I can see the status bar

第673章 试错（9月14日3K3更新）

In fact, in Sun Lien's view, there is still a huge difference between diagnosis and examination.At least in his eyes, using this set of cases to test and teach a few new colleagues seems a little...not difficult enough.The reason why Sun Lien made such a judgment is also very simple-Professor Zhang will use this case to test and teach several doctors who are about to work in the comprehensive diagnostic center, which means that the patient's disease must belong to one of the "intractable diseases".His condition is by no means as simple as shown in the medical records, and there must be something to dig out in it.

This directional hint is often the most important in clinical diagnosis.The status bar belongs to this kind of directional reminder - once the content of the reminder does not match the patient's symptoms, Sun Lien will be able to realize that he has stepped on a thunder.Although the status bar is of course more detailed and more sensitive to various indicators, in essence, the status bar is something that has great clinical significance but is of little use other than that.

Oh yes, prompting the patient's name can be very powerful to help Sun Lien avoid the embarrassment of not being able to call the other person's name.

Several doctors exchanged glances with each other, and they all seemed a little surprised.But since it is a question given by Professor Zhang Zhifu, it still has to be done.

"The collection of the patient's medical history was done well." When the three of them saw the medical record, the first thing they noticed was the collection of the medical history and the description of the course of the disease. Dr. Ma Yongfang made a comment while looking at it.Sun Li'en wrote the course of disease according to the model of "the king of internal medicine writes like a god".The logic is smooth, the organization is clear, and most importantly, he also tries to describe the reality as much as possible, rather than judge it.

This habit is more difficult to understand directly... For example, it is also "chest discomfort and fatigue after exercise", other doctors may directly use "pain in the chest area", while Sun Lien wrote "sternal first The third rib to the sixth rib feel discomfort, and feel weak when moving the limbs again, and the movement is difficult but can be overcome."

In the eyes of outsiders, this may be a trick that the training doctor is racking his brains to count the words.But Sun Lien's writing has already reflected his work habits.

The same is chest pain, which may be chest pain caused by myocardial ischemia, acute myocardial infarction, acute pericarditis or aortic dissection, or stomach pain, spontaneous pneumothorax, pulmonary embolism pneumonia or even lung cancer.As far as the symptoms of the patient are concerned, the medical history should reflect the patient's condition at that time, rather than the first judgment and reaction of the receiving doctor.

An objective and accurate record of the course of the disease not only facilitates the verification of the doctor's diagnosis, but also facilitates the examination—this is a benefit that Sun Lien had never thought of.

The three doctors quickly finished reading all the cases and looked at each other, as if they wanted to exchange some opinions.

"You can discuss it, or you can look up information - you can check Baidu." Professor Zhang sat on the seat, took a sip of warm water cautiously, and said with a smile, "There is no limit to the means, as long as you don't ask other doctors in the diagnostic center. .”

This can be regarded as a very broad means.Ma Yongfang began to look down at the examination results again, while the two doctors Wang Guonan and Chen Xuerong simply took out their mobile phones and started searching.And Professor Zhang Zhifu was still sitting in his seat, smiling and looking at the three young doctors in his group.Only Chen Tianyang remained silent in his seat. He looked at the list in front of him and asked, "Is the patient's condition stable now?"

"I'll answer this later." Professor Zhang Zhifu interrupted Chen Tianyang's question, "You are suspected of inducing them."

"I'm a surgeon, so I can't get these things." Chen Tianyang shook his head indifferently, "I just want to know, did this person do bridge building?"

"I'll tell you later." Not answering can also be regarded as a kind of answer in certain situations.Professor Zhang obviously has no experience in this kind of struggle, and he has not realized that Chen Tianyang is helping three young doctors with tips.

Chen Tianyang gave Sun Lien a very meaningful look, and then fell silent with a smirk on his face.

Despite Chen Tianyang's assistance, it is still a very difficult task to make a diagnosis in this situation - the most critical information that Sun Lien asked was not included in the information provided by Professor Zhang Zhifu.

"Does the patient have a family history? Has he ever had Kawasaki disease?" Chen Xuerong first started to ask. As a cardiologist, he has seen many such patients.Based on his experience, it is not uncommon for him to see patients with normal blood lipids but coronary artery stenosis.The most common is Kawasaki disease.As a disease with a self-limiting course, a small number of patients with Kawasaki disease may have sequelae such as coronary artery disease.This is one of the main causes of acquired heart disease in children, especially coronary artery stenosis.

The cause of Kawasaki disease is still unknown, but if Kawasaki disease was diagnosed in childhood, it is completely understandable and explainable for Wang Ge to suffer from coronary artery stenosis.

In addition to Kawasaki disease, family genetic history is also a high risk factor for coronary artery disease.For the Department of Cardiology, if a patient with normal blood lipids only suffers from coronary artery stenosis, these two relatively common factors should naturally be considered first.

The patient itself did not show symptoms of the immune system, or there was no such suspicious thing.Therefore, Chen Xuerong first asked about the two most common situations.

"The patient did not provide a family history, and he has never suffered from Kawasaki disease before." Sun Lien replied after obtaining the consent of Professor Zhang.

"I don't have any ideas anymore... It doesn't look like an autoimmune disease." Chen Xuerong sighed, turned to Wang Guonan who was beside him, "Brother Nan, do you have any ideas?"

"Why can't it be an autoimmune system disease?" Wang Guonan's answer was a rhetorical question, "This patient is young and has normal blood lipids, but he has three-vessel lesions—this situation is not exactly consistent with vascular lesions caused by autoimmune system diseases. feature?"

"But he doesn't have other symptoms." Chen Xuerong was very confident in his diagnosis, and he argued, "An autoimmune disease with cardiovascular symptoms as the first symptom...it's too rare."

"He still has proteinuria and abnormal renal function. Didn't you read the subsequent examination?" Wang Guonan continued to ask, "If it is an autoimmune system disease, it is easy to understand that abnormal renal function is the first symptom?"

"Before he had abnormal renal function, he had an angiography first. And because of coronary artery stenosis, the amount of fluids given to him has not been enough. This is very likely to be contrast-induced nephropathy, not some immune system disease..." Chen Xuerong argued with his colleagues, "I want to ask you, why do you believe that his abnormal kidney function is a symptom of immune system disease rather than contrast nephropathy?"

The two people were arguing louder and louder. At this moment, Dr. Ma Yongfang, who had been silent all the time, suddenly said, "It's not contrast nephropathy."

It can be seen that in this impromptu group, Dr. Ma Yongfang's words are more important than Wang Guonan and Chen Xuerong - as soon as she spoke, the two stopped arguing immediately, and then turned to look at Dr. Ma.

"The first urine routine was performed four to 10 minutes after the end of the contrast." She picked up the report in her hand and said, "Contrast nephropathy will not be so fast. His abnormal kidney function is a symptom, not a medical treatment." Turns out — at least the abnormalities in kidney function at the time were not."

With Ma Yongfang's judgment very accurate, Wang Guonan and Chen Xuerong quickly nodded and agreed with Ma Yongfang's judgment.

Professor Zhang Zhifu sighed softly. He kept looking at his watch under the table. Obviously, he was not very satisfied with the performance of the three doctors in his group.

They still spent more than 10 minutes discussing the condition when they knew clearly that "this patient has a problem", and so far they have only narrowed the scope to "the patient is likely to have an autoimmune system disease".Although compared with other doctors, their efficiency is already very high.But... There is still a big gap between this and Sun Lien's performance.

When Sun Lien was seeing an "ordinary" chest pain patient, it took less than 15 minutes to determine that Wang Ge had an immune system disease, and prescribed relevant tests to confirm his diagnosis.This time is evidenced by a checklist.

"Have you reached the result of the discussion?" Professor Zhang Zhifu waited patiently for another 5 minutes, and then interrupted the intense group discussion, "There are still patients waiting for treatment. What is your diagnosis?"

"I suspect an autoimmune disease." Wang Guonan replied, "We suspect systemic lupus erythematosus, Wegener's granulomatosis, or lymphomatoid granulomatosis."

Professor Zhang Zhifu put away his "gentle and kind" smile, and then continued to ask, "Since it has been narrowed down to three diseases, why continue to discuss?"

"Because we haven't been able to be sure..." Chen Xuerong was explaining, but Professor Zhang Zhifu suddenly patted the table.

"This is a patient with three-vessel diseased coronary artery stenosis. He is lying on the hospital bed and may have a myocardial infarction at any time! You spent 45 minutes discussing three possible autoimmune diseases. Why don't you ask for an examination immediately? A clear diagnosis? What’s the point of continuing the discussion?” He yelled at his team members, “Among the diagnosis and course records provided now, which item is likely to further narrow the scope of the diagnosis?”

Chen Xuerong was overwhelmed by Professor Zhang's roar, and he subconsciously explained, "The consultation and discussion will definitely take time...it's only about 40 minutes..."

"Dr. Sun only took 15 minutes to make a diagnosis!" Professor Zhang Zhifu looked really angry, "I have already emphasized to you that the Fourth Central Hospital is a major emergency center, and most of the patients who come here for consultation are Emergencies—the diagnosis must not only be accurate, but also fast!"

The three of them remained silent. Of course, it would be a miracle if they could be convinced in their hearts—it is not easy to judge that a patient may be suffering from an autoimmune disease in four or 10 minutes, and it is even more difficult to narrow down the list of suspects to three. It's rare.After all, none of these three were from the Department of Rheumatology and Immunology, and the one closest to this field is Dr. Ma Yongfang.

"Shut up all your arrogance and take a good look at how they did it!" Professor Zhang Zhifu threw the complete examination report and medical records on the table, "Remember clearly, you are now in the emergency room. The first-line clinic is not for interdepartmental consultation in the Affiliated Hospital of Tongde Medical College! No one will stare at your diagnosis and wait to see your jokes—only patients who are about to die are waiting for you to save their lives! Diagnosis does not need to be done It is 100% correct, but we must balance the treatment and the correct rate—there are so many inspection methods, just to help you use trial and error!"

　After this week, there is a high probability that it will return to normal... My mother will be discharged from the hospital by the end of the week.

　　These days, I have broken through [-] steps on foot every day. Sanguan is really tired and a little delirious. I actually wrote this chapter for three days... I'm sorry everyone.

　　
　
(End of this chapter)