If you have more contact with Mr. Cao, you will know that Mr. Cao is actually very lacking in clinical experience. He graduated from a graduate school and soon became the attending physician when he came to the hospital. However, during his graduate period, he mainly stayed in the laboratory. He lacked
Clinical experience, many times, there is very little experience in treating diseases. When encountering a patient, it is often necessary to consult certain information to formulate a corresponding treatment plan. I have only been here for a few days, and in my daily routine
During the ward rounds, Director Shi Tingbang asked about the treatment of several common cases, but Teacher Cao couldn't answer it, which made Director Shi very angry. It was extremely unlucky for me to fall into his hands. Fortunately, I was the same as the other interns.
Not the same.
Zhou Huaifang slipped over at some point and said, "Huang Jingyang, why are you still in the department at this time?"
"What's wrong? A big shot patient has come to the department. Teacher Cao doesn't dare to leave, so naturally I can't leave either." I thought Zhou Huaifang said that I didn't go back.
"I'm not talking about that. What I'm saying is that such an important patient has come to the Department of Internal Medicine. How can you still stay in the department? Why don't you go and sit in on the expert consultation? Expert consultation is a very rare learning opportunity. Let's go.
Sneak in and listen." Zhou Huaifang said.
"Teacher Cao doesn't even have a chance to go in, how can I get in?" I shook my head.
"What are you afraid of? We are different from their regular doctors. We are interns anyway. Even if we offend someone, they can't really deal with us. Besides, we are just going over to observe. As long as we don't talk too much, it will definitely be
It's okay. By the way, Dong Fucheng has already sneaked in. He just sent me a text message. Let's go there together." Zhou Huaifang said.
I couldn't resist Zhou Huaifang's strong invitation and followed him to the consultation room.
The patient complained of coughing, shortness of breath accompanied by dizziness, chest pain for nine days, and one episode of syncope.
Li Shun, an internal medicine expert, looked serious. The patient's status was special, so he naturally did not dare to neglect, "Based on the current examination results. The throat is slightly congested, the breath sounds in both lungs are rough, the X-ray is normal, and the electrocardiogram is generally normal."
After taking compound antihypertensive tablets and other medicines, the patient's symptoms were not relieved. This morning the patient suddenly fainted while urinating, his eyes turned up, and he woke up after a minute. He was dizzy and had chest tightness before being diagnosed and treated in the hospital. In addition, the patient suffered from high blood pressure six years ago.
.According to the current examination results, the cause of the cough and fainting cannot be diagnosed yet.”
"Now we are not asking you to talk about the disease, but to determine what disease the patient is suffering from. If the cause is not found out, a comprehensive examination will be carried out immediately. The real cause of the patient must be found out as soon as possible. Is there anything else you would like to add?"
Zhang Zhenyuan was very irritated. After searching for so long, the cause of the disease was not found. He looked at Li Shun angrily. Li Shun is an expert in internal medicine, but at such a critical moment, he cannot show the value of an expert and can
What kind of expert is he?
Zhang Zhenyuan quickly turned to Lu Maozhu and said, "Director Lu, when Ms. Lei entered the hospital, I had already applied for expert assistance from Yanjing Union Medical College Hospital. Now the experts are on their way to Donghai. They are expected to arrive soon. I
The expert invited is Shi Weiming, an authoritative expert in internal medicine at Union Medical College Hospital."
Lu Maozhu is a senior official in the health system, so he has naturally heard of the authoritative expert Shi Weiming. But he is still a little annoyed because he is worried about his wife's condition, "Tell me about your Ruihua Hospital, which is also a well-known hospital in Donghai. I'm outside.
I often say good things about your Ruihua Hospital. If there are any funding needs, I will try my best to lean towards you. Why do you drop the chain when the critical moment comes? I told you, Donghai is an international-level city, and it must be international-level.
Only hospitals with a large number of hospitals can match. Each department must find a way to equip heavyweight experts. You are not short of funds and conditions. Why can't you have a group of high-level medical experts?"
Lu Maozhu's words were obviously very dissatisfied with Zhang Zhenyuan, the dean.
Zhang Zhenyuan looked at the group of experts in the conference room with a livid face, and saw that these experts were silent. The interns standing around were also suffocated by this atmosphere, and felt like they were trembling.
The dean's secretary hurriedly walked in and whispered something in Zhang Zhenyuan's ear. Zhang Zhenyuan's face was immediately shocked. He quickly said to Lu Maozhu, "Director Lu, expert Shi Weiming is here. I'll go out to greet him."
"I'll go there with you." Lu Maozhu was overjoyed when he heard that Shi Weiming had come.
Zhou Huaifang pulled me gently and said, "Today is an eye-opener. This Shi Weiming is a real authority. He is very powerful in internal medicine. His name can be seen in many internal medicine textbooks."
"Where is the patient?" I asked.
"At this time, he must be in the intensive care unit. Ask Dong Fucheng, he will definitely know." Zhou Huaifang said.
Zhou Huaifang tiptoed to Dong Fucheng's side and gave Dong Fucheng a gentle push.
"What are you doing? Don't mess around here. Otherwise, you won't be able to eat and walk around." Dong Fucheng was startled.
Zhou Huai winked at Dong Fucheng, and the two of them walked outside together.
"What?" Dong Fucheng asked.
"Huang Jingyang asked you where this patient is?" Zhou Huaifang asked.
"What do you want to do? This patient is not an ordinary person. Don't mess around." Dong Fucheng said nervously.
"We don't know anything here, so what's the use of listening to what these experts say? It's better to go and see the patient's condition." I said.
"It's in the intensive care unit. It's no use even if we go there. There are people guarding it there, so we can't get in." Dong Fucheng shook his head.
"Let's go and take a look." I pulled Zhou Huaifang towards the intensive care unit.
"Are you two really going there? Don't mess around, or big trouble will happen." Dong Fucheng quickly reminded again.
"Don't worry. We are not stupid, how can we go out to show off? We just went over and took a look." I laughed.
When Zhou Huaifang and I came to the intensive care unit, we saw that the atmosphere in the intensive care unit seemed much heavier than usual. There were hospital security guards standing guard at the door. Through the glass, we could see that there were doctors on duty inside, especially one of the pictures
There were two or three doctors guarding the ward, and without even thinking, the big shot who came here today must be lying on this ward.
"Hey, you two interns, don't come here and cause trouble." The hospital security guard smiled at us.
"What are we causing trouble? Just take a look outside." I said with a smile. Through the glass, I could clearly see the condition of the patient lying on the bed. I actually saw that there was already an imperceptible black color on her body.
The gas began to escape from the body. It seemed that her condition was very bad. If she could not get effective treatment, she might not be able to survive for a long time. But judging from the consultation situation, Ruihua Hospital had not found a patient at all.
The real cause of the disease is that the current treatment for the patient is simply not symptomatic. If this continues, the consequences will be really serious. I don’t know if there will be any improvement after the experts come.
Zhou Huaifang and I stood there for a while, and then we saw a large group of people walking toward the intensive care unit.
The security guard hurriedly said to us: "Go quickly, the leader is here. If they see it, I will be in trouble."
Zhou Huaifang and I quickly stepped aside.
"Old Shi, please come here. As soon as Ms. Lei enters Ruihua Hospital, she will be admitted to the intensive care unit. The hospital has arranged several experienced doctors to monitor her at any time and pay attention to Ms. Lei's condition changes at any time." Zhang Zhenyuan's posture at this time was relaxed.
Very low.
Shi Weiming was surrounded by people, reading the patient's examination reports as he walked. He frowned. From these examination reports, he could not confirm the patient's condition.
"Is there a possibility of cerebral thrombosis? Has a brain CT been done? Has a chest X-ray been done? Is the heart normal?" Shi Weiming asked many questions along the way.
"CT has been done, there is no bleeding in the brain, and there seems to be no problem with both lungs on chest X-ray. There is no sound to percussion in both lungs, and there are no abnormalities on **** X-ray. Aspartate aminotransferase, alanine
The aminotransferase indicators are all normal, which can rule out the possibility of myocardial infarction. The ** chest X-ray shows no obvious abnormalities in the heart, lungs and diaphragm." Li Shun said quickly.
Shi Weiming frowned. He could not determine the cause of the disease from these examination results. However, the patient's cough, breathlessness, dizziness, and chest pain were definitely closely related to the cause, but some of the conditions he thought of were ruled out one by one.
Just when Shi Weiming entered the intensive care unit, the patient lying on the bed suddenly vomited. His breathing became rapid and he had convulsions.
"Quickly, give low molecular weight levulose anhydride and 5% glucose saline solution." Shi Weiming said.
However, the patient's condition did not improve. On the contrary, it continued to worsen. The patient's condition did not improve. Instead, the extremities of the limbs began to become cold, purple mesh patterns appeared on the skin of the dorsum of the feet, and consciousness began to become blurred. The heart boundary expanded slightly to the left.
.Thin moist rales are occasionally heard at the base of both lungs.
I saw that the patient's black energy seemed to be dissipating faster, and the situation was becoming more and more critical.
Zhang Zhenyuan naturally knew that the situation was not good. The sweat on his forehead rolled down like rain.
This Zhang Zhenyuan is a student of Teacher Qi, and it is also thanks to him that I am able to come here for internship. He is also kind to me, so at this time, I cannot stand idly by.
"President Zhang, since the patient has symptoms such as coughing, shortness of breath, dizziness, and chest pain, why not consider pulmonary thrombosis? Monitoring with a minimally invasive hemodynamic monitor on the periphery can detect pulmonary artery blood pressure. I know that our hospital
There is a minimally invasive hemodynamic monitor." I walked to Zhang Zhenyuan and said quickly.
Originally, Zhang Zhenyuan was very angry when he was blocked by an intern as soon as he came out of the intensive care unit. But after hearing what I said, his expression changed.
"Time is running out. If you delay the best treatment time, you will be in trouble!" I warned quickly.
Zhang Zhenyuan quickly returned to the intensive care unit. The intensive care unit already had such equipment, but because the possibility of myocardial infarction had been ruled out before, it was not equipped with such equipment at all.
"Quick! Get on the minimally invasive hemodynamic monitor! Focus on checking for pulmonary thrombosis!" Zhang Zhenyuan shouted to the doctor in the intensive care unit.
Misdiagnosis is often caused by one misunderstanding leading to another misunderstanding. In fact, all doctors are misled by some results obtained from examinations. Because pulmonary thrombus has been directly ruled out before, with electrocardiogram, fluoroscopy results, and percussion results, it seems that everything can be done
Pulmonary thrombosis was ruled out. Everyone began to ignore this point and think about more complicated symptoms. Shi Weiming was also misled. He did not consider pulmonary thrombosis at the beginning. But now that Zhang Zhenyuan was so impressed, everyone
Suddenly he woke up.
In fact, it is very simple. A normal electrocardiogram does not rule out pulmonary thrombosis, and the fluoroscopy results cannot tell people the true condition of the lungs in complete detail.
Although there are common symptoms of pulmonary thrombosis such as cough, chest pain, syncope, etc., no one suspects pulmonary thrombosis. If I didn't have special abilities, I'm afraid no one would want to think about the patient's condition from scratch, maybe until the autopsy
Only then will you wake up.
The test results of the minimally invasive hemodynamic monitor indeed showed pulmonary hypertension and normal or low pulmonary capillary pressure. This is obviously the strongest proof of pulmonary thrombosis.
"Quick! Intubate! Urokinase 264000iu plus NS100ml intravenously or intravenously for 10 minutes, then 132000iu/h for 12 hours." Shi Weiming said quickly. After symptomatic treatment, the patient's condition quickly turned from critical to safe.
"Old Shi, it's all thanks to you this time." By this time, Lu Maozhu's complexion had improved a lot. He could clearly see that his wife's illness had been diagnosed and was getting better.
Shi Weiming is not greedy for credit. After all, everyone at the scene saw it. The turning point in the treatment was when Zhang Zhenyuan suddenly advocated focusing on checking for pulmonary thrombosis. "This time, thanks to Dean Zhang, he thought of pulmonary thrombosis. There were many signs that ruled out pulmonary thrombosis. But right now,
It was the excluded pulmonary thrombus that caused the patient's condition to become increasingly serious.
"I feel ashamed to say it, but actually I didn't think of it. My teacher, Professor Qi Binhua, asked me to be an intern specializing in clinical medicine. He just reminded me to consider the patient's pulmonary thrombosis." Zhang Zhenyuan wanted to take the credit, but just now
The scene at the door was also seen by many people. He was simply more upright and did not covet the credit of Huang Jingyang.
"Oh, where is this classmate? It seems that everything is clear to the beholder, but the person in the drama is confused. Sometimes, we will be deceived by the equipment. So as doctors, we must be cautious. The patient entrusts his life to us, and we must be cautious and walk on thin ice.
." Shi Weiming sighed.
"I'll ask him to come in." Zhang Zhenyuan has long forgotten my name. For him, how can a little person like me get into his eyes?
Zhang Zhenyuan strode out of the intensive care unit and stopped me as I was about to leave, "Hey, wait a minute."
"I knew I couldn't escape, so I had to turn around. Dean Zhang, did you call me?" I said helplessly.
"Yes, thank you for your reminder just now. The experts from Yanjing want to see you. Director Lu also wants to see you." Zhang Zhenyuan thought I should be frightened. But my performance was very calm, which made me feel very calm.
