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Chapter 313 Sun Lien's Reasoning [Special Addition]

"So... it's sickness?" Xu Yourong heard Sun Lien's explanation, and she even shared the name of the disease with Sun Lien.But she was obviously still a little uncertain about this diagnosis, "Then how did his lung symptoms come from? Capillary blockage?"

Sun Li'en glanced at Xu Yourong helplessly, "How else could it have come about? The cold has dragged on for a month without taking medicine, so I dragged it out."

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—that is, the only solution—like a traditional physicist.It was at this time that the doctors acted like a true science student, and insisted on the principle of simplicity almost like a brain, that is to say, all the symptoms should be caused by the same disease.

Of course, there are absolutely exceptions to this situation.For example, the same bacterial infection caused by injury to the extremity, the symptoms of ordinary people and diabetic patients are likely to be very different. The infection manifestations of HIV patients and diabetic patients will be different.The same bacterial infection can manifest in different patients very differently.This is the so-called "underlying disease".At this time, if the doctor is still obsessed with his own experience, it will inevitably lead to missed diagnosis, misdiagnosis, or even misdiagnosis.In modern medicine, the reason for advocating evidence-based medicine is 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 With sickle cell anemia, his symptoms have already appeared, and he may show more severe symptoms."

Sickle cell anemia is the one with the worst prognosis.Patients will show more serious symptoms in childhood, including ischemic necrosis of organs, severe hemolysis and so on.Most patients with sickle cell anemia will die before adulthood, and those who can live past adulthood will hardly pass the 30-year-old barrier.

Rolls is 21 years old.And he didn't even know that he had this hidden danger in his body.This is enough to prove that his disease should be relatively mild sickle cell disease, not sickle cell anemia.

However, the relatively mild symptoms do not mean that the disease has no effect on him. Rawls's physical condition is not optimistic due to his long-term anemia.And when the cold is delayed into pneumonia, this pessimism quickly turns into "serious".People with sickle cell disease are already vulnerable to infection—the hemolysin released by the pneumococcus has a profound effect on normal red blood cells, not to mention the twisted and vulnerable sickle cells.The chronic malnutrition caused by sickle cell disease also weakened Rawls' immune system.

A weakened immune system, a body that is more susceptible to infection, and an adverse reaction to antibiotics.The combination of the three was able to directly smash the young Rawls from the training ground to lie down, and even now needs to rely on suspended red blood cells and oxygen inhalation to maintain the stability of vital signs.

"And the problem of antibiotics?" Xu Yourong was even more puzzled. If the diagnosis of sickle cell disease and pneumococcus was correct, then it should be able to explain the patient's symptoms.Where did this antibiotic problem come from?

"The course of the disease, the change of the course of the disease." Sun Lien sighed, "Rawls's cold dragged on for a month, and he was admitted to the training ground hospital because he had been 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, it should at least be deteriorating in a relatively smooth curve. 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.

"Rapid deterioration?" Xu Yourong grasped a doubtful point, "How did you make the judgment?"

Sun Lien took out the inspection report again, "The 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 a long time ago."

"So you think it's because of the effects of antibiotics?" This explanation is not as convincing as the previous one.Xu Yourong was still a little dubious.

"After all, blood collection will not cause hemolysis, and he has not received other treatments." Sun Lien scratched his head, this judgment was indeed not rigorous enough.Perhaps it can be verified later with an IgG antibody test. "However, the treatment methods and principles of drug-induced hemolysis are similar to those used for sickle cell disease."

Xu Yourong reluctantly accepted Sun Lien's reason, and she asked, "Then what should I do next?"

"I'm planning to go to the laboratory." Sun Lien replied with a smile, "In order to find out what type of hemolysis Rawls is, I asked Yuan Pingan to take a sample, and counting the time, the result should be ready soon. .”

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The Laboratory Department issued an inspection report and sent the blood smear to the Pathology Department for further examination.But sending it to the pathology department is just to ensure the standard process without errors.Under the microscope, the characteristic of sickle-shaped red blood cells is too obvious, and it has even reached the point where it is impossible to make mistakes... As long as the doctors in the laboratory are not blind, they will not fail to see this.

Sun Lien breathed a sigh of relief holding the inspection report.It's okay, okay, I didn't overturn my car this time.To be honest, if the patient has other diseases, and he hasn't found out in a while, then Major General Peng will transfer him to the hospital, and he has nothing to be ashamed of - Gui Peisheng's face is used Lost.Director Liu, who recommended people to come to the hospital for medical treatment, is probably going to have a very dull face.Being ashamed is only a little uncomfortable for a few days, but if Liu Da excavator loses face, I will have a hard time in the future.

"I'll be there later, there was a patient just now." Sun Lien walked towards the emergency room, and took out his mobile phone to call Hu Jia, "His problem is a little troublesome, but don't worry, I've already solved it gone."

"Then I'll order first." Hu Jia looked very happy on the phone, "I thought you wouldn't be able to make it at noon today."

"That's not enough." Sun Li'en looked at no one around, so he was a little presumptuous, "I don't even look at who we are! As the boyfriend of Nurse Xiaohu, he must have two brushes! "

Hu Jia laughed for a long time on the other end of the phone before stopping, "You look so stinky and shameless now, you really look more and more like an emergency doctor."

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Rawls's disease diagnosis is still in the final step. The IgG test will take some time, but because sickle cell disease has been diagnosed, the next treatment work should be handed over to the Department of Hematology.Professor Li's department is also very interested in Rawls' patient. After all, the vast majority of patients with sickle cell disease are blacks or people who are related to blacks.A very small number of patients in China may develop sporadic sickle cell disease.But after all, Asians are not a group with a high incidence of this disease. The incidence of this blood disease in East Africa can reach as high as 40%, and the average incidence in China is so low that there is not even a statistical data.If the hematology department of the fourth hospital can encounter such a patient, at least three Chinese core articles should not be lost—one case report, one treatment record, and one nursing content.

A patient comes with three papers.Hematology physicians are working at an all-time high.

　This article is a special addition to the 200 monthly ticket

　　At least one chapter will be updated normally today. As for whether it is possible to write the update of the answer that was guessed yesterday... I really don't know, try my best.

　　
　
(End of this chapter)