Healing Doctor

Chapter 303 Following Good Advice

The 120 emergency doctor felt slightly ashamed.

"You're diagnosing myocarditis just because a cold hasn't healed? Go back now." Meng Qingfei waved his hand impatiently, shooing him away.

"Dr. Meng," the 120 emergency doctor glanced at Meng Qingfei's name tag and said somewhat apologetically, "Let me know what the results are."

After saying that, he left a contact number.

Meng Qingfei didn't refuse; he wrote down the phone number and began the physical examination.

The patient is a 32-year-old male, 176cm tall and weighing approximately 65kg.

The patient reported having lunch with colleagues at noon and drinking half a glass of baijiu (Chinese liquor). Afterward, the patient experienced chest pain, chest tightness, and vomiting. The vomit consisted of stomach contents and no coffee-ground-like substances were observed.

Physical examination: Heart rate 102 beats/min, blood pressure 154/103 mmHg, no other positive signs were found during the physical examination.

The patient was lying in bed in poor spirits. Although his vital signs were stable, he looked like he had a serious problem.

After taking the patient's medical history and conducting a physical examination, Meng Qingfei stood beside the patient without saying a word. Ji Xiang noticed that he was constantly fidgeting with his right hand, as if he were telling fortunes.

The thumb taps rapidly across the other fingers; if the other hand is adorned with a peach wood sword and someone is muttering incantations, the scene truly comes to life.

Ji Xiang was very curious about what Meng Qingfei was doing.

Although the patient seemed very uncomfortable, he wasn't in a critical condition, so Ji Xiang didn't go to the operating room.

After ordering other tests, Meng Qingfei briefly left the emergency room and returned to his consultation room to ponder.

"Teacher Meng, may I bother you for a moment?" Ji Xiang asked.

"Go ahead," Meng Qingfei said, his finger still tapping.

"What is this...?"

"Differential diagnosis," Meng Qingfei said. "The patient has had chest pain for nearly 12 hours, and the pain is so severe that there is most likely an organic problem."

Differential diagnosis 1: aortic dissection.

In general, if a patient experiences chest pain accompanied by elevated blood pressure, aortic dissection should be ruled out first.

However, since the blood pressure difference between the left and right upper limbs is not significant, and the dissection pain is generally tearing or stabbing, relevant examinations of the abdominal major blood vessels can be completed first to rule it out. If necessary, a CTA examination of the thoracic and abdominal aorta can be performed.

The contrast-enhanced CT scan is currently unavailable due to the end of the workday, so we're not considering it for now.

"Second, viral myocarditis..."

"Third, spontaneous pneumothorax..."

"Fourth, acute pancreatitis..."

Fifth, myocardial infarction...

Meng Qingfei was talking to himself, his right thumb constantly tapping on his other fingers, as if each tap was a differential diagnosis.

But he never found the right answer.

Soon, the emergency room serum troponin test came back negative, temporarily ruling out viral myocarditis and acute myocardial infarction.

This made Meng Qingfei even more confused.

Ji Xiang also found the patient very strange, and focused his attention as he went to the operating room.

Meng Qingfei's lips began to move as he muttered to himself, concentrating intently on making the differential diagnosis.

His skill level is quite good. The patients in the emergency department generally have relatively simple conditions, unlike this patient who doesn't even know who to consult.

"Teacher Meng, I'd like to go see the patient," Ji Xiang suddenly said.

"I just finished checking," Meng Qingfei replied casually. "What are your thoughts?"

"During your physical examination, you didn't check the patient's armpits."

"Oh, indeed, but not all..." Meng Qingfei was focusing 80% of his attention on differential diagnosis, and originally wanted to casually tell Ji Xiang that not all places needed to be checked.

It's like if you have chest pain and go to see a doctor about your genitals, you'd be beaten to death by the patient and their family.

Even if they aren't beaten to death, if someone posts it on social media, they'll most likely be killed.

However, Ji Xiang's words were only the beginning, but Meng Qingfei immediately thought of many things.

"Are you saying there might be a problem with the mediastinum?!"

Ji Xiang's words opened up Meng Qingfei's mind.

"The rest of the body looks fine for now; the only thing I missed is my armpit," Ji Xiang replied frankly.

Meng Qingfei's eyes lit up immediately. He strode out, went to the emergency room, opened the patient's clothes, and instructed the patient to raise his arm.

When Meng Qingfei touched his armpit, a slight sensation of gripping snow was transmitted through him. Upon closer inspection, he confirmed that it was indeed an atypical sensation of gripping snow.

"Damn it, this really isn't an internal medicine issue. Go get an emergency CT scan," Meng Qingfei hurriedly told the nurse. "The patient's condition has some problems. I'll take the patient for tests. I need Old Li from internal medicine to take a look at the other patients first!"

After saying that, he hurriedly went out to prepare to write up the prescription, but then remembered something and turned back to say, "Call the general thoracic clinic and tell them to prepare a bed."

Ji Xiang genuinely admired Meng Qingfei.

Chest pain is not something that needs to be examined in the armpit, and spontaneous mediastinal pneumothorax is extremely rare.

He mentioned it himself, and Meng Qingfei readily accepted it and took it to heart.

He was truly fluid, like the Yellow River, overturning all his previous assumptions.

His unwavering thinking was admirable, and his mind worked incredibly fast, only slightly slower than the system NPCs.

"Xiao Ji, you stay here. Have the patient checked by Dr. Li in internal medicine first. Don't let him go. I'll come back to check on him." Meng Qingfei said hurriedly, pushing the patient and running all the way.

The oxygen bag on the flatbed cart almost fell off, but Meng Qingfei caught it with his arm and disappeared around the corner.

"Xiao Meng's diagnosis is quite good, but he's a bit impatient." The internist, who had already been called up and was standing in the corridor, gave a soft evaluation after Meng Qingfei disappeared.

Ji Xiang was slightly disappointed. He also wanted to know the patient's final diagnosis, but he didn't say no. Instead, he stayed as Meng Qingfei had suggested.

"You must be Ji Xiang. I heard you broke the record that's been held for so many years at the competition," Dr. Li from the internal medicine department asked, looking at Ji Xiang.

"Just a coincidence," Ji Xiang smiled.

"Xiao Meng really likes you. By the way, I heard you were the one who diagnosed the tetanus patient a while ago?"

"happen."

Dr. Li, an internal medicine specialist, gave Ji Xiang a deep look. One coincidence can happen, but a series of coincidences must mean something is wrong.

"What was the diagnosis for that patient just now?" Dr. Li from the internal medicine department asked.

"I don't know either. I just said something randomly, and Teacher Meng seemed to have made a diagnosis." Ji Xiang deflected all questions, saying he didn't know anything no matter what anyone asked.

"This is an internal medicine case, but... sigh." Dr. Li sighed, then suddenly smiled, "Everyone knows that Xiao Meng's diagnoses are good. When patients from other hospitals come for consultations, the nurses go directly to Xiao Meng. That's good, it saves us a lot of trouble."

"Xiao Meng looks carefree, but he's actually quite good. You're pretty capable too. Out of all the doctors in the emergency department, you chose Xiao Meng. I've noticed you always come with him to work shifts."

"Professor Meng is funny. When I first came to the residency training, he told me that the toilets in the emergency department had been blessed, and patients with urinary tract stones were willing to use the toilets there."

Ji Xiang smiled.

(End of this chapter)