What are good case writing skills? Just look at the records in Sun Lien's hand and you will know. Unlike ordinary outpatient clinics, most emergency patients have acute and serious illnesses. Doctors have very little time left to write cases.
At the Fourth Central Hospital, most of the cases in the emergency department are completed by interns and trainees. In the past two months, Sun Lien's main job every day was to start writing after he finished helping Zhou Jun.
Cases. In the emergency room, there are at least four or five patients who need to be taken over by Zhou Jun and kept under observation and treatment every day. Their cases are basically written by Sun Lien.
If he were to write a case according to the requirements of the association... Sun Lien was so frightened by his idea that he would break into a cold sweat. The description of a patient's case would take two dense pages, starting with at least 2,000 words. For five patients, that would be 10,000 words.
.This is just a record of the case. In the meantime, we have to deal with patients, participate in rescue operations, go to various departments to invite doctors for consultation, and seize the time to study and enrich ourselves. Even an iron man cannot resist it!
Although it is easy to use, it is difficult to implement. This is the biggest problem with the Concorde model. Ordinary people always say that there are two major problems in seeing a doctor: it is difficult to see a doctor and it is expensive. In fact, when I think about it, looking at the world, China's medical system is definitely among the top.
Like the British NHS system, medical treatment is not expensive, but the price is that you have to wait in line for seven or eight hours in the emergency room, and wait for several days after the condition is stable before you can be transferred to specialist treatment. Seeing a doctor is extremely difficult. But in
In the United States, it is not difficult to see a doctor. But even with commercial insurance with a million-dollar compensation limit, it is inevitable that the middle class will be exhausted even if they go to the hospital. If surgery is required, the bill issued by the hospital will never be less than 20,000 US dollars.
.
In China, as long as you come to the hospital to register, you can get timely treatment from emergency doctors and specialists. Moreover, the price of general surgeries is covered by social security, and the amount borne by an individual at one time will basically not exceed 2,000 yuan.
Regarding this difference, there was a joke among doctors. A man suffered from appendicitis. In the UK, he had a perforated appendix due to a referral error by the NHS. In the United States, he was sued because he could not pay the $50,000 surgery fee.
He was imprisoned. In China, this patient beat up the doctor who performed the surgery because he didn't like the minimally invasive surgery on his stomach.
The national conditions are different, and the requirements are also different. Sun Lien's thoughts turned around and returned to the case record book in front of him. It is not his job to consider medical reform now. Participating in diagnosis and treating patients is what he should do now
Things to do.
After thinking about it for a long time, Sun Lien suddenly looked at the treatment records and asked, "Have you given her antibiotics?"
"Because it is initially suspected to be bacterial meningitis." Yuan Pingan replied, "This patient's symptoms are actually quite obvious. I don't quite understand why Boss Zhu asked you to diagnose this case."
Sun Lien glanced at Lu Xuexin's status bar again and suddenly asked, "Did you do a cerebrospinal fluid smear and culture on her?"
If the cerebrospinal fluid protein is so high, it is basically equivalent to directly claiming that the patient's nervous tissue has a serious infection or disease. If the deputy director of the emergency department of Tongxie believes that Lu Xuexin has bacterial meningitis, then this patient will basically not be diagnosed further.
It is necessary. As long as a sufficient amount of antibiotics is given and other symptoms are treated symptomatically.
"The patient was brought in this afternoon, and the smear test did not detect any pathogens. The culture will have to wait for about two days." Yuan Pingan replied, "Is there any problem?"
"The results of the cerebrospinal fluid biochemical test are a bit strange." Sun Lien found the cerebrospinal fluid biochemical test report that his colleagues had done for Lu Xuexin a few hours ago. Although the cerebrospinal fluid protein indicated above was still very high, it was only about 800mg/l. Compared with the current state
The 1720 mg/l indicated in the column was much lower. After pondering for a moment, he asked, "The patient has a history of SLE (systemic lupus erythematosus) and has been taking immune system suppressants for a long time. This condition must also be taken into consideration."
Yuan Pingan frowned, "You mean... the bacteria that cause infection may not be common?"
"If it is caused by common bacteria, her symptoms should have improved slightly after receiving antibiotic treatment for more than ten hours." Sun Lien expressed cautious affirmation of Yuan Pingan's inference. "Her temperature is still 39 degrees.
He's left and right, and he's delirious, and it doesn't look like he's getting any better."
"Dr. Yuan, the MRI results of bed 9 are out!" The nurse who sent the MRI looked at Sun Lien curiously, "Is this the new doctor in our department?"
Yuan Pingan took the imaging photo and said with a smile, "This is a doctor from another unit who came to communicate. He was caught by Director Zhu in the bathhouse and came here for consultation."
Sun Lien smiled awkwardly, stood behind Yuan Pingan, stretched his neck with him, and watched the movie under the light of energy-saving lamps.
"There is obvious signal enhancement in the meninges..." Sun Lien's ability to read pictures is not very good, but he can still see something is wrong. "There is an abnormal signal in the right basal ganglia."
Sun Lien pointed to the area where he found the abnormality, which is near the basal ganglia of the human body and close to the thalamus. In the MRI image, you can clearly see several white circles concentrated in this area.
As the two continued to read the films, more and more abnormalities were identified. Lu Xuexin's brain included bilateral frontal and parietal lobes, corona radiata, left lateral ventricle, right basal ganglia, right parahippocampal gyrus, etc.
Abnormal signals appeared in multiple locations.
These abnormal signals are different from the small white balls in Chen Wen's brain. They are more like small circles. There are obvious white signals where the outside connects with the brain tissue, and the inside of the circle behaves worse than the outer brain tissue.
The color is darker. This proves that the things inside the circle are at least denser than normal brain tissue.
"What is this?" Yuan Pingan, who was well-informed, was also a little dazed. He subconsciously wanted to invite doctors from the neurosurgery and imaging departments for consultation, but suddenly saw the silent Sun Lien. "Doctor Sun, what do you have in mind?
What?"
"Look here." Sun Lien pointed to the abnormal signal area that he and Yuan Pingan discovered at the beginning, "Have you noticed that the shape of the abnormal signal here is different? It has penetrated part of the third ventricle.
"
Yuan Pingan frowned and asked, "What does this mean?" He did not see the significance of this intrusive feature.
"The main components of the human brain are fat and protein." Sun Lien used his own knowledge to explain, "and its density should be relatively uniform in all regions. But the brain ventricles are different. The cerebrospinal fluid contained in the brain ventricles can be approximated
Think of it as water. They are denser than brain tissue."
Yuan Pingan felt a little dizzy after hearing this. He shook his head and asked, "The density of cerebrospinal fluid is greater than the density of brain tissue. I know this. What next?"
"The intrusion here proves that the density of the material in these white signals should be greater than that of cerebrospinal fluid. Otherwise, it would not have intruded into the brain ventricle, but should have been squeezed out by the ventricle." Sun Lien clicked on the MRI film, "I think
, these could be abscesses."
"Abscess?" Yuan Pingan asked confused, "If it's a brain abscess, her condition should improve after antibiotic treatment."
Sun Lien looked at the treatment plan, shook his head and said, "This is the main reason why Director Zhu used this case to test me." He pointed out the treatment plan in the case to Yuan Pingan, "You have already used meropenem and cephalosporins.
Qupine, but did not improve performance."
Meropenem is a beta-lactam antibiotic used in combination with ceftriaxone and is a common treatment option for bacterial meningitis and brain abscesses.
"So, the bacteria that infected Lu Xuexin's brain should be a type of bacteria that is not sensitive to either meropenem or ceftriaxone, or is resistant to them." Sun Lien continued his diagnosis, "At the same time, the infection with this type of bacteria should not be sensitive to either meropenem or ceftriaxone."
It’s not common. It can show symptoms of brain abscess and meningitis at the same time. At least I haven’t heard of this bacteria.”
"What does uncommon mean?" Yuan Pingan asked, "You mean...infections caused by rare bacteria?"
Sun Lien nodded, then shook his head, "There are two possibilities that I can think of at the moment. One is that this bacteria itself is very rare, so there are relatively few corresponding case reports. But this possibility is not very high.
I have never seen Xie Xie, so the possibility of the existence of this kind of bacteria is low. The second possibility..." Sun Lien paused, "The second possibility is that this may be some relatively common and not uncommon bacteria.
Infection caused by virulent bacteria.”
Yuan Pingan's eyes widened, "Because...sle?"
"Strictly speaking, it's because of the medication used to control SLE." Sun Lien nodded. This was the part he was most worried about. "The patient has been taking hydroxychloroquine sulfate and methylprednisolone for a long time because of SLE, and her immune system will be weaker than before.
Ordinary people are much more vulnerable. Some common bacteria may cause serious consequences."
Yuan Pingan looked at the comatose Lu Xuexin with a headache, "That's troublesome. What kind of bacteria can be insensitive to two broad-spectrum antibiotics at the same time, and cannot be detected in cerebrospinal fluid smears? Moreover, after infecting the brain, it can also cause meningitis at the same time.
inflammation and brain abscess..."
"My suggestion is to strengthen observation and ask a neurosurgeon and radiologist for consultation. First discuss whether puncture and decompression of the brain abscess is needed." Sun Lien sighed. Even though he said so much, he didn't understand what it meant.
Bacteria caused Lu Xuexin's symptoms. "At the same time, you should ask the laboratory department if there are any testing methods that can detect the pathogen other than cerebrospinal fluid culture." Sun Lien paused, and he suddenly thought of the idea and initiative proposed by Xiao Linfeng.
"By the way, can I do a mngs check with my colleagues?"