My medical skills add experience

Chapter 552 Six-level Pharmacological Syndrome Differentiation

"It feels like his voice is hoarse when he cries. It's not okay to have a throat that lacks water for a long time."

Zhou Can frowned slightly, then turned to the nurse.

"Do you have a clean straw? The one with the balloon."

"Have!"

"Please bring one here, I'll give this little baby some water first, it's so distressing to see."

He patted the baby on the back to soothe it.

After the nurse fetched the straw, he asked the nurse to open the feeding bottle, sucked a few drops of water from it, and squeezed it into the baby's mouth.

The whole process was very gentle and careful.

The baby stuck out his tongue and licked the water stains on his lips, and the crying stopped. He looked at Zhou Can with longing eyes.

It seems to say, uncle, give me another drink.

"It turns out that we can still feed water in this way. Why didn't we think of it? I tried to feed water with a small spoon before, but he was choked and cried, so I didn't dare to feed him anymore."

The mother watched Zhou Can easily feed her baby water. Not only did the baby not choke, but he also seemed to be enjoying it.

Immediately, he had great trust in Zhou Can's ability.

The family members looked at Zhou Can differently.

With respect and trust.

"Feeding water with a spoon is suitable for older children. For about six months, it is not so easy to choke when feeding water with a spoon. Also, if you keep choking when feeding water, it is easy to cause problems such as pneumonia. This Be careful."

Zhou Can didn't completely scare the family members.

Babies are just born and their lungs are not fully developed.Because they are in their mother's womb, they have been breathing through the umbilical cord.

In addition, it is not a bad thing for a baby to cry, it helps exercise lung function and helps the lungs adapt to the outside world.

Especially for newborn babies, midwives will be very anxious if they don't cry or fuss.

Will try to make the baby cry.

For example, patting the soles of the baby's feet and so on.Of course, try not to let the family members see this scene, so as not to cause unnecessary misunderstandings.

"Did you have a natural birth or a caesarean?"

"Successful delivery!"

"Since the child can drink water, he should be able to use this method to switch to milk. Breast milk is rich in nutrients and has many special elements that can enhance the baby's immunity. If he is unwilling to drink, you can Squeeze it out, put it in a bottle, and then use a straw to feed him a little bit. When feeding with a straw, be careful not to suck too much at one time, so as not to cause the baby to choke. If he chokes twice more, he will reject it because he is uncomfortable. way of eating."

Zhou Can explained the essentials of feeding to the mother.

Now we must find a way to let the baby eat some milk to maintain the body's immunity and nutrient absorption.

"Okay, I'll do it later."

Now that there are so many people, mothers naturally have no way to express milk.She has learned the method, and after the doctors leave, she can operate by herself.

Zhou Can continued to feed the baby some water.

The expression on the child's face is also more comfortable and natural.The frown that was originally frowning has expanded a lot.

The family members and mothers are very happy to see all this.

Children are born without food for so many days, which makes their hearts hang higher and higher.It's a little bit down now.

"I'm going to do some medical tests on the baby and need to put him in a crib."

Zhou Can greeted his family members.

"OK."

Family members and mothers readily agreed.

Now, in their hearts and eyes, Zhou Can is an absolute expert.They are very happy to let Zhou Can help their children with diagnosis and treatment.

Zhou Can first touched the child's neck pulse, which felt very thin.

In patients with heart failure, the pulse is often very thin.

Then he made a detailed examination of the whole body of the child, including auscultation of heart and lung sounds and so on.

On auscultation, he found a murmur in the child's left chest.

After careful identification, it was found that it was a murmur from the middle and upper position of the left sternal border.

And this murmur is very regular, only when the heart contracts.

Ordinary doctors may not be able to distinguish whether the heart sound is in contraction or relaxation, but doctors who have reached Zhou Can's level can accurately distinguish.

"The patient's X-ray examination showed that the heart was enlarged, the pulmonary vascular shadow increased, and some even showed pulmonary vein congestion. In addition, the patient's electrocardiogram also indicated that the electric axis was right-deviated and the right ventricle was hypertrophic. So I highly suspected that the aorta was out problem."

Many chief doctors were present at the scene, including Director Le of the Department of Cardiothoracic Surgery.

Now that Zhou Can's diagnosis has a certain result, he naturally doesn't need to hide it, just speak it out and discuss it together.

The only caveat when discussing on the ward is to respect the doctor above.

Can't hit them in the face.

For example, the superior doctor just said in front of everyone that there may be a problem with the left ventricle, but you immediately said tit for tat that the problem is in the right ventricle, which is basically an antithesis to the superior doctor.

It will make it difficult for superior doctors to step down.

"Director Le, what's your opinion?"

Director Tang Fei is not very good at heart surgery diseases, so she can only ask Director Le for his opinion.

"Zhou Can's suspicion has a certain basis. You can do an echocardiogram to clarify."

Director Le's diagnosis level is not low, but Zhou Can has opened up the gap in many aspects.He seems to seldom refute Zhou Can's diagnosis.Because of the few rebuttals, only one was not slapped in the face.

That was a long time ago.

Now Zhou Can has left him far behind in terms of diagnosis and surgery, so he dare not refute Zhou Can's diagnosis easily.

Doing an echocardiogram will indeed be of great help in the diagnosis of the aorta.

Considering that the child's condition was very dangerous, an echocardiogram was arranged for the child on the spot.

After investigation, it was found that the child's aortic valve was stenotic, and there was a rather long section.The blood signal in this segment is poor.

"Probably an aortic canyon lesion."

Zhou Can said so after reading it.

"Basically, it can be confirmed that a section of the aorta is narrowed, which leads to a severe weakening of blood in the aorta." Director Le also agreed with Zhou Can's diagnosis opinion.

"The child is just three days old, and surgery can be avoided. I think it should be avoided as much as possible. You can try medical treatment to control heart failure first, and then elective surgery depending on the situation."

After Zhou Can's diagnostic opinion was supported, he gave further treatment advice.

Director Le belongs to the kind of doctor who looks gentle and elegant, and decides on the treatment plan as fiercely as a thunderbolt.

It is better for Zhou Can to decide on the treatment plan for the newborn.

"What internal medicine method is Dr. Zhou going to use?" Director Tang Fei also felt that it would be safer to use medical treatment as much as possible for newborns.

"Prostaglandin E1 is a good choice for opening the ductus arteriosus. It can effectively reduce the hypoxia in children."

Zhou Can gave the answer after serious thinking.

[Pharmacological syndrome differentiation experience value +1, bonus experience value +10. 】

[Congratulations on your promotion to the sixth level in pharmacology syndrome differentiation.The current experience value is 1/1000000, and the chief physician is at the primary level. 】

His pharmacological syndrome has already reached the critical point of upgrading.

This medical skill is extremely important, but the upgrade speed cannot be compared with other medical skills.Even slower than the upgrading of pathological diagnosis and medical skills.Now that he has been promoted to the level of chief physician as he wished, Zhou Can finally made up for a huge shortcoming.

The situation of being hanged and beaten by her nurse Jiang Wei also changed.

Now both pharmacology and pathology have reached the sixth level, and his clinical level is already at the level of a real director.

Whether it's consultation, surgery, ward rounds, or rescue of critically ill patients, they can provide Zhou Can with great help.

He carefully felt the changes brought about by the upgrade of pharmacological syndrome differentiation.

It is obvious that the clinical use of various drugs is more flexible and precise, and the subtle differences among them can be well controlled and grasped.What surprised Zhou Can the most is that now he can naturally form a prediction in his mind about the specific effect of the drug after use and how much it can be absorbed by the patient.

For example, when the patient in front of him is given medicine and the prostate E1 is used, he can make a comprehensive assessment based on some examination reports of the child and form a map in his brain.What drugs cannot be used, what drugs can be tried in emergency situations, after the use of prostate E1, which drugs cannot be used for a long time, whether it will hinder the next emergency operation of the child, etc.

He can form a drug map in his mind.

This ability is not possessed at the fifth level.

It made him faintly touch the realm of meridian-directed medicinal effect that is often said by Chinese medicine practitioners.

When the injection technique was promoted last time, when injecting drugs into the corresponding skin, muscle and other parts of the patient, he was able to judge whether the drug absorption in that area of ​​the patient had reached saturation.This ability, in fact, has already faintly touched the realm of medicine effect returning to meridians.

If the level of injection can go further and reach the intermediate level of chief physician, or even advanced level, this ability is likely to be improved.

For example, it is still only possible to judge which piece of skin and muscle has reached saturation of drug absorption.

Going a step further, it may be possible to judge whether a certain organ is saturated with drug absorption.

Now that the pharmacological syndrome differentiation has been promoted to the sixth level, it is basically equivalent to stepping directly into the door of medicine effect meridian.

"Director Tang, Director Le, and Director Zhuang, I suggest waiting until the child's condition is slightly stable before performing a cardiac catheterization and retrograde aortic root angiography. In the case of such a long aortic isthmus, it is often necessary to It can be solved by surgery. It is very necessary to find out the lesion location and corresponding conditions in advance and eliminate potential hidden dangers before surgery. It can also provide a good basis for the formulation of surgical plans."

Zhou Can felt that the examination done by the patient was not perfect enough.

According to his surgical experience, medical treatment of this child can only alleviate the condition, but cannot cure it.

The best way is to wait until the child's physical condition allows surgery.

"Yes! If the family members agree, I will choose the most suitable time to arrange it."

Director Tang Fei nodded in agreement.

"It is really necessary to do an aortic root angiography."

Director Le also strongly supported Zhou Can's proposal.

Pediatrics do not have the ability to perform cardiac surgery, and children will eventually be sent to cardiothoracic surgery for surgery.Let the children complete the preoperative examination first, which can greatly reduce the risk of surgery and allow the doctor to make adequate preparations before the operation.

Basically all major surgeries require preoperative preparation.

I am going to have heart aortic surgery, and I am still a newborn, so there will only be more preoperative preparations.

"We have no objection at all. With so many directors and experts of yours helping to diagnose and treat my child, our family members are grateful to the hospital, and the rest should only trust us. Our family members are willing to fully cooperate with the hospital's treatment plan and examination plan. .”

It should be the patient's grandfather who spoke.

Although he is a grandfather, he is not particularly old, and he looks less than 50 years old.

As for the parents of the child, they are all young people in their early 20s, and they are still quite immature.

Major events are decided by the children's grandparents.

"Well, thank you for your trust and cooperation. Our hospital will definitely go all out. In fact, everyone's goal is the same. We all hope that this smart and cute baby will recover as soon as possible."

Director Tang Fei made a concluding speech, and the consultation basically came to an end here.

……

When it was time to eat at noon, Zhou Can checked his phone, and Director Tang Fei sent him a WeChat voice message.Tell him that after the child was treated with prostaglandin intravenous infusion, his symptoms improved significantly.

The main symptoms of heart failure are chest tightness and difficulty breathing.

She also told Zhou Can that the child's mother specially sent him a message, thanking him for helping him think of a way to feed the child with a dropper.

Although this method is a bit time-consuming, after breastfeeding the child, the child has slept peacefully for more than two hours and has not woken up.This was almost unimaginable two days ago.

The child hardly distinguishes day and night, and is always crying.

Because babies can't speak, they can't tell their parents when their body is itchy. Crying is the only natural way to express it.

Even us adults cry when we feel bad.

When encountering a particularly noisy child, especially a child who has just been born, you must be alert to whether the child has disease or pain.

When Zhou Can was in the pediatric department, he once saw a child who was only more than four months old.The child's mother was about to collapse, and told Zhou Can that she didn't know why the child had been crying for the past few days.

The noise at night made her hardly sleep a wink.

Later, after examination, Zhou Can found a plaster on the child's navel.

After questioning, I found out that it was the child's grandmother who saw the hot weather, and the child was sweating from the heat at every turn.She was worried about her child's heat stroke, so she took the child to the small clinic downstairs to put on children's cooling stickers.

Some of the children's colleagues have reported that the children's heat-relieving paste has a good effect.

It can prevent children from heat stroke, prickly heat and so on.

Then, in order to sell the plaster, the "doctor" in the clinic also advertised that this plaster is pure Chinese medicine, has no side effects, and so on.

The child's grandma naturally has abnormal trust.

Two days before the plaster was applied, the child slept very peacefully.Especially at noon, usually because it is too hot, the child always makes a fuss and refuses to fall asleep.

After posting the heat-relieving stickers for children, the child slept soundly for two consecutive days.

On the third day, the baby started to cry a little.

It was already the morning of the fifth day when I brought it to the hospital to see a doctor.At that time, after Zhou Can received the doctor, based on his experience, he immediately deduced that the child's problem was probably caused by the plaster.

When I carefully removed the plaster for the child, I found that the child's immature skin was already red and swollen.

Moreover, the belly button seems to have a tendency to suppurate, and there is a faint smell of rotting corpses.

If you come a day or two late, the consequences will be disastrous.

The weather was hot at that time, and the children's resistance to bacteria and viruses was already weak.The navel is equivalent to the 'eye' of the abdominal cavity, and it bears the heavy responsibility for the baby to absorb nutrients and oxygen from the mother during the fetal period.

They have already begun to rot and suppurate, and continue to invade the abdominal cavity. A sepsis can easily kill the child.

(End of this chapter)