems that thanks to the home advantage, the outpatient and emergency volume at Tuya Hospital is at a completely different level from that at Xinxiang Women and Children's Hospital.
The fifth patient was a teenager with a dislocated left arm. He was only nine years old, but was over 1.7 meters tall.
Zhou Can is very good at treating this kind of bone injury.
It is much easier than diagnosing and treating those difficult and complicated diseases.
However, he still asked about the injuries in detail and understood the course of the incident to prevent misdiagnosis. Sometimes, some insignificant injuries may be ignored by the patient, but they can seriously threaten the patient's life.
In the news, there are often reports of car accident victims choosing to settle privately, and they were not seriously injured at the time. But they returned home and suddenly died after one or two days, or four or five days.
This sounds scary, but it is actually preventable.
If you can go to the hospital and ask a professional doctor to diagnose and identify hidden dangers after a car accident, you can control and prevent serious consequences such as death.
Thanks to Dr. Xu's strict teaching, Zhou Can has a very good style in medical safety.
No matter how common the illness is, he always remains highly vigilant.
After a physical examination of the big boy, no hidden dangers were found. He was given an X-ray and sent away.
After this patient and his family left, two patients came in at the same time.
One was a new patient, and the other was the first patient seen today—the girl who sprained her ankle while dancing.
"Doctor Zhou, we have finished the examination."
The girl's mother gave him the test results.
"Please wait a moment. They are the first patients to come to see me this morning. I will treat her first and then you."
Zhou Can explained to the family of another patient.
"Of course! They came first, so they should be dealt with first."
This family member is reasonable and easy to talk to.
After Zhou Can calmed the other person down, he calmly began to check the film of the little girl.
"Little girl, you should be more careful when dancing next time! This time you directly dislocated your right ankle. Fortunately, there was no fracture, which is a blessing in disguise."
After Zhou Can looked at the patient's X-ray, he already had an idea in mind.
In this case, there is no open wound or bone fracture, only an ankle dislocation, which can be completely repositioned by manipulation.
"Did you hear what Doctor Zhou said? Your body is your own. Don't be so aggressive when you practice dancing next time." When the girl's mother scolded her daughter, it was clearly three parts scolding and seven parts love.
After she finished scolding her daughter, she looked at Zhou Can with a flattering expression, with a hint of worry between her brows.
"Doctor Zhou, what should I do about my daughter's injury?"
"I tried to help her restore the bone manually, which is much better than surgery. But she must take good care of herself. I will prescribe some anti-inflammatory and analgesic drugs for her when the time comes."
Zhou Can gave a treatment plan.
"Okay, okay, we'll listen to you. We're just afraid of having to undergo surgery, so we came to you for treatment. It seems we've come to the right place." The girl's mother was obviously relieved when she heard that the fracture could be repositioned manually.
For the family members, not having to undergo surgery means that the cost of treatment will be greatly reduced and the child will suffer less.
Surgery is risky. If it goes wrong and my right foot becomes disabled, I will have no place to cry.
"You can't be happy too soon. The success rate of manual reduction is not 100%, and there is a possibility of failure. I can only say that we will do our best to reduce the burden on the family members and give priority to the most affordable and effective treatment plan."
Zhou Can probably didn't even realize that, when he was communicating with family members, he gradually mastered the communication skills of the chief physicians .
Create a good and positive image to the greatest extent possible to gain the gratitude and trust of the family members.
"Sit tight! The manual reduction will definitely be a little painful, but don't be afraid, the pain will last very short time." While explaining the precautions to the little girl, Zhou Can squatted down and began to manually reduce the position for her.
To prevent any accidents, Zhou Can looked at the girl's mother.
"Otherwise, you should just support her."
"OK!"
The family members walked to the little girl's side and supported her.
The little girl didn't dare to look at Zhou Can's hand.
She turned her head away and squeezed her eyes shut.
At the beginning, Zhou Can slightly adjusted the angle of the manipulation, and the girl started screaming in pain.
He ignored the girl's cries of pain, and instead found the best angle to reposition the ankle joint, then pushed forward with a slight force.
"clatter!"
There was a clear sound of bones crackling, and the little girl also let out a scream.
"It's okay, it's normal to feel pain! Try to curl up your right toes again."
Zhou Can comforted the patient.
In the seemingly very short treatment time just now, Zhou Can had successfully helped her complete the ankle joint reduction.
The girl tried to stand on tiptoe of her right foot.
"Wow, I can really do it!" the girl said to her mother in great surprise.
"That's great! Dr. Zhou's medical skills are superb. He really helped you to successfully restore the fracture!" The girl's mother smiled happily. She looked at Zhou Can and said, "Thank you, Dr. Zhou, thank you!"
"You're welcome! Saving the dying and healing the wounded is what we doctors do. I'm actually happier than anyone else that I was able to successfully reposition her. If such a young girl had surgery, she would definitely be left with ugly scars. The recovery time would also be much longer. Now that she's fine, you and I can both breathe a sigh of relief."
After Zhou Can helped her check carefully and confirmed that the ankle joint had indeed been successfully repositioned, he sat back in his seat.
"I'll prescribe some medicine for her. Celecoxib can relieve pain and prevent joint inflammation..." His current pharmacology and dialectical medical skills are at level four, which is more than enough to handle this kind of small situation.
When prescribing medicines for patients, the most suitable medicines and dosages can be used accurately.
This ability seems simple, but many residents need to work hard until they are promoted to attending physicians, or even longer to acquire it.
Even senior residents are very careful when prescribing medicine to patients, and they have to look up materials and consult senior doctors from time to time. The difficulty lies in prescribing medicine.
Medication errors can directly lead to a rapid deterioration of the patient's condition.
If the dosage is too high, drug harm will occur. If it is too low, the treatment effect will not be achieved. Even the way of administering the medicine has to be considered.
For example, for the most common infusion, most novice doctors do not know that some patients need to keep the temperature of the infused liquid at around 30 degrees during infusion.
It was only after three months of regular training in the Department of Critical Care Medicine that Zhou Can mastered the advanced experience of intravenous infusion.
Some patients are admitted to the intensive care unit because they have serious health problems, such as poor blood circulation, heart failure, and poor circulation. Maintaining body temperature requires a large amount of energy stored in the patient's body.
When the ice-cold liquid is injected into the blood vessels, it is fine if the drip rate is slow. However, if the infusion is rapid, it can easily cause the patient to die of burping.
During Zhou Can's regular training in the Department of Critical Care Medicine, many senior doctors told him about this.
Anesthesiologist Dr. Feng also mentioned this.
After the medicine was prescribed, the little girl's right foot sprain was cured.
Among outpatient doctors, few personally perform manual reduction on patients.
Because this is already a special skill.
Mainly because other doctors don’t know how to do it.
Normally, patients who need manual reduction must go to the orthopedic surgery department's manual reduction room for treatment.
Zhou Can performed manual reduction surgery on the patient in the pediatric outpatient clinic, and he didn't know whether it broke the rules.
However, from the patient's perspective, they would definitely like this one-stop medical service.
Otherwise, after the family members have completed the pediatric examination, they will have to take the examination results to the orthopedic surgery department to queue up for registration again.
The young mother left with her daughter, expressing her gratitude profusely.
She is very satisfied with the treatment results.
Zhou Can has gained another "loyal fan".
This is how fame is accumulated, just like sand piles form a tower and water accumulates to form a river.
"Dr. Zhou is amazing! Please help my nephew. He has been complaining about pain in his legs lately, especially in his knees."
It seems that this elegant woman in her thirties is not the boy's mother.
There are many causes of leg pain, ranging from leukemia and malignant tumors to arthritis and rheumatism.
After Zhou Can learned about his condition and medical history in detail, he gave him a physical examination and then prescribed three examination items: blood routine, B-ultrasound, and X-ray. Each examination had his profound intention.
It can identify the patient's disease condition as quickly as possible.
…
The child named Lele who had macrodactyly also came back after the examination.
After Zhou Can read the test results, he was basically diagnosed with neurofibromatosis type II macrodactyly. The incidence of this type of neurofibromatosis is one in three thousand, and it is a chromosomal dominant inheritance.
Most of these patients will have stillbirths, or will be found to have deformed fetuses in the womb and eventually have induced abortions and remove the babies.
In the early years, the birth rate of disabled babies in the country was very high.
Many children are born with mental retardation, limb defects, major congenital defects or diseases, etc. It was not until recent years that my country's medical technology and level have made great progress, multiple screenings have been added to prenatal examinations, and close relatives have been banned from marrying, which has greatly reduced the birth rate of disabled babies.
Most mothers who have been pregnant should know about tests such as Down syndrome screening and four-dimensional color ultrasound.
Take Down syndrome screening as an example. This disease is also known as congenital idiocy or Down syndrome.
It is a disease caused by chromosomal abnormalities. The fetus has an extra chromosome 21 compared to normal people. 60% of the affected children are aborted in the early fetus, and the survivors have obvious mental retardation, special facial features, growth and development disorders and multiple deformities.
It is most beneficial to screen for this disease around 12 weeks of pregnancy.
After the diagnosis, the pregnancy can be terminated immediately by abortion, which greatly reduces the loss of the parents and the harm to the family. Just imagine, if such a mentally retarded fetus is born, the parents will need to raise him/her for the rest of his/her life. I believe it will be a huge disaster for any family.
Many couples who originally had a good relationship have their relationship broken down and their families collapsed after bearing such a heavy burden.
"I need to take his clothes off and examine the child."
Zhou Can said to the patient’s grandmother.
There are several diagnostic methods to determine whether it is neurofibromatosis.
So far, the child has only undergone X-ray examination and B-ultrasound.
X-rays clearly showed bone deformities and long, streaky images, which were consistent with neurofibroma.
Also, when he did a Sugarcane exam, he found a café-au-lait spot on the child's neck.
I didn't think much about it at the time and thought it was a birthmark.
Now after seeing the test results, he thinks the patch might not be a birthmark.
After the child's clothes were taken off, multiple cafe au lait spots of varying sizes were found on his body.
The largest ones are over four centimeters in diameter.
Generally speaking, if there are more than six cafe au lait plaques on the body, it can be used as a basis for the diagnosis of neurofibromatosis. However, this cannot be the gold standard, it is only a superficial basis for diagnosis.
Genetic testing reveals NF1 or NF2 mutations, which can become the gold standard.
In addition, X-ray, ultrasound, CT, and MRI examinations can also provide a basis for diagnosis.
For example, this patient's X-ray showed bone deformity and stripe-shaped images, which is a basis for diagnosis.
Diagnosing the true cause of a disease requires verifying it one item at a time, and ultimately making a comprehensive diagnosis based on symptoms, examination data, the patient's medical history and other information before a definitive diagnosis can be made.
