Sun Lien was a little ashamed. Body temperature is the basic value of the human body. Like heart rate, blood pressure, and blood oxygen, it is the first priority that doctors need to pay attention to. Due to the special way of maintaining body temperature of warm-blooded animals, the measured value often lags behind the body's
The actual situation. When he was "nonsense" several times before, Sun Lien did use body temperature as an explanation for the patient's symptoms. He usually forgot the explanation when it came in handy.
It must be said that Dr. Pascal's eyes were very sophisticated and vicious. He could see at a glance the fundamental reason why the test results were different from what the facts should reflect.
"Your excellent diagnostic skills and current professional position are actually a deep misfortune." Dr. Pascal patted Sun Lien on the shoulder with some sympathy, "Other young doctors at your age are still
Keep making mistakes and learning. But you are different from them. Even if they make mistakes, it doesn't matter. After all, no hospital will let them be responsible for the life and death of patients. But you are different. You are now leading many famous people, including me.
Doctor, you are responsible for complex cases that other senior doctors cannot handle. If these patients cannot be handled by you, they will have to be transferred to a higher-level hospital."
Listening to Dr. Pascal's words, Sun Lien suddenly felt that he was under a lot of pressure.
"So, you can't make mistakes." Dr. Pascal's eyes became sharp. "Other young doctors can make mistakes, other senior doctors can make mistakes, and even I can make mistakes. But you can't. It's up to us.
The patients taken over by this treatment group are all patients who have no other way to seek medical treatment, and the conditions are often very serious. If others make mistakes, they can leave the patients in your hands, but if you make a mistake, you may have to pay the price.
The patient’s life.”
Sun Lien was silent for a long time, then raised his head and said, "I can't guarantee that I will never make mistakes, but I promise that I will do my best to avoid mistakes."
"In the future, you must not only pay attention to whether you will make mistakes, but also pay attention to the position of the viewing angle." Dr. Pascal nodded with satisfaction, and then continued, "You are not only a person working alone, you are also a member of a treatment team.
In addition to doing things themselves, leaders should also rely on the professional abilities of their team members."
Sun Lien nodded honestly. Anyway, Lao Pa is not so much his subordinate as the supervising teacher Xu Yourong hired for him. He is experienced, has rich teaching experience, and most importantly, he speaks directly.
Personality. If you were another doctor, you might have many concerns due to the relationship with the group leader, or because you are not familiar with the so-called "working atmosphere".
Although it is always uncomfortable to have mistakes clearly pointed out, Sun Lien also knows very well that these are valuable experiences that cannot be bought. For Pascal, who would rather give up life in the United States and come to China to carry out research, treat diseases and save lives, Sun Lien cannot give birth to him.
Despite a trace of resentment, I admired this ginger-red-haired, semi-bald old man from the bottom of my heart.
"Then, knowing that his coagulation status is abnormal, we can know that there is some serious problem with his body." Sun Lien reorganized his mood and began his diagnosis. "First of all, it is certain that the blood clot has already
It affected his brain and small intestine. He also had thrombus in the deep veins of his lower limbs. Although we have removed the large thrombus through interventional treatment, if we do not solve the coagulation problem, he will still continue to face the risk of embolism."
"Two organs were affected at the same time, but the most vulnerable lungs and heart were not affected." Dr. Pascal nodded, "It should be said that he is still very lucky."
"Then the next question is, how bad is the coagulation function, and why does coagulation disorder occur?" Sun Lien frowned and considered for a moment, then suddenly picked up the phone, "Doctor Yuan, prescribe a urine routine for Xia Hongyuan, check
Check the condition of his kidneys."
"The investigation has been completed." Yuan Pingan's voice on the other end of the phone sounded serious, "The situation is not good, he has cast urine."
Casts are cylindrical protein aggregates formed by the condensation of proteins, cells, cell fragments, etc. in renal tubules and collecting ducts. Casts are an important component in urine sediment, and their appearance means that the patient has kidney disease.
Substantial damage means that the patient's glomeruli or renal tubules are damaged.
"When was the sample taken?" Sun Lien immediately stood up from his seat and walked quickly towards the emergency room. Renal parenchymal damage had not appeared in the patient's status bar before. This was a new symptom.
"I took the sample when Lao Pa entered the emergency room." Yuan Pingan replied, "Probably less than five minutes?"
Sun Lien bypassed the busy medical staff in the emergency room and rushed to Xia Hongyuan's side.
"Xia Hongyuan, male, 26 years old, suffered from left pretibial blood blister (74.26.28), ischemic necrosis of the small intestine (53.58.41), and ischemic acute kidney injury (00.14.36)." Xia Hongyuan's status bar changed significantly.
The most eye-catching thing is the new indication of kidney damage and the two sets of numbers that have changed.
Sun Lien was stunned for a while, and then he saw Yuan Pingan who hurried back to the emergency room.
"It's not coordinates..." Although Sun Lien's eyes saw Yuan Pingan, his attention was on the changes he had just discovered. "Those numbers are not coordinates, they are time!"
Yuan Pingan looked at Sun Lien, whose eyes were dull, and patted his arm with some worry, "Doctor Sun, you..." He was about to ask Sun Lien if he felt uncomfortable, but this action suddenly made Sun Lien turn around.
God comes.
"Follow me!" Sun Lien was as energetic as an electric doll that suddenly had a fully charged battery. He rushed Yuan Pingan into the small conference room with quick movements. He didn't even have time to say anything more to Dr. Pascal.
Instead, he rushed to the whiteboard in the small conference room and started recording the symptoms.
The first thing that appeared was left common iliac vein thrombosis, then venous thrombosis. Soon, blood blisters appeared, and then small intestinal ischemic necrosis occurred. Until the occurrence of stroke, and now acute kidney injury. A timetable emerged
on the whiteboard.
"His left common iliac vein first developed a thrombus, which caused the blood return to the entire left lower limb to slow down and produce venous thrombosis." Sun Lien told the doctors present about his findings, "We already know that blood circulation
The blisters appeared at least three days ago. In other words, the thrombosis in the veins of the lower limbs must be caused by the venous return disorder of the lower limbs three days ago, which is the cause of the appearance of the blood blisters."
Sun Lien's explanation was very convincing, and both Dr. Pascal and Yuan Pingan nodded.
"And even without a CT scan, I can be sure that the length of the patient's small intestinal ischemic necrosis is not too large. After all, he can still go to work more than two days after the onset of abdominal symptoms." Sun Lien continued, "From this point of view
It can also be proven in reverse that the cause of ischemic necrosis of the small intestine is not insufficient blood supply from the small intestinal arteries, or blockage of the channel between the small intestinal veins and the hepatic portal vein, but capillary blockage."
"Until the patient develops symptoms of stroke, we have solved this problem through interventional surgery." Sun Lien drew two large circles on the whiteboard, enclosing the symptoms of ischemic necrosis of the small intestine and the symptoms of stroke. Then he used
The pen drew a triangle behind the two deep vein thrombosis.
"I wonder if you have noticed that the patient's abnormal coagulation before admission included both large and small blood vessels?" Sun Lien said about his findings. "Just now, we confirmed that the patient had cast urine.
In other words, even after surgically removing two deep vein thrombosis and receiving anticoagulant therapy, the patient's kidneys still suffered acute damage."
Yuan Pingan's eyes lit up, "Are you trying to say that kidney damage is also ischemic?"
"If so." Sun Lien did not answer the question directly, but continued following Yuan Pingan's hypothesis, "That is the third case of abnormal coagulation of small blood vessels in two days, and it has affected a third organ."
Dr. Pascal stood up with a stern look on his face, "This is caps, catastrophic antiphospholipid-antibody syndrome."