Auto chess in the operating room

Chapter 265 Multidisciplinary Consultation
[Patient, Xiao Yunyun, female, 1 year old and [-] months old
Symptoms: persistent fever for 12 days, bilateral bulbar conjunctival hyperemia, bleeding from eyes, mouth, nostrils, navel and other organs, and diffuse hyperemia of oral mucosa.Abdominal pain, facial paralysis and arthritis.Coronary artery damage.

Diagnosis: This disease is an atypical rare disease, and cannot be diagnosed due to the low level of host diagnosis.

Tips: lymphadenitis, infectious mononucleosis, urinary tract infection, pneumonia, Epstein-Barr virus infection, etc. can be clearly ruled out. For specific symptoms and treatment options, it is necessary to upgrade to diagnostic surgery (two stars, 9)]

Tang Lou left the ward very helplessly. Another time, the level of diagnosis was not enough. It can only be said that there are still many rare cases in the usual diagnosis.

Especially for this rare disease with atypical symptoms, the human body is too complicated, and often a disease is often mixed with various complications, which are intricate and complicated. Even experienced doctors will misdiagnose in various misleading , delaying treatment, and even leading to patients not receiving timely treatment and dying of the disease.

"Oh, I hope that the expert consultation will find out the condition in a while."

Tang Lou could only place his hopes on Deputy Director Shen Bingbing and senior physicians from other departments.

Soon the general consultation organized by Shen Bingbing started on time. Dr. Wang Chuan was of course invited, and there were Qingping, Hangcuishan, and Tanglou in the general surgery department.

In addition, senior attending physicians from dermatology, cardiothoracic surgery, and urology were also invited.

In general, the consultation lineup this time is very strong.

Since the patient's condition was very critical, everyone didn't spend too much time opening the scene. Deputy Director Shen Bingbing directly turned on the projection, and began to review the patient's treatment process in the past few days, as well as various examination data, and treatment methods that failed to review.

Tang Lou was also assigned a thick stack of photocopied materials by Guo Caier, with various data in it to assist in checking information.

Deputy Director Shen Bingbing took the lead in putting forward her speculation: "The child developed a fever of unknown origin, which lasted for 12 days, and the blood white blood cell count was between 8.31×109 and 36.9×109L, the hematocrit decreased, the C-reactive protein increased, and the liver Functional impairment, and a polymorphic rash. The symptoms are very atypical, complex, and scattered. I personally think that there is a problem with the immune system, which causes the mucous membranes to be attacked by viruses."

"Initial guess is some kind of infection, a urine culture done yesterday detected an E. coli infection."

Shen Bingbing pushed her eyes up towards her nose: "Is it possible that Escherichia coli infection caused the patient's immune system to overreact, causing a systemic disease?"

After hearing Shen Bingbing's guess, several attending doctors were silent for a while, and they could only say that it was possible, but it was not enough to explain all the symptoms of the patient.

Immediately after Director Shen, the attending physician of the Department of Cardiothoracic Surgery began to put forward his thoughts: "I do not agree with Director Shen's conjecture. It is absolutely impossible for a simple Escherichia coli infection to have such a large body reaction. It can only be said that the patient has A complication of coliform infection, but definitely not the main cause."

"I agree with Dr. Lin."

Another attending physician also agreed.

Dr. Lin continued: "I carefully looked at the patient's coronary arteries. The picture showed that the patient's coronary arteries were larger than 2.5mm, which is far beyond the normal value for infants aged 0-3 years. Therefore, the patient is likely to have myocardial infarction. Infarction, sudden death or ischemic cardiomyopathy. Although I can't determine the patient's condition yet, I recommend immediate anti-infective treatment for fever and constant monitoring of the heart condition."

Hearing what Dr. Lin said, it is obvious that the doctors in the field are very heavy, but they all agree that in many cases, when the disease cannot be diagnosed, the most common treatment is conservative treatment, nutritional supportive treatment, starting with anti-infection Let's start, let's hang our lives first.

Listening to the opinions of the various attendings, Tang Lou also frowned. In addition to waiting, there is another way to upgrade the two-star diagnostic skill as soon as possible, but the diagnostic skill is very rare, and it is estimated that he will not be able to collect all the gold coins.

"Ugh."

Tang Lou sighed, and Qing Ping, who was standing next to him, patted Tang Lou's thigh and said softly: "This situation is very normal, and there is no way to diagnose it. It can only be sent to a higher-level hospital. You are not too selfish. responsibility. After all, we are doctors, not gods.”

"Ah."

Tang Lou smiled wryly.

At this time, Dr. Fang, the attending physician of the Department of Dermatology, put forward another idea: "The patient's body temperature was between 12-38°C for 40 consecutive days, conjunctival hyperemia overflowed, and pleomorphic rash on the trunk. Combined with the current season, there is Is it possible that it is Epstein-Barr virus infection?"

After hearing Dr. Fang's diagnosis, several attending doctors also exchanged opinions. So far, it is the most likely.

"I agree."

"I agree."

Two attending doctors in a row expressed their agreement, and it seemed that the consultation was going to go in this general direction.

Suddenly a very discordant voice sounded: "I think there are other possibilities, not Epstein-Barr virus infection."

The person who spoke was of course Tang Lou. Although he didn't know the final cause, the system diagnosis clearly ruled out Epstein-Barr virus infection. He couldn't let everyone go down the wrong path. Days later, if the treatment is ineffective, a new direction can be set, which is very unfavorable for the diagnosis of patients.

Everyone looked at Tang Lou. The faces of the general surgery staff were a little better. They were still very concerned about Tang Lou's opinion. The head of cardiothoracic surgery and dermatology suddenly frowned.

However, it was the territory of general surgery after all, so they didn't show too much anger, but their tone was still a bit cold: "Oh, I don't know what advice this little doctor has?"

Shen Bingbing also looked at Tang Lou, his face was full of curiosity, this kid is really courageous, he dared to speak out frequently in this kind of senior attending consultation.

It's just that I don't know what dry things he can say.

"I don't know what the cause is, but I don't think it's simply Epstein-Barr virus infection. The reason is the same as Dr. Lin questioned Director Shen before."

With a serious face, Tang Lou stood up very seriously, leaned forward, took the laser pointer on the table, pointed at the projection, and at the same time signaled Shen Bingbing to slide the page.

Regarding Tang Lou's command of Director Shen so naturally, the rest of the attendants were stunned. This kid is too courageous.

Even Qingping is somewhat convinced and proud.

It is indeed a tenement building.

"The reason for the treatment this time, I personally think, is more rare and complicated than all the possibilities we currently think. I can't point out the final answer, but I hope my suggestions can help you avoid some detours."

Listening to Tang Lou's old-fashioned words, of course the several attendings were disdainful, and even wanted to laugh. It's better for young people to be more modest.

"In addition to EB virus infection, if I only catch a scale feather, I can even infer that lymphadenitis combined with infectious mononucleosis can be inferred from the patient's neck lymph node enlargement, which is unilateral neck over-swelling, with a diameter greater than 1.5cm. disease."

Hearing what Tang Lou said, several attending doctors were stunned, especially Dr. Lin who didn't pay much attention to Tang Lou's opinion before.

Immediately looked through the data, really, if this disease is viewed in this way, it is very similar to lymphadenitis combined with mononucleosis.

"Look here, this data, and this group of pictures, can I still diagnose Mycoplasma pneumoniae infection?"

Tang Lou analyzed the easily misdiagnosed illnesses provided by the systematic diagnosis technique.

"If these data are combined, it may be a urinary system infection, so I personally think that the patient's condition is more complicated and rare than we imagined. Due to my personal experience, I can't make a conclusion. I just want to bring up these symptoms. To provide you with some ideas, is there an atypical disease that can synthesize so many diseases?"

After Tang Lou finished speaking, he put the laser pointer on the table, sat down, and looked at everyone sharply.

(End of this chapter)