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Qin Chuan also felt very proud when he heard his "original" music in a foreign country.
Speaking of which, "Fireworks" is a very good song to use as the opening song of a party. Everyone's emotions have been aroused. Even Wang Ze, who has a very reserved personality, has also integrated into the atmosphere of the party.
"Xiao Qin, come here. Let's have two more drinks today." Although he seemed to be somewhat different from Qin Chuan, it did not prevent the two fellow villagers from talking about their nostalgia.
After Qin Chuan signaled to Gillian Jacobs, he walked over with a wine glass and said, "Dr. Wang, let's get drunk today."
"No problem, just get drunk and rest. Let me tell you, I just received the green card from the Immigration Bureau recently, and I am in a very good mood." Although Wang Ze has been engaged in medical work in hospitals for more than ten years, he has always been engaged in hospitals.
In the laboratory in the background, he was most looking forward to the situation heading towards the operating room in the front.
"Do you think I am particularly fond of foreigners? In fact, based on my current experience, if I go back, life will definitely be easier than here. I can even get very good treatment. But I am not willing to go back like this. I am here
After staying there for more than ten years, I feel bleak when I go back. And most importantly, the environment in China is so different from here. I can often see news here about doctors in China being attacked by patients.
My relatives and friends in China also advised me not to go back as much as possible. Most cities in China are now in smog for half of the year. Xiao Qin, I know you have ambitions. I also wish you success. But I am already
As a father of three children, I want to give my three children a better growing environment. To tell you the truth, I am now the father of three Americans. Haha.”
Wang Ze's smile was very vicissitudes of life. Qin Chuan could hear his helplessness from his laughter.
Qin Chuan patted Wang Ze on the shoulder: "Come, drink!"
"Actually, it's not easy to stay here now. The economy is in recession and employment opportunities are very tight. It's getting harder and harder for Chinese students to stay here. Many of them have chosen to go back to their country. If you choose to go back, it may also be a very good choice. You can
Not bad. I was able to get Ms. Jillian's approval. She doesn't just approve of anyone." Wang Ze said with a smile.
"She may think that I have been a doctor in China and have more experience than other students." Qin Chuan said with a smile.
"Yes. The emergency department is indeed a place to train people. Especially the emergency department in our country. I heard that it is crowded every day." Wang Ze nodded. But he seemed a little absent-minded.
"I came here to learn about the situation in the United States. It turns out that Americans don't just go to the emergency room. The cost of the emergency room is more expensive than the ordinary outpatient clinic. And if it is not necessary, the outpatient clinic can refuse to admit patients. We accept all comers. Slow.
Slowly, it is almost developing into a comprehensive department." Qin Chuan clinked the cup with Wang Ze while holding the cup.
"Come on, let me take you over to meet some people. They are all doctors from Johns Hopkins Hospital. They will also be good for you in the future. Don't look at the principles of what the Americans do. In fact, they don't care about interpersonal relationships at all.
We hope that if you have such an opportunity in the future, you must actively participate. Contacting these experts more will be very helpful for your future internships and internships. By the way, you have graduated from a domestic medical school. You don’t have to wait until you finish the basic courses.
.You can apply for USMLE (United States Medical Licensing Examination). By then, before you graduate, your USMLE certificate will have been obtained." Wang Ze still takes good care of Qin Chuan, a fellow countryman.
"I have already signed up." Qin Chuan has already signed up for step 1 and step 2 this semester. This kind of exam is not too difficult for Qin Chuan. Obtaining the USMLE certificate is naturally something Qin Chuan has at his fingertips with the [Genius Famous Doctor] system.
.However, Qinchuan does not plan to develop in the United States in the future, and this certificate does not mean much to Qinchuan.
When the show was over, Wang Ze specially exchanged contact information with Qin Chuan.
"Xiao Qin, come to my house as a guest this weekend. We haven't had domestic guests in our house for a long time." Wang Ze warmly invited him.
"No problem, as long as you don't think it's troublesome for me. It's been a long time since I've been here. I haven't eaten domestic flavors for a long time. Your family should still eat domestic flavors," Qin Chuan said with a smile.
"Of course. My wife has been working as a full-time housewife at home, and we eat Chinese food every day. I still don't get used to this old American taste. Wherever we Chinese go, we will bring the taste of China. And
There are Chinese supermarkets everywhere, and it is very convenient to eat Chinese food." Wang Ze seemed to have finally met a Chinese person, and he spoke a little too much unconsciously.
After the show, Qin Chuan stayed to help Gillian Jacobs pack her things.
"Thank you so much, Qin. By the way, my team will have a consultation tomorrow. If you are interested, you can go over and participate." Gillian Jacobs thanked Qin Chuan in disguise and gave Qin Chu a
Very good learning opportunity.
Naturally, Qin Chuan would not let go of such an opportunity. Speaking of which, this was the first time he encountered such a situation after coming to the United States.
"It's a great honor." Qin Chuan quickly agreed.
Seeing Qin Chuan's eager eyes, Gillian Jacobs also smiled.
The next day, Qin Chuan did not go to class, but went directly to Johns Hopkins Hospital and found Gillian Jacobs' office.
"Qin, come with me, my colleagues are all here." Gillian Jacobs led Qin Chuan to a small conference room.
There were three people sitting in the conference room. Two men and one woman. They were all in their early thirties. When they saw Qin Chuan next to Gillian Jacobs, the three people were very strange.
"Everyone, let me introduce to you a doctor from China, Qin. He is now studying at Johns Hopkins University School of Medicine. Come to join our discussion today. Qin has obtained a medical qualification certificate in China and has relatively rich clinical experience.
"Hello everyone." Qin Chuan greeted everyone in a friendly manner. This patient, Dubov Paul, is now a key case of Gillian Jacobs' research team.
Dubov Paul, 50 years old, has suffered from diabetes for 15 years. He developed plantar ulcer infection 3 weeks ago. Plantar ulcer is a common complication in the later stages of diabetes. The outpatient doctor prescribed antibiotics to control the infection. Three days later, Dubov.
Mr. Paul developed a high-fever rash and was admitted to the hospital. In order to identify the cause of the rash and fever, the internal medicine ward requested a specialist in connective tissue diseases (ctd) for consultation.
The attending physician on duty at CTD is Dr. Taylor McDonald. Dr. Taylor McDonald is a specialist professor and is familiar with medical books. After seeing Mr. Dubov-Paul’s situation, he immediately remembered that the book said that the differential diagnosis of fever rash includes nodules.
Polyarteritis. In order to prove her hypothesis, Dr. Taylor McDonald took a skin biopsy for Mr. Dubov Paul. The pathology report came back and saw leukocyte infiltration in the walls of small arteries. And nodular polyartery.
The pathological changes were consistent with polyarteritis nodosa. Dr. Taylor McDonald believed that the pathological examination supported the diagnosis of polyarteritis nodosa, which was consistent with her judgment, and immediately gave Mr. Dubov. Paul a large dose of hormones. Taylor McDonald
The doctor seemed very excited. She summarized the information and literature about polyarteritis nodosa in detail and included it in the medical record. She also told the resident doctor that although she was a CTD specialist professor, she had to establish the diagnosis of polyarteritis nodosa from scratch from the initial symptoms.
But this is the first time.
Mr. Dubov-Paul became a patient with polyarteritis nodosa, and Dr. Taylor McDonald became a doctor who can diagnose and treat polyarteritis nodosa.
High-dose hormones comprehensively suppress the immune system, causing the body to lose resistance to infection, and the patient's original infection will generally be aggravated. Therefore, the guidelines for using high-dose hormone treatment point out that the patient should be actively searched for tuberculosis, bacteria, or other
Evidence of microbial infection and treated accordingly. X-ray showed fibrosis in the apex of Mr. Dubov-Paul's right lung, indicating that he may have had tuberculosis. Moreover, Mr. Dubov-Paul had been to Mexico, where medical treatment was backward and treatment was not standardized.
Drug-resistant tuberculosis bacteria are common. Considering this situation, Dr. Taylor McDonald prescribed a comprehensive treatment of 5 anti-tuberculosis drugs to Mr. Dubov-Paul according to the treatment guidelines for drug-resistant tuberculosis. Vitamin b6 was also added to prevent side effects.
Mr. Dubov Paul's illness began with a foot ulcer and later developed high fever. Although the spread of infection could not be confirmed or denied, for the sake of safety, two other broad-spectrum antibiotics were also used at the same time.
A week later, Dubov and Paul's plantar ulcer healed. The rash subsided, but his condition worsened, with high fever, gradual loss of consciousness, and organ dysfunction. He was transferred to the ICU. Since the antibiotic spectrum already covered tuberculosis and
Bacteria, Dubov and Paul were given antiviral drugs and invited to the Department of Infectious Diseases for consultation. The Department of Infectious Diseases has guidelines for dealing with high fever in immunosuppressed patients. It says that if such patients still have high fever despite antibiotic treatment for more than 7 days, they must be considered.
Complicated fungal infection. For this reason, Dubov and Paul added antifungal drugs to the plan.
Dubov Paul had a high fever for nearly three weeks and his blood pressure dropped. His treatment plan included 9 antibiotics, as well as hormones, vasopressors, antipyretics, sedatives, nutrients and fluids. To give these things, 3 intravenous lines
24 hours a day. In addition, pulmonary artery cannulation is used to monitor cardiac output, radial artery cannulation is used to monitor blood pressure, tracheal intubation is connected to artificial ventilation, and femoral vein cannulation is used for hemodialysis to replace failing kidneys to eliminate metabolites. In addition, there is also ECG,
Blood oxygen and body temperature are continuously monitored, and various signals require two fluorescent screens. In addition to various monitoring and life-sustaining tube lines for ICU patients, Dubov and Paul are also covered with ice blankets for physical cooling, which is a real battle.
Dubov Paul's case mobilized all specialties to monitor almost all indicators that can be monitored by modern medicine. His care required a nurse and an assistant because each department had inpatient medical records to check and review.
Following the attending doctor's ward rounds, people were coming and going in Dubov-Paul's ward, and there was almost a queue. This is why the resident doctor said that Dubov-Paul was a key case.
However, Dubov Paul's condition continued to deteriorate.
Because Dr. Taylor MacDonald was involved in many medical accidents, Leanne Jacobs, as the director of the CTD Department, had to arrange for Dr. Taylor MacDonald to retire early, and this key case in his hands naturally needed someone else to take over.
.Leanne Jacobs had no choice but to take over the job herself when no one was willing to take over the job for Dobrev Paul.
"Okay, everyone already knows about Dubov and Paul's situation, and everyone has their own opinions," said Leanne Jacobs.
The three people on Leanne Jacobs' team are Jess Wilson, Alan Bowen and Ruth McCullan.
Jess was the first to say: "It is a rare connective tissue disease that manifests as a triad, that is, fever, rash, and insufficient blood supply to organs at the same time. The treatment of polyarteritis nodosa requires high-dose hormones, but the effect
Unexpectedly, Mr. Dubov Paul is in serious condition, suffering from multiple organ failure of the heart, lungs, liver, kidney and brain. In particular, despite taking large doses of hormones and multiple antibiotics, Mr. Dubov Paul has been suffering from high fever for more than three weeks. Every day
The body temperature is almost above 40 degrees. If it continues, it will be very dangerous."
Gillian Jacobs nodded: "Everyone already knows the basic situation. I just want to know what solutions you have to this case."
Ruth frowned and thought for a while and said: "Dr. Taylor McDonald was forced to retire because he was involved in many medical malpractice. I think his diagnosis is questionable. We should re-examine the patient and evaluate the patient's condition.
Get to know each other again.”
Allen also nodded: "I support Ruth's statement. Dr. Taylor McDonald's diagnosis is too subjective. If his diagnosis is wrong, then there will be problems with the subsequent series of treatments."
Jillian was not satisfied with their answers, so she turned her attention to Qin Chuan.
Qin Chuan came here today with a learning mentality, and he did not intend to express his own opinions. Just like when he was an intern. At that time, the instructor told the interns to talk less and read more and dare to take action.
"Qin, tell me what you think." Jillian didn't seem to intend for Qin Chuan to remain silent.
Jess and others all turned their attention to Qin Chuan, and they also wanted to hear the Chinese doctor's opinion.
Since Jillian is already asking for her opinion, Qin Chuan doesn't intend to hold anything back.
"I think Dr. Taylor McDonald is right to rely heavily on pathology reports, but he has forgotten that pathological examinations come from skin biopsies. The samples taken are very small and not important organs, so the limitations are naturally great. Moreover, the words '' and nodularity are often used in pathology reports.
"Arteritis consistent" is a word with a lot of reservations, which means that the pathology department is actually not sure. The time when Mr. Dubov and Paul's fever rash appeared coincided with the first group of antibiotics he took. But the drug was not excluded from the beginning.
Possibility of reaction. Later, the rash disappeared but the high fever worsened, which further showed that the current fever and rash were no longer related, so the triad of polyarteritis nodosa was no longer established. Mr. Dubov. Paul received nearly 20 kinds of drugs every day
, these high-purity chemicals have to be absorbed and metabolized in his body, and it is entirely possible to cause drug fever. And, the most important and certain thing is that all drug treatments have been proven to be ineffective. Therefore, you might as well try stopping the drug." Qin
Chuan expressed his opinion.
"Stop the medication?" Not to mention Jess and others, even Jillian felt that Qin Chuan's idea was too bold.
The patient has already used a large amount of antibiotics at this time. Once the medication is stopped, the antibiotics will no longer suppress it. Once the bacteria in the patient's body multiply rapidly, it is very likely to lead to the patient's death.
"This cannot be done carelessly. Once an accident occurs, the patient will die directly. I think it is safer to conduct a comprehensive examination first." Allen strongly disagreed with Qin Chuan's opinion.
"Yes, this approach is too risky. It is simply making fun of the patient's life." Jess also objected repeatedly.
Ruth was worried about another problem: "Although I agree with re-examination, this will inevitably cause Mr. Dubov. Paul's treatment to be delayed again. His condition is already very bad, and no one can be sure.
How long can we persist? If serious problems arise during the inspection, we will be very passive."
Jillian didn't say who was right or wrong, and said to Qin Chuan with a smile: "This is a new idea. But how do you explain Mr. Dubov Paul's multi-system failure?"
It can be seen that in Jillian's eyes, Qin Chuan is still a first-year medical student.
Qin Chuan explained: "Mr. Dubov Paul's organ dysfunction appeared after a week of sustained high fever. Continuous high fever changes the protein structure, which can naturally affect organ function. There is no need to find another reason."
"Yeah." Jillian nodded.
Qin Chuan didn't know whether Jillian was agreeing with his point of view, or praising him for being able to consider so many issues as a medical student.
Qin Chuan doesn’t know much about polyarteritis nodosa. This rare disease is something that Qin Chuan would rarely encounter in a hospital like Tanshan. But in the [Genius Doctor] system, Qin Chuan is learning systematically
In the process of basic medical education, I have naturally seen various rare cases, and polyarteritis nodosa is among them. However, Dubov-Paul's situation is very different from the diseases Qin Chuan knows. The previous attending doctor
There is a problem with the diagnosis. This wrong treatment method is the main culprit that caused Dubov-Paul's deterioration.
"Notify the inpatient department to stop Mr. Dubov-Paul's use of antibiotics." Jillian actually accepted Qin Chuan's opinion, which surprised the other three.
"But, teacher, Qin is just a medical student. If his judgment is wrong, there will be serious consequences." Jess said worriedly.
"No, I support his point of view. I also think that Mr. Dubov-Paul's symptoms are not consistent with the symptoms of polyarteritis nodosa. Moreover, Mr. Dubov-Paul's condition is already very bad." Gillian was very
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