Tanglou entered the ward.

After darkness, the female model appeared in front of the tenement building.

When the assistant doctor saw that it was a tenement building, he deliberately took the case and paused for a moment, but did not read the question: "Ahem~"

Tanglou naturally understood that this was a deliberate attempt to "make things difficult" for him in order to avenge himself for his previous insults.

"please!"

Tanglou extended his hand and invited the young lady to continue his discussion in a very gentlemanly manner.

This is more or less the same. Seeing that you are so handsome and sincerely invite me, this girl is not as knowledgeable as you.

"Patient: Female, 55 years old, was sent to the emergency department by her community contracted doctor. In the past three weeks, her shortness of breath has gradually worsened, her lower limbs have been edematous, and her weight has increased by 10 kilograms. She denies chest pain and has no history of cardiovascular disease. She denies any urinary activities. Gastrointestinal symptoms.”

"In family history, two of her sisters suffer from rheumatoid arthritis."

Tanglou nodded and took another physical examination:

Vital signs:

Body temperature: 36.7°Hg; heart rate 90/min, regular, breathing: 24 times/min.

Oxygen saturation is 93% (non-oxygen).

...

"Dr. Tang, the patient has obvious difficulty breathing when speaking, but is conscious. The heart examination shows a significantly elevated JVP (+ 6 cm), and the respiratory system examination shows obvious crackles at the base of both lungs. The abdominal examination is normal. There are depressions below the knees. Edema.”

The assistant doctor continued to add.

Tanglou received another X-ray from the patient, which showed a small amount of bilateral pleural effusion and pulmonary congestion.

"....Hb11.4, WCC 8.5, PLT 220, Na 131, K 6.4, Ur 35, Cr 220, HCO3 18.

The pH of venous blood is 7.25.

The patient's previous examination showed that Cr was 80 at the last examination 5 months ago..."

"The first question is, please ask the doctor to make a diagnosis and what are the further examinations for the patient?"

For the first question, Tanglou naturally had it at his fingertips:

"Through vital signs and preliminary physical examination, it can be found that the patient exhibits symptoms and signs of fluid overload, accompanied by hyponatremia, hyperkalemia and metabolic acidosis, which is an obvious acute acoustic injury, also known as AKI."

“There are many definitions of AKI: Kidney Disease Improving Global Outcomes, KDIGO

Kidney?Disease: Improving Global Outes defines AKI as meeting any of the following:

i.Sg/dl (≥26.5 umol / L) within 48 hours;

ii. SCr increases ≥1.5 times the baseline value, which is known or assumed to have occurred within the previous 7 days;

iii. Urine output 0.5ml/kg/h for 6 hours.

Obviously we can obtain from the physical examination that the patient's baseline ol/L is nearly three times the baseline level, which can be used to diagnose AKI."

"above!"

Tanglou looked at the assistant doctor gracefully.

The corner of the young lady's mouth twitched. It is natural to diagnose AKI, but when most people mention the definition of AKI, they will use domestic classics.

The definition of KDIGO proposed by Tang Lou was somewhat beyond the answer on the card in her hand.

"Just wait a minute..."

The assistant doctor ran out in a hurry, picked up his mobile phone and called his colleagues in the data room:

"Dongyao Dongyao, I am Dongguai. A large-scale show-off incident occurred in the examination room. It is out of control. Rescue is urgently needed~"

"Speak humanly!"

"...KDIGO definition, KDI...how do I know the pronunciation and how to pronounce...I want to know and ask you...oh...completely correct?...Okay..."

After a few minutes, the assistant doctor ran back with a dark face. Looking at the harmless smiling faces of the people in the tenement building, he became more and more sure that this guy did it on purpose!

The definition of AKI proposed by Tanglou is more authoritative and rigorous than the domestic classic definition, but it is really unfamiliar.

It's like naming a normal person Tang Lou, but he insists on having a Tang rude and 绳焺 (if you know one of them, I lose)!

Isn't this making things difficult for the little nurse? I'm obviously a question-reading machine with no emotions, no knowledge, no skills, just a text-reading machine?

"Please ask the doctor to continue to answer questions about further examination of the patient."

The assistant doctor announced that he would continue answering questions without any sense of achievement.

Tanglou nodded and continued to answer his super outline. He really wanted to keep a low profile, but there was a task with a total score of 90 pending. In order to get full marks, he had to answer everything he knew. come out.

Tanglou is also in a dilemma, with a detailed and trivial analysis:

There are three main pathogenic types of AKI:

(i) Prerenal (i.e. hypoperfusion)

(ii) Renal (i.e., kidney disease itself)

(iii) Postrenal (i.e. urinary tract obstruction).

The initial evaluation should attempt to determine what is causing the patient's AKI.

Therefore, the first step of urine testing is necessary and must be performed immediately because it can help determine whether there is evidence of disease in the kidneys themselves.

For example, red blood cell casts and glomerulonephritis, white blood cell casts and interstitial nephritis, or renal tubular epithelial cell shedding can be seen in the urine during acute tubular necrosis.

The second key examination is renal ultrasound to determine whether there is obstruction. Hydronephrosis or hydroureter can be seen on ultrasound during obstruction.

...

The fear of missing something is like answering a question in a liberal arts course. You won't stop until the answer column is filled.

Tanglou continued to add seriously and rigorously:

"On this basis, further tests can be performed, such as serological testing for glomerulonephritis."

After recalling it again, there should be nothing missing, so Tanglou stopped.

The assistant doctor licked his lips. This is simply a detailed version of the answer. In fact, only a urine test and kidney ultrasound are enough to make full marks.

The assistant doctor suddenly missed Yang Ming's words as precious as gold. After saying so many words, the score was not worthy of the saliva consumed by Tanglou:

"First question, the answer is completely correct. +4"

"Second question, could the doctor briefly describe the initial treatment plan for HDU?"

The assistant doctor took the liberty of emphasizing the pronunciation in the summary, fearing that the scumbags in the review room would be clouded.

...

...

In the review room, the directors were also dumbfounded.

"Although Tanglou's answer is a bit exaggerated, his solid theoretical knowledge is indeed rare for people of this age group."

Diao Xiwen looked at Tanglou as if he were looking at the second Yundi Li, just as handsome and as fond of playing.

A good sentence of "I love you" must be said that tonight's night is so beautiful.

But it’s really cool.

Among the eliminated contestants in the back row, there were also a lot of emotions.

"If I don't search Baidu, I can no longer understand the master's answer."

"It turns out that Lu Xun's word "Hui" is written in four ways. It's really not a joke. Next time I will put my hands on my hips in front of the pretty nurse: Hey, have you heard of the four definitions of AKI?"

"If you grow up to be like a tenement house, even if you say there are eight colors of shit, the little girl will listen to it with gusto. Unless you are someone like you who knows the ten ways to drive a Porsche."

The companion next to him said disgustedly.

"...."

"I wonder if Yang Ming lost points for the second question, can Tanglou get full points?"

"It's very possible. I think Tanglou is the kind of person who has a lot of stamina. After all, you can't do it if you don't have experience the first time. The more you go on, the better you get!"

"Full marks, full marks!"

Many players in the back row have become Tang Lou’s support team.

...

...

Tanglou's calm answer sounded in the ward:

"HDU's initial treatment of this patient should focus on the two major complications caused by AKI - volume and electrolyte problems."

"...Concerning volume, a urinary catheter should be inserted to allow accurate measurement of urine output and hourly recording of fluid intake, output and weight..."

"This patient is clinically volume overloaded, and the chest radiograph supports this. Therefore, diuretic therapy should be given to both relieve symptoms and observe the effect on urine output. Intravenous furosemide is the diuretic of choice

agent..."

While Tang Lou was discussing diuretics, the other simulators in the ward also followed Tang Lou's treatment plan.

One of the young nurses drew a needle of furosemide and was about to simulate piercing it into the model's vein.

"Wait a minute, there's something wrong with your dose extraction!"
Chapter completed!