Chapter 177 The diagnosis of lobular pneumonia was immediately eliminated

"Siying, if you think about this case carefully, it should be of great help in improving your clinical diagnostic thinking."

Li Jingsheng turned to look at Han Siying next to him.

"Uh-huh!"

She has already begun to think about dialectics.

Li Jingsheng began to do some necessary physical examinations for the child.

The body temperature is 38.7 degrees, moderately hot.

The child had no diarrhea, but had vomiting due to severe coughing, which was retching.

Lifting up the child's clothes, you can see the collapsed abdomen and clear ribs. The child is very thin.

"Too thin, I need to give my child more nutritious food!"

Li Jingsheng said to his family members.

"OK."

The middle-aged woman nodded in agreement, but her words didn't match her words.

I can understand how difficult it is for this family.

She just called this child the fourth child, indicating that there are probably more than four children in her family.

For a family with good economic conditions, it is already very difficult to support four children. For a family with financial difficulties like hers, it will only be even more difficult.

It is good to be able to let children study and have enough to eat.

How is that possible if you give your children milk every day and eat and drink every day?

Li Jingsheng auscultated the child's heart and lung sounds.

The wet rumble of bursting blisters can be heard clearly.

After checking this step, Li Jingsheng already felt a little confident.

"Siying, come and listen to his lung sounds."

She took the stethoscope and was very unfamiliar with the operation. She seemed clumsy in everything and felt a bit confused.

Even because I was too nervous, my auscultation position was wrong and I didn't hear the lung sounds, which made me laugh.

Under Li Jingsheng's guidance, she mastered the basics.

"I heard it, a very rough sound."

she said.

"Listen carefully, are there any other sounds? Or remember the child's lung sounds. In addition, many patients have obvious differences between the left lung sounds and the right lung sounds, so you have to distinguish them carefully."

Li Jingsheng is not a good teacher.

But for this motivated and simple female medical student, he was willing to try his best to cultivate her.

A doctor's energy and time are limited and he cannot treat several patients.

Only by cultivating more doctors can we meet the domestic demand for medical treatment.

The current medical situation in China is that people die from drought and die from waterlogging.

Small hospitals have a hard time finding patients, big hospitals have long queues all night long, and many large hospitals have a hard time finding a bed.

Even patients with very serious conditions meet the admission criteria, but there are no beds and they have to wait.

With Han Siying's medical skills and motivation, as well as her demonstrated learning ability, I believe that she will definitely do well as long as she enters a large hospital in the future.

When she needed help and guidance the most, Li Jingsheng helped her like this, which was considered a kind of fate.

As long as she is not a white-eyed wolf, she will definitely remember this master-disciple relationship.

When Li Jingsheng needs help in the future, she will do her best to help him.

"I seem to hear a strange sound, like a friction sound, or... a sound like bubbles bursting!"

Her talent is really very good.

It's amazing how quickly you can discover so many things.

"Do you remember that sound?"

"Um!"

She nodded.

"The abnormal sounds you hear in the lungs are crackles. Pay attention to distinguish their subtle differences. The crackles like this child's are relatively thick and are the sound of large vesicles bursting. Those that are lighter are moderately moist.

There is also a milder rale that requires careful attention to hear, which is a thin wet rale. There is also a sound similar to a twisting hair, which is also a wet rale.

Finally, you should pay attention to distinguishing the location and differences of the sounds. Novices can easily confuse it with the cardiophrenic fricative sound..."

Li Jingsheng carefully taught her these clinical techniques.

You can't learn it from textbooks at all, because the theoretical knowledge is described in words. Only in this kind of real practice, you can easily tell which sound is a wet rale, which is a dry rale, and which is a dry rale after listening to it several times.

Wet rales exist at the same time.

It can also be seen from this that Li Jingsheng's level is N times higher than hers.

After all, Li Jingsheng himself worked as a resident doctor in a large hospital for several years, and later relied on the attribute panel to improve in-call diagnosis to a minor level.

Under normal circumstances, she may need more than ten years of clinical accumulation to reach Li Jingsheng's current level.

This is because she has great talent.

"It is initially suspected that your child has a lung problem. He needs a chest X-ray. The fee is one hundred yuan. It is just the examination fee. Can you think of it?"

Li Jingsheng asked his family members.

"Okay! If I come here, I believe you. Going to a big hospital will only require more examinations."

A woman with four children must have been to a large hospital.

She feels that clinics are much more affordable than hospitals.

It took Li Jingsheng more than 20 minutes to make the film, and he wanted to smash his grandpa's machine.

Now that I have some money left in my hand, and as a doctor of the Second Hospital, I have the opportunity to build a good relationship with the hospital's logistics department, and maybe I will have the opportunity to buy a retired X-ray testing equipment.

Based on my feeling, the hardware facilities of the second hospital should be quite good.

The clarity of X-rays taken by patients undergoing orthopedic surgery is really great.

This grandpa's machine can be disposed of cheaply by then.

After taking the X-ray of the child, he already had a relatively clear diagnosis in his mind.

In the cardiophrenic angle area and inner zone of both lungs, there are small patchy darkening shadows with blurred boundaries, darker density in the middle and shallower edges. Moreover, the density is uneven.

The density is uneven and flaky, which is caused by the doping of air-filled alveoli.

From the above X-ray findings, it can be judged that the patient is most likely to have pneumonia.

The lung texture was obviously thickened and the edges were blurred.

This indicates that there is extensive alveolar inflammation that masks part of the thickened lung markings.

Then it can be seen from the film that there are atelectasis in two lobes of the lung.

Combined with the patient's multiple symptoms, Li Jingsheng's final diagnosis was lobular pneumonia.

When I first had a physical examination, I thought it might be lobar pneumonia. Now that I have X-rays for auxiliary diagnosis, the results are clearer.

It is undoubtedly lobular pneumonia.

Because in lobar pneumonia, bacteria often invade from the airways and stay directly in the alveoli, with a single alveolar as the center, and then spread widely to adjacent alveoli through the foramen of Connell, eventually forming lobar segment inflammation.

Lobular pneumonia occurs when bacteria invade the bronchus from the upper respiratory tract, causing inflammation in the trachea and then spreading to the alveoli.

To put it bluntly, it’s bronchopneumonia.

Li Jingsheng's treatment for the patient mainly focused on anti-infective treatment, cooling down and eliminating phlegm.

"Does the child have a history of penicillin allergy?"

Before prescribing medicine, he asked his family members.

"I don't know!"

How could the family know this?

There is no other way but to do a skin test.

Lactam and macrolide antibiotics are the drugs of choice for Li Jingsheng.

If the pathogen cannot be detected, we can only use probability theory to test drugs.

In fact, even if the pathogen can be detected, large hospitals will still make adjustments and replace other drugs if they find that the effect is not good after using the drugs.

"For the time being, I will prescribe medicine for the child for three days. It is best to come in the morning for infusion every day. It is recommended that you get some nutritious food for the child to eat after returning home."
To be continued...