Chapter 933: 914 Physical Symptoms Don't Match (Six More Chapters, Seeking Monthly Votes)

"Cui Lao is employing the warm‑water frog trick—first finding you patients, then, as long as you can't handle it, he'll give you benefits to keep you working in the emergency department." Su Yun said.

Zheng Renye had also thought of those little tricks, but who would go work in the emergency department—a busy, tiring, unprofitable place—when they have a Nobel Prize project in hand?

Zheng Ren merely smiled and did not answer Su Yun's words.

Both of them knew in their hearts that, like Director Pan, Cui Lao was also unwilling to accept the situation.

The emergency department has no new staff, but it must still exist. They are merely burning what little life they have left, desperately trying to keep going.

They give their all until they can only die after exhaustion.

But is an individual's power of any use?

It's completely useless; even though Cui Lao, at seventy or eighty years old, persists in giving lectures nationwide, the results are still meager.

But if we try to improve the emergency department doctors' treatment, these problems will trigger a chain reaction—something an academician of the Engineering Academy cannot decide alone.

It sounds impressive to be an academician, but it's just a signboard. Saying it's useful makes it useful; saying it's useless makes it truly useless.

Let the hospital and society self‑regulate? Then how much cost must be paid before any improvement can be seen?

Not long ago, the matter of insulting and scolding bus drivers gained attention; now those who insult and scold drivers are already being judged as endangering public safety and sentenced.

But when it comes to medical care, the situation becomes even more complex.

Forget it—I'm just a little doctor, Zheng Ren chuckled ruefully.

All the way to the emergency department, Inpatient Chief Zhou Litao was already waiting in the hallway.

He is short and stocky, his face covered in pockmarks, dark‑skinned; standing beside Su Yun, they form a stark contrast.

"Boss Zheng, there's a patient whose symptoms don't match; Cui Lao happens to be seeing patients today, so he asked you to take a look." Zhou Litao stepped forward and said politely.

"No, no." Zheng Ren immediately replied, "Cui Lao's favor is too much; I dare not accept it."

Zhou Litao laughed, exchanged a few polite words, and brought Zheng Ren to Cui Lao's consultation room.

After entering, Zheng Ren saw an old man with white hair and beard sitting in the consultation room, currently taking a history.

"Greetings, Cui Lao." Zheng Ren bowed deeply, first expressing his respect.

"Hmm, Xiao Zheng, come take a look at this patient." Cui Lao nodded, "Litao, tell Xiao Zheng about the patient's condition."

Zhou Litao immediately said: "The patient came to our hospital with one day of intermittent upper abdominal pain, accompanied by nausea and one episode of vomiting. He has a smoking history of over 30 years and a 12‑year history of hypertension, treated with Luo Huo Xi, and his blood pressure is well controlled."

"The patient's abdomen shows no bulging, no intestinal contours or peristaltic waves, no skin scars, and no abdominal wall venous distension."

"There is deep tenderness in the upper abdomen, without rebound pain or muscle rigidity. The liver and spleen are not palpable below the rib cage, Murphy's sign is negative, no obvious mass is felt. Abdominal percussion yields a tympanic sound; there is no tenderness over the liver or spleen areas, nor over both kidney areas; shifting dullness is negative; bowel sounds are about three times per minute; no abnormal vascular bruits are heard."

"The ultrasound reported mild fatty liver, everything else negative. But the patient complains of severe pain; Cui Lao suspects it could be an aortic or mesenteric arterial dissection and is preparing to do an emergency 64‑slice blood vessel CTA."

Zheng Ren understood—probably the 64‑slice machine still had a patient waiting for a call, so during the gap he asked me to come take a look.

This is surely Cui Lao's intention.

While listening to Zhou Litao recount the patient's history and looking at the patient, Zheng Ren saw the system panel flashing bright red.

Isolated superior mesenteric arterial dissection type IIb, hypertension, and a few other diagnoses appeared before his eyes.

"What a troublesome disease," Zheng Ren thought to himself.

Vascular dissections are always troublesome. From Cui Heming's aortic dissection to this patient before us, if the hospital were of lower capability, they would admit the patient for observation under "abdominal pain, rule out" or keep them in outpatient observation.

If a timely, clear diagnosis cannot be made, once the dissection ruptures, the patient's fate is death.

Especially in small and medium‑sized hospitals, encountering this disease leads to a high misdiagnosis rate.

And Cui Lao, relying solely on physical examination, basically confirmed the disease diagnosis—this level of skill and experience is no empty boast.

Zheng Ren nodded and began the physical exam.

Just as Zhou Litao said, the patient's abdominal tenderness is not obvious; there is some deep tenderness, but it is not the main feature.

The tenderness on exam is slight, yet the patient's face is pale, drenched in sweat from pain—this belongs to the situation where subjective symptoms outweigh objective findings.

This is what is meant by "physical symptoms do not match."

After finishing the physical exam, Zheng Ren glanced at the emergency ultrasound and lab report. The patient can be said to be quite healthy; aside from the severe pain, there are few positive test indicators.

"Cui Lao, I think the likelihood of a mesenteric arterial dissection is higher." Zheng Ren said: "We can opt for a 64‑slice CTA or interventional angiography to confirm, then proceed with surgical treatment."

"What about conservative treatment?"

"Well… conservative treatment depends on the family's opinion. I come from a surgical background and am not too keen on conservative treatment. Whether it's an isolated mesenteric arterial dissection or one accompanied by aortic dissection, if we treat conservatively and assume the dissection ruptures suddenly at night, it would cause greater harm to the patient." Zheng Ren said.

He also knew his attitude belonged to the more aggressive kind.

Surgeons are generally aggressive. If a problem can be solved with surgery, why leave a hidden danger nearby?

Of course, the cure rate for conservative treatment of isolated superior mesenteric arterial dissection is also high, and Zheng Ren knows this.

But Cui Lao was only asking for his opinion, so Zheng Ren voiced what he truly thought.

Cui Lao looked at Zheng Ren and then said lightly, "Can you perform the patient's surgery?"

"I just need to coordinate with General Surgery for the operating table, no problem." Zheng Ren said: "I will try to minimize the patient's injury as much as possible."

"Alright, you and Litao take the patient for the test; let me know when it's done." After saying this, Cui Lao waved his hand, signaling them to push the patient for the 64‑slice blood vessel CTA.

The old man had an imposing presence; Zheng Ren recalled yesterday's scene of Cui Lao pointing at Director Kong's nose, then gave a wry smile.

Those who work in emergency medicine can't have a calm temper; even a naturally slow person will quickly be worn down in the ED.

But the Cui Lao before us is quite kind; he reminded us to watch the patient's blood pressure and personally checked the concentration and rate of the vasopressor being pumped in, only then allowing Zheng Ren and the others to push the patient away.

"Boss Zheng, do you think the patient has an isolated dissection or one accompanied by aortic dissection?" Zhou Litao asked softly as they walked.

The patient's family were all nearby; in the absence of objective evidence, everything is speculation. So we kept our voices low.

"I think the patient's signs point to an isolated type." Zheng Ren replied: "The pain point is wandering, not like the fixed pain point with radiating pain of an aortic dissection."

This is reverse inference, based on the system panel's reverse inference.

Zheng Ren felt it was normal; the physical exam and the system panel diagnosis matched, so he guessed the Big Pig Trotter was still right this time.

He thought it was quite normal, but to others hearing it, it was another matter entirely.