This miracle doctor just wants to be fired!

All the doctors from the emergency internal medicine department were present.

Including some senior attending physicians and some young doctors, everyone lowered their heads and pondered when they heard Fang Hang's question.

Zhang Biao, in particular, is very nervous right now. He's the one who basically plans the patients' treatment schedules for lunch.

If there's a problem, then Zhang Biao is the person primarily responsible.

This question reveals Fang Hang's difference from the others; he has the highest level of education, enjoys pondering various issues, and raises his own questions.

The first to answer was not Li Degang and Zhang Biao, the two senior attending physicians, but Zhou Cheng!

Hearing Fang Hang's question, Zhou Cheng pondered for a moment.

However, adhering to the principle of keeping a low profile, he originally did not want to answer.

But Fang Hang was now staring at him alone, looking like he wouldn't give up until he got the answer from him.

Furthermore, as the doctor on duty in the afternoon, he also bears some responsibility if the patient's treatment plan is questioned.

"I think this issue can be analyzed from three perspectives. The gastric lavage performed by Dr. Zhang at noon is entirely in line with the basic principle of the emergency department: 'saving lives first, then providing precise treatment.'"

Upon hearing Zhou Cheng's speech, everyone turned their attention to him.

Zhang Biao looked at Zhou Cheng curiously and quickly said, "Continue telling me."

Zhou Cheng wasn't his student, but he knew that Zhou Cheng was a very down-to-earth and hardworking young man, much more reliable than Zhao Rui!

Zhou Cheng nodded and continued, "First of all, when the patient was admitted to the hospital, it had only been one hour since he swallowed 1000 nifedipine sustained-release tablets. At this point, most of the tablets were still undissolved or partially dissolved and scattered throughout the stomach cavity."

"The core objective of emergency treatment for poisoning is to remove as much poison as possible from the stomach before it is absorbed into the bloodstream. The advantage of gastric lavage is that by injecting saline solution into the stomach through a lavage tube, repeatedly flushing and then aspirating it out, it can remove 70%-80% of the lumpy or granular drugs from the stomach in a short time, usually within 30-60 minutes, rapidly reducing the total amount of poison in the stomach and reducing the dose that will be absorbed into the bloodstream later."

"The core function of gastroscopy is to accurately locate and remove residual substances. Before the procedure, anesthesia assessment and equipment preparation are required, such as the endoscope and foreign body forceps. The entire process takes at least 1-2 hours. For emergency patients who have just swallowed a large amount of medication or toxins that may be rapidly absorbed, this time is too long. It is very likely that during the preparation for the endoscope, a large amount of nifedipine will have already been absorbed into the bloodstream, causing a sudden drop in blood pressure, worsening heart failure, and missing the optimal time for intervention!"

"Simply put, gastric lavage is like 'washing away most of the garbage in the yard with a large amount of water,' while gastroscopy is like 'picking up the small pieces of garbage hidden in the corners with tweezers after rinsing.' The two are a complementary relationship of 'first effectively blocking the spread, then precisely remedying it,' rather than a substitution relationship."

Upon hearing Zhou Cheng's explanation, everyone nodded in agreement.

The principle may seem simple, and everyone probably understands it, but it may not be so easy to express it clearly!

Zhang Biao was the first to stand up and speak, expressing his support for Zhou Cheng: "That's right, gastric lavage is the quickest way. If we had done a gastroscopy from the beginning, it would have caused a delay."

Li Degang nodded, "Xiao Zhou is right."

Fang Hang, who had been pondering, suddenly felt that Zhou Cheng's words made some sense. "Junior brother, what you said does seem to make some sense."

Seeing that everyone agreed with his point of view, Zhou Cheng added, "There's one more thing, we need to consider the patient's circulatory status at the time."

He looked at Zhang Biao and said, "When Teacher Zhang made the treatment plan at noon, the patient had not yet developed severe heart failure, but he already had symptoms of chest tightness, swelling in his limbs, and his blood pressure was also showing a downward trend."

"Gastroscopy requires anesthesia, and the process may irritate the stomach wall, causing nausea, vomiting, and even fluctuations in blood pressure. For patients with unstable circulation, this stimulation is too risky and could worsen their condition."

"In contrast, gastric lavage is a relatively gentle procedure that can be performed while the patient is in a semi-recumbent position. Our medical staff can also monitor vital signs in real time, and can immediately stop and adjust if there is a change in blood pressure."

Zhou Cheng paused, picked up the medical record on the table, and flipped to the patient's vital signs record upon admission.

"Look, the patient's blood pressure was 100/65 mmHg when admitted to the hospital. During the gastric lavage, the blood pressure dropped to as low as 90/60 mmHg. We slowed down the lavage in time and added fluids, and the blood pressure quickly rose. If we had done the gastroscopy directly at that time, the blood pressure might have collapsed long ago."

Hearing this, Zhang Biao's tense shoulders finally relaxed. He picked up the water glass on the table, took a sip, and said with relief, "Zhou Cheng is right. I chose gastric lavage because I considered the patient's unstable circulation. If I had rashly performed a gastroscopy from the beginning, and something went wrong, I would have been in great responsibility."

His gaze toward Zhou Cheng held a newfound approval.

Previously, I only thought Zhou Cheng was down-to-earth and hardworking, but I didn't expect him to have such a good grasp of the details of diagnosis and treatment, and he could even explain his own considerations at the time.

A young doctor nearby raised his hand and asked, "I also want to ask, why not prepare gastric lavage and gastroscopy at the same time? While the gastric lavage is being done, the endoscopy center can prepare the equipment, so that the gastroscopy can be performed directly after the lavage, wouldn't that save time?"

Zhou Cheng smiled and patiently explained, "This idea is good, but it's not practical in actual operation."

"First of all, the emergency resources of the endoscopy center are limited and not available on call, especially at noon when doctors may be on break. It takes at least an hour to prepare equipment and anesthesia team."

"The gastric lavage was completed long ago."

"Secondly, we need to assess the amount of residue in the stomach through gastric lavage. If the patient's vital signs are stable and symptoms are relieved after lavage, it means there is very little residue, and a gastroscopy may not be necessary, thus avoiding wasting medical resources. Only when the patient's condition continues to worsen after lavage, as in this case, is further CT and gastroscopy necessary."

Li Degang kept nodding as he listened to Zhou Cheng's words.

The points Zhou Cheng just mentioned are not only in line with emergency guidelines, but also take into account the actual situation of patients, which is much better than simply copying knowledge from books.

He was growing to appreciate his apprentice more and more, and really wanted to keep Zhou Cheng in the emergency department!

However, with Fang Hang and Zhao Rui standing in front of Zhou Cheng, it would be easier said than done for him to stay quickly!

Li Degang thought for a moment, then looked at the young doctors present and said in a serious tone, "When you handle cases in the future, you should also think about this aspect more. Don't just focus on the doctor's orders; you should adjust the treatment plan based on changes in the patient's condition."

The young doctors in the department continued their discussion.

Fang Hang, in particular, is now talking to Zhou Cheng about his illness and some of the pathophysiological mechanisms, and he simply doesn't want to let go of Zhou Cheng.

Li Degang looked at the lively discussion scene before him and felt secretly satisfied.

In the past, when discussing cases in the department, only senior doctors would speak, while younger doctors either dared not speak or their opinions were not relevant.

Now, with Zhou Cheng leading the way, not only can they offer professional insights, but they can also inspire other young doctors to ask questions and think critically.

The learning atmosphere in the entire department has improved.

He clapped his hands to draw everyone's attention: "Alright, that's all for today's discussion. Zhou Cheng, you continue to keep a close eye on the patient this afternoon, and report to me immediately if anything happens. Share this with everyone at tomorrow's morning meeting so that everyone can learn about this treatment approach."

"Okay, Teacher Li," Zhou Cheng replied.

After everyone dispersed, Zhang Biao walked up to Zhou Cheng and patted him on the shoulder: "Zhou Cheng, thanks to you today, otherwise I would have had to explain to them for ages. In the future, we can talk things over more."

Zhou Cheng smiled and nodded: "Teacher Zhang, you're too kind. I still have a lot to learn from you."

After Zhang Biao left, Zhou Cheng could only sigh.

I used to keep a low profile in the department, but now it seems to be developing in the opposite direction.