Chapter 935: 915 A Low-Key Approach with Substance

Zhou Litao still had questions he wanted to ask, but seeing the patient's family's gaze fall on him, he held back and didn't continue speaking.

Arriving at the CT room, they still waited a short while; the CT doctor explained the situation to the patients behind and added the emergency patient to the schedule.

The other patients also understood; seeing the patient arrive on a gurney, accompanied by three doctors and a nurse, they all thought this patient was not going to make it.

There are also people who are unreasonable and don't consider others, but they are not common.

But in front of this window in the emergency department, frequent contact makes it become the norm.

After sending the patient into the CT room, several people came to the operating area.

Zheng Renye didn't take over. Always overstepping is not good. He stood quietly behind the CT room doctor, looking at the images.

"Boss Zheng, the patient has no bloody stools; I think if the diagnosis is an isolated superior mesenteric artery dissection, conservative treatment would be better." At this moment there were no family members present, so Zhou Litao immediately voiced his opinion.

Su Yun's eyebrows rose; he was about to retort, but Zheng Ren lightly tapped his elbow with his own and smiled: "If there's no thrombus in the lumen, conservative treatment is fine. After all, the pressure of the dissection in the superior mesenteric artery is lower and cannot compare to that of the aorta."

Zhou Litao was also a bit puzzled; just now Boss Zheng had suggested surgery—how did he change his mind so quickly?

"It's just a possibility; Elder Cui asked, so I said." Zheng Ren smiled: "Each has its own advantages. Surgery can avoid missing monitoring, extensive intestinal necrosis, and other possible complications. If conservative, it reduces surgical trauma and saves expenses for the patient and their family."

That was really smooth talk; Zhou Litao didn't know how to respond.

"Let's look at the diagnosis first; then we'll decide what to do based on the family's wishes." Zheng Ren said.

The 64-slice CT takes a long time; plus the patient had obvious abdominal pain and agitation, so it took half an hour before they wheeled the patient out.

Afterwards Zheng Ren said: "Manager Zhou, you take the patient back first; I'll look at the reconstruction results here."

Seeing Zhou Litao leave, Su Yun asked puzzled: "Boss, this guy talks too much."

Zheng Ren felt Su Yun had it backwards—it wasn't that Zhou Litao talked too much, but that his own words were more numerous. He chuckled and said: "What they say is true."

"Tch." Su Yun scoffed: "The pain of a dissection isn't something ordinary people can endure. I once had a patient; after surgery I asked him, and he said the pain felt like a knife stirring in his chest—he didn't even want to live. If one could die outright, that would be cleaner."

"Well, if surgery can be done, it should be done; I also don't agree with conservative treatment." Zheng Ren said.

"Then why don't you retort him?" Su Yun expressed disdain for Zheng Ren's nice-guy attitude.

"It's pointless; this kind of patient can't be admitted to our department anyway—it should be general surgery, they have more experience." Zheng Ren said: "If we need to step in, we'll do it; if not, vascular surgery can handle it. In the CT room, arguing with the emergency department's inpatient chief—are you just bored?"

"You're just being a timid person." Su Yun gave Zheng Ren a half-smile and said: "Is there any need to be so low-key?"

"This is a low-key approach with substance. Besides, didn't you say you didn't want to go to the emergency department? Why are you being so arrogant then?" Zheng Ren countered.

"..." Su Yun was speechless.

This really is a difficult choice; after thinking it over, Zheng Ren's argument makes a lot of sense, but I still disagree.

It's really frustrating.

"There are two schools of thought in academia—surgery and conservative treatment. But I still lean toward surgery; we should analyze case by case. If conservative treatment is chosen, there's a risk of recurrence." Zheng Ren said: "This point will have to wait until the 64-slice blood vessel CTA results come out before we can decide."

Su Yun nodded, quietly watching the CT room doctor perform the examination, his black hair limp and drifting above his forehead.

Because it's an emergency, the three-phase reconstruction of the 64-slice CT was completed quickly.

The superior mesenteric artery showed a true and false lumen; the true lumen had no thrombus, while the false lumen showed thrombus formation.

The false lumen wasn't large enough, compressing the vessel and causing occlusion of the superior mesenteric artery.

The superior mesenteric artery supplies blood to the entire small intestine and two-thirds of the large intestine; once ischemia occurs, it leads to ischemic pain in the small intestine.

In Hai Cheng, Zheng Ren once treated a patient with intestinal bleeding, embolizing part of the superior mesenteric artery and deliberately letting the small intestine necrose and be removed—this was the reason.

But the former patient wanted intestinal necrosis to locate and remove the bleeding point; the current patient wants to avoid that situation.

Based on the patient's condition, whether to operate is uncertain.

If this were the emergency department of Haicheng First Hospital, Zheng Ren would certainly not hesitate to inform the family and proceed with surgery. But here it's 912, an ambiguous matter; Zheng Ren only offers opinions, he doesn't take responsibility for the decision.

After sending the images back, Zhou Litao had already taken the patient to general surgery and wasn't there. Elder Cui inserted the film into the viewer, put on his magnifying glasses, and examined it frame by frame.

More than ten minutes later, Elder Cui finally said: "Little Zheng, what's your opinion?"

"It could be conservative, or..."

"I'm asking for your opinion, not for you to pass the buck." Elder Cui was displeased, glancing at Zheng Ren.

White hair like snow, eyes like blades.

"I recommend surgery." Zheng Ren immediately replied: "On the way I observed that the patient's pain threshold is relatively low and blood pressure control is poor. For such patients, even though the true lumen of the superior mesenteric artery has no thrombus, conservative treatment reduces the likelihood of a good recovery."

Elder Cui said nothing, sat down, and quietly watched Zheng Ren.

"Surgery is also relatively simple—just place a stent. Superior mesenteric artery angiography plus PTA plus stent placement. If the patient's family has no financial issues, they can be discharged after three days of postoperative observation."

"Hmm, that's right then." Elder Cui said: "Young people should be energetic, not put on a pretentious, deep-acting act."

"..." Zheng Ren was hearing this kind of evaluation of himself for the first time.

Elder Cui, he really is different from the rest.

However, practicing medicine in his era, the difficulty cannot be compared to today's. The doctor-patient conflict, as medicine has been pushed onto the market, has become increasingly sharp.

"The patient has a smoking history and hypertension, with poor blood pressure control. Based on my experience, patients with a smoking history basically cannot be conserved. Now we've given low-molecular-weight heparin anticoagulation, cilostazol to dilate vessels, and papaverine to relieve spasms—go to general surgery and prepare for surgery." Elder Cui said.

He not only gave the diagnosis, but also determined the subsequent treatment.

The statement that a smoking history makes conservative success difficult is worth a fortune to Zheng Ren; such certainty doesn't sound like something a doctor would say.

But Elder Cui just said that.

This is a summary of experience; although the statement isn't rigorous, precisely because of that it cannot appear in journal articles.

This is merely a summary of Elder Cui's lifelong experience; you can't learn it elsewhere.

Zheng Ren felt a chill in his heart, nodded, and bowed deeply.