Chapter 142 Sun Lien's Reasoning (Part 2) [Special
"So... it's sickle-poverty?" Xu Yourong heard Sun Lien's explanation, and she even told Sun Lien the name of the disease together. But she was obviously still a little unsure about the diagnosis, "Then what are his lung symptoms?"
Is it coming from? Blocked capillaries?”
Sun Lien glanced at Xu Yourong helplessly, "How else could it have come about? It's just a cold that I haven't taken for a month."
Generally speaking, when encountering a patient with a very complicated condition, Sun Lien, as a doctor, will try to find the only explanation for this bunch of symptoms, the only solution, like a traditional physicist. It is at this time that doctors
Only then will he behave like an authentic science student, almost stubbornly adhering to the principle of simplicity, which means that all symptoms should be caused by the same disease.
Of course, there will definitely be exceptions to this situation. For example, for the same bacterial infection caused by injury to the end of a limb, the symptoms displayed by ordinary people and diabetic patients are likely to be very different. The symptoms of infection will be different between HIV patients and diabetic patients.
The same bacterial infection will manifest very differently in different patients. This is the so-called "basic disease". At this time, if the doctor is still obsessed with his own experience, it will inevitably lead to missed diagnosis and even misdiagnosis.
Misdiagnosis. Modern medicine and the reason for advocating evidence-based medicine are also related to this.
"His problem is not just sickle cell disease." Sun Lien explained his opinion to Xu Yourong, "First of all, I think he has sickle cell disease, not the more serious sickle cell anemia. If it is
His symptoms of sickle cell anemia have already appeared and may become more severe."
Sickle cell anemia has a poor prognosis. Patients will show severe symptoms in childhood, including ischemic necrosis of organs, severe hemolysis, etc. Most patients with sickle cell anemia will develop symptoms in early childhood.
Those who die of illness before adulthood, and those who survive beyond adulthood, will rarely survive past the age of 30.
Rawls is 21 years old this year. And he doesn't even know that he has this hidden disease in his body. This is enough to prove that his disease should be a relatively mild form of sickle cell disease, not sickle cell anemia.
But the relatively mild symptoms do not mean that the disease has no impact on him. Having been anemic for a long time, Rawls's physical condition is not optimistic. And when the cold is delayed into pneumonia, this unoptimism quickly turns into "
"Severe". Patients with sickle cell disease are already susceptible to infection. The hemolysin released by pneumococcal bacteria has a great impact on normal red blood cells, not to mention the twisted and fragile sickle cells. And because of sickle cell disease
The resulting long-term malnutrition also weakened Rawls' immune system.
A weak immune system, a physical foundation that is more susceptible to infection, and a negative reaction to antibiotics. The three combined together directly knocked the young Rawls from the training field to lying down, and even now he needs to
Maintain stable vital signs by suspending red blood cells and inhaling oxygen.
"Is there another issue with antibiotics?" Xu Yourong was even more puzzled. If the diagnosis of sickle cell disease and pneumococcus is correct, it should be able to explain the patient's symptoms. Where did this antibiotic issue come from?
of?
"The course of the disease, the changes in the course of the disease." Sun Lien sighed, "Rolls' cold lasted for a month. He went to the training ground hospital because he was ill for a long time, right?"
Xu Yourong nodded, as if she had grasped some key points.
"So for a patient with a weak immune system and sickle cell disease, although his physical condition is poor, at least it should deteriorate in a relatively smooth curve. But Rawls received medical treatment at the training ground hospital.
After treatment, the condition deteriorated rapidly." Sun Lien felt a little awkward when he said this, as if he was speaking ill of other hospitals.
"Deteriorating quickly?" Xu Yourong grasped a doubtful point, "How did you make a judgment?"
Sun Lien took out the examination report again, "Hemoglobin dropped from 11.8g/dl to 8.4g/dl within three days. If his physical condition had deteriorated at this rate before, he would have died long ago."
"So you think it's because of the influence of antibiotics?" This explanation was not as convincing as the previous one. Xu Yourong was still a little skeptical.
"After all, blood collection will not cause hemolysis, and he did not receive other treatments." Sun Lien scratched his head. This judgment was indeed not rigorous enough. Maybe it can be verified later through IgG antibody testing. "But the treatment methods and principles of drug-induced hemolysis
It's similar to how you deal with sickle cell disease."
Xu Yourong reluctantly accepted Sun Lien's reason and asked, "What should we do next?"
"I plan to go to the laboratory." Sun Lien replied with a smile, "In order to find out what type of hemolysis Rawls has, I asked Yuan Pingan to take a sample. Calculating the time, we should have the results soon.
."
The laboratory department issued an examination report and sent the blood smear to the pathology department for further examination. However, sending it to the pathology department was just a standard process to ensure that there were no errors. Under the microscope, the sickle-shaped red blood cell characteristics were too obvious.
, even to the point where it is unlikely to make a mistake... As long as the doctor in the laboratory is not blind, he will not be unable to see this.
Sun Lien breathed a sigh of relief as he took the examination report. Fortunately, he did not overturn his pretense this time. To be honest, if the patient has other diseases and he hasn't found it out after a while, then Major General Peng will take care of him.
He was transferred to the hospital, and he had nothing to be ashamed of. Guipei Sheng's face was just for embarrassment. But Director Liu, who recommended him to the hospital for treatment, would probably have a very disgraceful face. He would only feel a little uncomfortable for a few days if he was embarrassed.
, but if Liu Da Excavator loses face, his life will not be easy in the future.
"I'll be there in a moment. There was a patient just now." Sun Lien took out his mobile phone and called Hu Jia while walking to the emergency room. "His problem is a little bit troublesome, but don't worry, I have solved it."
Already."
"Then I'll order first." Hu Jia looked very happy on the phone, "I thought you wouldn't be able to make it through noon today."
"That's not the case." Sun Lien looked at no one nearby, so he became a little more presumptuous, "You don't even know who we are! As nurse Xiao Hu's boyfriend, he must have two brushes!
"
Hu Jia laughed on the other end of the phone for a long time before he stopped and said, "With your shameless look now, you are really becoming more and more like an emergency doctor."
The diagnosis of Rawls' disease is still in the final step. The IgG measurement will take some time. However, since sickle cell disease has been diagnosed, the next treatment work should be left to the Department of Hematology. Professor Li's department is very concerned about Rawls' disease.
Patients are also very interested. After all, the vast majority of patients with sickle cell disease are black or people related to black people. A very small number of patients in China may suffer from sporadic sickle cell disease. But after all, this is not the case for Asians.
A group with a high incidence of this disease. This hematological disease has an incidence rate of up to 40% in East Africa. The average incidence rate in China is so low that there is no statistical data. The hematology department of the Fourth Hospital can encounter such a patient, at least
The three core Chinese articles should be indispensable: a case report, a treatment record, and a nursing content.
One patient brings three papers. The enthusiasm of the hematologists for their work is unprecedentedly high.