After more contact with Teacher Cao, I know that Teacher Cao is still very lacking in clinical experience. He was a graduate student and soon became the attending physician when he came to the hospital, but he mainly stayed in the laboratory during his graduate studies. Lack of clinical experience, many times, the treatment experience for the disease is very lacking. When encountering a patient, it is often necessary to consult certain information to formulate a corresponding treatment plan. I came here a few days ago. During the daily routine rounds, Director Shi Tingbang asked on the spot about the treatment of several common cases, but Teacher Cao couldn't answer, which made Director Shi very angry. It was utterly unlucky for me to fall into his hands. Fortunately, I am not the same as the average intern.
Zhou Huaifang sneaked over at some point, "Huang Jingyang, why are you still in the department at this time?"
"What's wrong? A big-name patient came to the department. Teacher Cao didn't dare to leave, so of course I couldn't." I thought Zhou Huaifang said that I didn't go back.
"I'm not talking about this. I'm talking about such an important patient in the internal medicine department. How can you stay in the department? Why don't you go to the expert consultation? The expert consultation is a very rare learning opportunity. Come, let's also Go in and listen." Zhou Huaifang said.
"Mr. Cao has no chance to go in, how can I go in?" I shook my head.
"What are you afraid of? We are different from their official doctors. We are interns anyway, and even if we offend people, they can't really deal with us. Besides, we are just going to listen. As long as we don't talk much, we must be It's alright. By the way, Dong Fucheng has already sneaked in. It was just a text message he sent me. Let's go, let's go together." Zhou Huaifang said.
I couldn't resist Zhou Huaifang's strong invitation, so I went to the consultation room with him.
The patient complained of cough, suffocation with dizziness, chest pain for nine days, and a syncope.
Internal medicine expert Li Shun has a serious expression and the patient's identity is special, so he naturally does not dare to neglect, "Judging from the current examination results, the throat is slightly congested, the breath sounds of both lungs are rough, the **** X-ray is normal, and the electrocardiogram is generally normal. After the patient has taken compound antihypertensive tablets and other drugs, the symptoms have not been relieved. This morning, the patient suddenly fainted while urinating, turned his eyes up, woke up a minute later, dizziness and chest tightness before hospital diagnosis and treatment. In addition, the patient suffered from high blood pressure six years ago .According to the current test results. The cause of the cough and fainting has not yet been diagnosed."
"Now I don't want you to talk about the disease, but to determine what kind of disease the patient is suffering from. If the cause is not found out, a comprehensive examination should be carried out immediately. The real cause of the patient must be found out as soon as possible. Do you have anything else to add?" Zhang Zhenyuan was very irritable. After checking for so long, no cause was found. He looked at Li Shun angrily. Li Shun is an expert in internal medicine, but at this critical time, if he can't show the value of an expert, what kind of expert can he be
Zhang Zhenyuan hurriedly turned to Lu Maozhu again, "Director Lu, when Ms. Lei entered the hospital, I had already applied for expert assistance from Yanjing Union Medical College Hospital. Now the expert is on its way to the East China Sea. It is estimated that I will be there soon. I The expert invited is Shi Weiming, an authoritative expert in internal medicine at the Union Medical College Hospital."
Lu Maozhu is a high-ranking official in the health system, and naturally he has heard the name of the authoritative expert Shi Weiming. But I was still a little annoyed because I was worried about my wife's situation. "Tell me about your Ruihua Hospital, which is also a well-reputed hospital in Donghai. I often say good things about your Ruihua Hospital outside. If there is any need for funding, I will try my best to give it to you. You are inclined. How can you lose the chain at a critical time? As I told you, the East China Sea is an international-level city, and only an international-level hospital can match it. Each department must find a way to equip heavyweight experts. You don’t Lack of funds, not bad conditions. Why can't we have a group of high-level medical experts?"
Lu Maozhu's words were obviously very dissatisfied with Zhang Zhenyuan, the dean.
Zhang Zhenyuan looked at a group of experts in the conference room with a livid face, and saw that these experts were silent. The interns standing around were also stunned by this atmosphere, and they felt shivering.
The dean's secretary hurried in and whispered something in Zhang Zhenyuan's ear. Zhang Zhenyuan's face was shocked immediately. He hurriedly said to Lu Maozhu, "Director Lu, expert Shi Weiming is here. I'll go out to greet him."
"I'll go with you." Lu Maozhu was overjoyed when he heard that Shi Weiming had come.
Zhou Huaifang gently pulled me, "Today can be an eye-opener, this Shi Weiming is a real authority. He is very good in internal medicine. Many textbooks on internal medicine can see his name in it."
"Where is the patient?" I asked.
"At this time, it must be in the ward. Ask Dong Fucheng, he must know." Zhou Huaifang said.
Zhou Huaifang crept up to Dong Fucheng's side and gently pushed Dong Fucheng.
"What are you doing? Don't mess around here. Otherwise, you won't be able to eat and walk around." Dong Fucheng was startled.
Zhou Huai gave Dong Fucheng a wink, and the two walked outside together.
"What?" Dong Fucheng asked.
"Huang Jingyang asked you where this patient is?" Zhou Huaifang asked.
"What do you want? This patient is not an ordinary person. Don't mess around." Dong Fucheng said nervously.
"We don't know anything here. What's the use of listening to these experts? Why don't we go and see the patient's condition," I said.
"In the intensive care unit. It's useless for us to go there. There are special people guarding there, and we can't get in at all." Dong Fucheng shook his head.
"Let's go and have a look." I took Zhou Huaifang to the intensive care unit.
"You two really passed? Don't mess around, something big will happen." Dong Fucheng quickly reminded again.
"Don't worry. We're not stupid, so how could we be in the limelight? Just go and have a look." I laughed.
When Zhou Huaifang and I came to the intensive care unit, we saw that the atmosphere in the intensive care unit seemed to be much heavier than usual. There are hospital security guards at the door. Through the glass, you can see that there are doctors on duty, especially one of the sick beds. There are two or three doctors guarding them. You don't have to think about it. The big man who came here today must be lying in this sick house.
"Hey, you two interns, don't come here to cause trouble." The hospital security smiled at us.
"What are we doing? Let's take a look outside here." I said with a smile, through the glass I could clearly see the condition of the patient lying on the sickbed. I actually saw that an imperceptible black qi started to escape from her body. It seemed that her condition was very bad. if no effective treatment is available. I'm afraid it won't last long. However, according to the consultation, Ruihua Hospital has not found the real cause of the patient at all, and the treatment of the patient is not symptomatic at all. If this goes on, the consequences are really serious. I don't know after the experts came. Will there be any improvement.
I stood with Zhou Huaifang for a while when I saw a large group of people approaching the intensive care unit.
The big brother of the security hurriedly said to us: "Go quickly, the leader is here. If they see it, I will be unlucky."
Zhou Huaifang and I quickly stepped aside.
"Old Shi, this way please. As soon as Ms. Lei enters Ruihua Hospital, she will be placed in the intensive care unit. The hospital has arranged for several experienced doctors to monitor at any time, and pay attention to the changes in Ms. Lei's condition at any time." Zhang Zhenyuan's attitude at this time was relaxed very low.
Shi Weiming was surrounded by the crowd, looking at the patient's examination report as he walked. His brows were furrowed. From these inspection reports, he could not confirm the patient's condition.
"Is there a possibility of cerebral thrombosis? Have you had a CT of the brain? Have you had a chest X-ray? Is the heart normal?" Shi Weiming asked a lot of questions along the way.
"CT has been done, there is no hemorrhage in the brain, and there seems to be no problem with the two lungs in the chest X-ray. The two lungs are unvoiced by percussion, and there is no abnormality in the **** X-ray. Aspartate aminotransferase, alanine The aminotransferase indexes were all normal, which could rule out the possibility of myocardial infarction. The chest X-ray next to the ** showed no obvious abnormalities in the heart, lungs and diaphragm.” Li Shun said quickly.
Shi Weiming's brows furrowed, from these inspection results. He was unable to determine the cause. However, the patient's cough, suffocation, dizziness, and chest pain must be extremely related to the cause, but some of the diseases he thought of were ruled out one by one.
Just when Shi Weiming entered the intensive care unit, the patient lying on the bed suddenly vomited. Shortness of breath and convulsions.
"Quick, give low-molecular-weight levocan, 5% glucose salt solution." Shi Weiming said.
But the patient's condition did not improve, but continued to deteriorate. The patient's condition did not improve, but the ends of his limbs began to become cold, purple mesh patterns appeared on the skin of the dorsum of his feet, and his consciousness began to become blurred. The heart circle expands slightly to the left. Occasionally fine moist rales were heard at the bottom of both lungs.
I saw the patient's black gas escape seemed to be accelerating, and the situation became more and more critical.
Zhang Zhenyuan naturally knew that the situation was not good. Sweat dripped down his forehead like rain.
This Zhang Zhenyuan is a student of Teacher Qi, and it is also thanks to him that I can come here for an internship. He is also kind to me, so this time. I cannot stand idly by.
"President Zhang, since the patient has symptoms such as coughing, suffocation with dizziness, chest pain, etc., why not consider pulmonary thrombosis? The pulmonary artery blood pressure can be found by monitoring with a minimally invasive hemodynamic monitor next to the hospital. I know our hospital There is a minimally invasive hemodynamic monitor." I walked over to Zhang Zhenyuan and said quickly.
Originally, Zhang Zhenyuan was very angry when he was blocked by an intern as soon as he came out of the intensive care unit. But after hearing what I said, my expression changed.
"Time is running out. If the optimal treatment time is delayed, it will be impossible for the gods to save!" I quickly warned.
Zhang Zhenyuan hurriedly returned to the intensive care unit. The intensive care unit already had this kind of equipment, but because the possibility of myocardial infarction was ruled out before, it was not used at all.
"Quick! Get on the minimally invasive hemodynamic monitor! Focus on pulmonary thrombosis!" Zhang Zhenyuan shouted to the doctor in the intensive care unit.
Misdiagnosis is often one misleading with another misleading. In fact, all doctors are misled by some of the results of the test. Because the pulmonary thrombosis has been directly excluded before, there are electrocardiograms, fluoroscopy results, and percussion results, it seems that pulmonary thrombosis can be ruled out. Everyone starts to ignore this and think about more complex symptoms. Shi Weiming was also misled. He didn't think about pulmonary thrombosis in the first place. But now that Zhang Zhenyuan was drinking like this, everyone suddenly woke up.
In fact, it is very simple. A normal electrocardiogram cannot rule out pulmonary thrombosis, and the results of fluoroscopy cannot tell people the true condition of the lungs in detail.
Although there are common symptoms of pulmonary thrombosis such as cough, chest pain, syncope, etc., no one suspects pulmonary thrombosis. If it weren't for my special ability, I'm afraid no one would want to think about the patient's condition from the beginning, and maybe they would not wake up until the autopsy.
The results of the minimally invasive hemodynamic monitor showed pulmonary hypertension and normal or low pulmonary capillary pressure. This is clearly the strongest evidence of pulmonary thrombosis.
"Quick! Intubation! Urokinase is intravenously infused or injected for 10 minutes, and then/h for a total of 12 hours." Shi Weiming said quickly. After taking symptomatic treatment, the patient's condition quickly turned to safety.
"Old Shi, this time is really thanks to you." By this time, Lu Maozhu's complexion was much better. He can clearly see that his wife's illness has been diagnosed and improved.
Shi Weiming is not greedy. After all, everyone at the scene saw it. The turning point of the treatment was because Zhang Zhenyuan suddenly advocated focusing on the investigation of pulmonary thrombosis. "This time, thanks to President Zhang, he thought of pulmonary thrombosis. There were many signs to rule out pulmonary thrombosis. It was the excluded pulmonary thrombus that made the patient's condition worse.
"I'm ashamed to say it, but it's not what I thought. My teacher, Professor Qi Binhua, gave me an intern in clinical medicine. He just reminded me to consider the patient's pulmonary thrombosis." Zhang Zhenyuan wanted to take the credit for this, but just now The scene at the door is also seen by many people. He simply was a little more upright and did not covet Huang Jingyang's credit.
"Oh, where is this classmate? It seems that the onlookers are very clear, and the players in the play are obsessed. Sometimes, we will be deceived by the instrument. Therefore, we must be careful for the doctors. The patients entrust their lives to us, and we must be careful, like walking on thin ice. "Shi Weiming sighed.
"I'll ask him to come in." Zhang Zhenyuan had long forgotten my name. For him, how could a little guy like me get into his eyes
Zhang Zhenyuan strode out of the intensive care unit and stopped me, who was about to leave, "Hey, wait a minute."
"I know I can't escape. I have to turn around. President Zhang, are you calling me?" I said helplessly.
"That's right, thanks to your reminder just now. The experts from Yanjing want to see you. And Director Lu also wants to see you." Zhang Zhenyuan thought I should be shocked. But my performance was very calm, which surprised him. (.)