"Come on, please lie down, I'll check it out for you." Shi Yuanteng helped Wu Yuting lie down flat, then took off the stethoscope hanging on the head of the bed, and carefully auscultated it on his back and chest.

"There is no noise in the heart, and the breathing sounds of both lungs are slightly thick, but there is no dry or wet rales. The heart and lungs are not bad, so it's not so bad." After hearing this, Shi Yuanteng thought to himself.

"Aunt Wu, please have a good rest and try to eat as much as possible, including drinking more water. I will discuss with Director Luo and others later, hoping to relieve your pain as soon as possible." Shi Yuanteng didn't dare to talk all over this place.

"Thank you, Professor Shi! Thank you for your hard work! I will treat me immediately as soon as I arrive. Thank you very much." Although I am still in a good condition.

Everyone returned to the doctor's office. Shi Yuanteng took a glass of water handed to him by Director Luo, took a sip, and then started talking.

"I'll tell you my opinion. If there is anything wrong, please criticize and advise me. You can also interrupt and discuss at any time."

"I summarize Aunt Wu's situation into the following points."

"First, the patient started with fever, and the course of the disease has been more than three weeks. Since the onset, the condition has tended to worsen progressively. So far, the patient has been in shock and his blood pressure has been maintained by pressure boosters. The situation is really not good."

"Secondly, after the patient was admitted to the hospital, your hospital has been treating infectious diseases. I read the medical advice for taking the medicine. I have used all the commonly used and most powerful antibiotics. Recently, I also used the antifungal drug Dafukang. However, the patient's body temperature did not improve, and he had high fever on time every afternoon. The latest blood routine suggests that the white blood cells are still very high, and they are mainly neutrophils."

"Third, the patient's stomach appetite after the onset of the disease is poor, he eats very little, and even drinks very little water. The patient's basic condition is not ideal at present, and a small amount of urine can tell the problem."

"Let me talk about several urgent issues that the patients currently have and some of my views on these issues."

"First, the patient's fluid replenishment volume is not enough. Under normal circumstances, a person must replenish 2,000 to 2,500 milliliters of fluid every day. As you have heard just now, the patient's fever every afternoon causes the patient to sweat. This sweat is estimated to lose more than 1,000 milliliters of water. In other words, the patient's fluid replenishment volume should be at least more than 3,000 milliliters."

"Everyone has focused on the application of antibiotics. In fact, let's change the idea. If the patient loses water so severely, how can the body temperature drop? So, I suggest that you should supplement enough fluid."

"The current reduction in urine volume of patients is actually related to dehydration. If there is no inlet, how can I get it out? Therefore, the next step is to observe the urine volume."

"Secondly, the patient has a serious lack of nutrition. I saw the patient's biochemical examination and there was only 25 grams of albumin. With such a low albumin, even if we gave her the best antibiotics, there might not be enough protein in her body to transport these drugs to the lesions. Besides, the patient's albumin is still so low when the patient is dehydrated and blood concentrates. If the patient is in normal blood volume, the patient's albumin will be lower."

"With such low albumin, the patient's own resistance and repair ability will be greatly reduced. Therefore, while replenishing fluids, it is recommended to supplement albumin, at least two bottles a day, until the albumin is more than 35 grams."

"Third, the patient's current shock condition is actually related to dehydration. Don't look at the distal edema of the patient's limbs, it is edema caused by hypoproteinemia. I just checked that the proximal skin elasticity of the patient is very poor, and the wrinkles in the skin are very slow, which is also an indirect evidence of dehydration. Therefore, when the amount of fluid is increased, closely observe the blood pressure and urine volume. If the blood pressure rises and the urine volume increases, the pressure booster can be slowly removed. After all, if this vasoactive drug is used too much, it is not good for the patient."

"Fourth, if the fluid replenishment volume increases, the patient's body temperature will probably recover. We must seize this time window to allow the patient to slowly increase the amount of food intake. As for the configuration of nutritious meals, I believe your hospital is doing a good job, so I won't say much."

"Fifth, the application of antibiotics. No pathogenic bacteria was found in the blood culture and sputum culture in patients. Of course, the positive rate of bacterial culture is not high. If it is some rare bacteria, the positive rate will be even lower."

"Since we have used so many kinds of advanced antibiotics before, the patient has not achieved any results. To be honest, if you are in my hospital, in this case, I will stop all antibiotics and handle the problems I mentioned earlier. Because we will observe closely and are not worried about the patient's infection."

"Of course, you can also use some antibiotics targeting rare bacterial species, such as doxycycline. You may feel much more at ease with this choice, and I think you can use it."

Shi Yuanteng's speech completely changed his view of Shi Yuanteng, who was originally arrogant and disdainful, and listened to Shi Yuanteng's speech with all his attention, for fear of missing a little. Director Luo was even more excited. Shi Yuanteng's words made him "intellectual" and he also spoke more.

"Professor Shi, what do you think of the guide?"

"For guides, experts must have a greater say than me. Your institute also has experts involved in the formulation of guides. My view on guides is that there is a guide, not just a guide."

"Guidelines are just a guide to clinical practice. Maybe you have already discovered some new guides, directly trampling the old guide under your feet. Later, during the use, it was discovered that the new guide was wrong and the old guide was right. This situation is not uncommon."

"So, we need to study the annual guide, but never be led by the guide." Shi Yuanteng's view coincided with Director Luo's.

"Yes, that's right. I feel the same as Professor Shi's meaning, but Professor Shi's statement is more specific, thorough and practical. Thank you Professor Shi!"

"Director Luo is polite! Let's exchange mobile phone numbers and add a WeChat friend. I want to stay in Hannan for a few days and I will go back when the situation becomes clear." Shi Yuanteng has a good impression of Luo Xiaomin.

"Okay, okay, okay, I will contact Professor Shi in time if there is any situation." Luo Xiaomin's words were a big taboo. This also shows from another aspect that Luo Xiaomin is a person of the same personality as him.

"Director Luo, please adjust the doctor's orders immediately according to Professor Shi's opinions." Dean Chen chose to believe Shi Yuanteng.

"Okay, I'll go now." Luo Xiaomin immediately left the office with the medical record book.
Chapter completed!