I can see the status bar

第637章 弥补错误（8月10日3K6更新求订阅）
Sun Li'en doubted SLE, not because he suspected that there was something wrong with Kobayashi Kaoru's gender.After all, the status bar has made it clear that this is a man. Although SLE has a high incidence in women of childbearing age, it also occurs in men.

He suspected that Kaoru Kobayashi had SLE mainly due to his inference based on the course of the disease a year ago and now.Although this possibility is very low - but if the status column really misses the diagnosis or Sun Lien himself deduces the cause of hyperthyroidism wrongly, then Sun Lien now has reason to associate Kobayashi Kaoru's symptoms with the hyperthyroid crisis a year ago for judgment .

In the treatment of hyperthyroid crisis, in addition to actively maintaining the patient's vital signs, the only way to completely eliminate the threat of hyperthyroidism to the patient's life is to take iodine-131 treatment or surgical removal of part of the thyroid gland.Kobayashi Kaoru received iodine-131 treatment in the fourth hospital. At the same time, during the hyperthyroid crisis, in order to prevent Kobayashi Kaoru's thyroid gland from secreting excessive thyroid hormone as soon as possible, he also received hormone and iodine treatment.

Excessive intake of iodine can suppress thyroid secretion instead.Excessive use of hormones can simultaneously suppress the thyroid and Kobayashi Kaoru's immune system.

If he had already suffered from a systemic immune disease such as SLE at that time, then through hormone therapy, it is indeed possible that the symptoms will improve and even appear to be cured.

Sun Li'en thought about this, and the cold sweat on his back was about to break out.It's okay if you don't think about it, but the more you think about it, the more he feels that this is really a fucking missed diagnosis.

Although even if it is really a missed diagnosis, this complex and atypical SLE missed diagnosis is completely normal.But Sun Lien still felt particularly uneasy in his heart.This feels like the night when Sun Li'en rode a bicycle when he was a child, accidentally smashed the neighbor's uncle's flower pot, and then hid back home.

"In short, you must take this into consideration when you meet for a consultation." Liu Tangchun called Sun Lien to a place where no one was around to teach the opportunity, and it was also to remind his students - try to look at this with a broader perspective and thinking patient.He was really worried that Sun Li'en's diagnosis at the beginning was negligent.And if such omissions do exist, treating the previous symptoms separately from the current symptoms will inevitably lead to missed diagnosis or even misdiagnosis.

If the other Gui Peisheng were even hospitalized for treatment, if they were misdiagnosed, Liu Tangchun would naturally be the first to spare them.But Sun Li'en is different... In all fairness, it is not easy for a young doctor who has not even completed the training to encounter such a complicated case, to think of hyperthyroidism instead of following Xu Yourong's advice when he sees bleeding and is emotionally agitated. up.Even if Sun Li'en really missed the diagnosis, Liu Tangchun would at most say a few words like "be careful next time" and let it go.

I hope Xiao Linfeng won't get angry because of the possible missed diagnosis... I hope he won't turn back and ask the Fourth Hospital to pay for that diagnostic center.

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After a year, Sun Lien saw Xiao Linxun and his wife Lin Lan again.His first impression was that Kobayashi seemed to have gained a little weight during this time.

"Doctor Sun." After Lin Lan saw Sun Lien, she stood up a little excitedly. She was very impressed with this young doctor—after all, the old uncle kept saying in front of her, "Doctor Sun is your doctor." My savior."Coupled with the seriousness of Sun Lien who came to ask about his situation almost every day after that, Lin Lan unconsciously felt a little more trust in Sun Lien, "I'm going to cause you trouble again."

"It's true." Sun Li'en nodded with a wry smile, "If possible, I really hope that I will never see you again."

It's really not rude for doctors, patients and their families to say "see you again".Rather, this kind of words hides the deep expectation of the doctors, hoping that the patients will stay away from the hospital in good health.

But since he's already here, he can't drive people away.Sun Li'en sighed, and picked up the inspection report that had just come out from the bedside.

白细胞14.01×10^9/L，血红蛋白87g/L，降钙素原0.385ng/ml，C反应蛋白226mg/L。

Sun Lien immediately found out the abnormal parts in the report, especially the two indicators of procalcitonin and C-reactive protein - when the laboratory on Daishan Island tested procalcitonin, it used anti-sandwich immunochemiluminescence method, the reference value is 0.1ng/ml.And Kobayashi Kaoru's index directly exceeded by nearly four times.The C-reactive protein is about three times higher.

Seeing this inspection report, Sun Li'en felt a lot less guilty immediately.This indicator does not look like SLE at all, but rather the result of some kind of infection.

"From the data, it looks like some kind of infection." Sun Lien explained to Lin Lan, "Since when did he start showing symptoms?"

"I had a fever several times in the past few months, but it was fine after taking antipyretics." Lin Lan replied after recalling, "It's as serious as this time...it's never happened in the past. He started to have a fever yesterday , the doctor on board gave him some antibiotics and antipyretics. But he still has a fever today."

Sun Li'en took out the small notebook and a pen that he never left with him from his pocket, and began to record the medical history he asked, "Except for fever, weakness, cough..." He glanced at the top of Xiao Linxun's head, and then continued Asked, "Besides the rash and lymphoma, are there any other symptoms?"

"Xun Xiaolin, male, 25 years old, bone marrow hyperplasia was obviously active, C-reactive protein increased, fever, cough, rash, positive antinuclear antibody, positive antiphospholipid antibody, positive anti-β2-GP1-Ab antibody."

Although he didn't look at the duration carefully, Sun Li'en didn't have the time to take care of those things anymore.The next three positive antibodies made his hands tremble slightly.

The first anti-nuclear antibody positive, usually in patients with autoimmune diseases, tumors and thyroid diseases.The latter two antibodies mean that the patient may have antiphospholipid syndrome (APS).

When antinuclear antibody positive and antiphospholipid syndrome (APS) come together, every qualified physician should first think of systemic lupus erythematosus (SLE).

Antiphospholipid syndrome mostly follows other autoimmune diseases, especially in SLE patients.The probability of appearing alone is not without, but the simple occurrence of APS will not directly lead to positive anti-nuclear antibody reaction.

Sun Lien looked quite calm on the surface.But deep in his heart, he kept questioning himself, "Is there really nothing wrong with your previous diagnosis?" Is it?" "If the previous treatment did not use hormones, would he have died because of your misdiagnosis?" "Did you do it right?"

Sun Lien, who was shaken in his heart, suddenly felt a little cold.The previous feeling of staring at him with the help of the status bar, no matter what difficult and miscellaneous diseases he could see, completely disappeared.He felt as if he were in the Antarctic and had been stripped and thrown in the wild.There is a chill in the body, a chill in the bones, and even... a chill in the heart.

There is nothing wrong with the status bar, and the only one who made the mistake is myself.Sun Li'en felt cold all over, and he began to constantly recall the patients he had diagnosed before.Is the etiology of those patients suspicious?Is there anything I might have gotten wrong?Will someone delay treatment because of their own diagnostic errors?Even... paid the price of life?
Sun Li'en is constantly sinking in his own self-doubt and cannot extricate himself.He didn't even listen to what Lin Lan said later.But Lin Lan keenly noticed that Dr. Sun in front of her... seemed a little absent-minded.

"Doctor Sun?" She cautiously called out to Sun Lien twice, but all she got was a perfunctory "Mmmm" answer from Sun Lien.After concluding that Sun Lien really didn't listen to her, she tugged at Sun Lien's sleeve angrily - it was true that she couldn't help but not be angry, her husband was lying on the bed suffering from illness, but Dr. Sun looked absent-minded, Where does this work?

"Ah!" Sun Lien's thoughts were pulled back to reality. He stared at Lin Lan in front of him, and after a few seconds he realized that he had lost his mind while asking about the course of his illness. "I'm sorry..." Sun Li'en apologized to Lin Lan with a guilty conscience, "I..." He was trying to use his brain to find excuses for his distracted behavior.But Lin Lan sighed, and took the initiative to help him out, "I heard that you, Dr. Sun, just boarded the boat today. I'm really sorry to trouble you to see Xiao Lin."

Sun Lien replied a few words in embarrassment, and decided in his heart that even if it was a big matter, he had to wait until Kobayashi Xun had finished seeing his illness - entanglement in the past would not help the current situation.Before tangling the lives of others, you must first focus on saving the life of the patient in front of you.

Even if he really got Kaoru Kobayashi's cause wrong before... at least he still has a chance to make up for it now.

Sun Lien took two deep breaths, and then asked the military doctor on the side, "What equipment is available on the ship now?"

Every patient on the ship is received and treated by the military doctor on the Daishan Island.This is someone else's patient, even if Sun Li'en wants to make up for the big mistakes he may have made before, he has to get the permission of the military doctor.

The military doctor who saw Kaoru Kobayashi was surnamed Jiang, and he was a physician from Yuanhai Hospital.He knew Liu Tangchun's background, and after learning that the patient and his family members he was treating were rescued by Sun Li'en's diagnosis a year ago, he immediately looked at the doctor Gui Pei who had just obtained a medical license in front of him. Got interested.

To be able to diagnose hyperthyroid crisis in that situation, and to be able to see at a glance that another patient with severe trauma had internal bleeding, this doctor is very capable.

"There are two CTs that can be used now, and they can do PET scans." Dr. Jiang replied, "MRI can't do it... After all, the ship is made of steel. But other equipment is basically available."

"Do a CT scan of the chest, and draw blood for culture." Dr. Jiang's cooperation was really good, and Sun Li'en even mistakenly thought that this was his home stadium. "Let's see the condition of the lungs first."

The three positive antibody tests behind the status bar must be done, but with Kobayashi Kaoru's current symptoms, Sun Lien really can't think of any direct reason for Daishan Island to test these three antibodies.Then we can only start with the symptoms that are currently manifested.

If you don't look at the three positive antibody reactions behind the status bar, Kaoru Kobayashi's symptoms are a typical infection.However, the focus of the infection is not clear - from the symptom of cough, the most likely focus of infection is naturally the respiratory tract or lungs. A CT scan can quickly confirm whether Kaoru Kobayashi has lesions in his lungs.

As for the obvious active bone marrow hyperplasia... Sun Lien sighed, if the CT scan showed that the lungs were basically normal, then Kaoru Kobayashi had a big problem.Lymphatic swelling, active bone marrow cell proliferation, long-term recurrent fever... These are typical manifestations of leukemia or tumors.

An unknown infection that is not sensitive to antibiotics, leukemia of unknown stage and type, SLE, or an autoimmune disease that can affect the whole body.These are the only three explanations that Sun Li'en can think of so far.And no matter which of them Kaoru Kobayashi recruited...I'm afraid it can't be easily solved by the medical equipment on the Daishan Island.

Sun Lien sighed secretly while exchanging diagnosis and examination plans with Dr. Jiang.He didn't even know if he should pray for a chance to make up for his mistakes, or just pray that this illness had nothing to do with the previous misdiagnosis.In his opinion, Xiao Lin Xun had finally turned back from the closed door of hell, and had just lived a comfortable life with Lin Lan.This makes young people... face another life and death?
For the first time, Sun Li'en hated himself as a doctor.If he hadn't become a doctor... at least he wouldn't have suffered so much, right?
(End of this chapter)