"Guillain's Syndrome.WwW, QunabEN, coM Hearing Xu Ze's words, Zhai Shui's eyes flashed under the mirror of Xu Ze, and he looked at Xu Ze steadily, but there was something... Unexpectedly: "You also know about this disease? "
Seeing Director Huo ask this question, Xu Ze felt happy. As expected, Director Zhai knew secretly that he didn't need to waste any time talking about it.
He nodded lightly, then handed over the medical record in hand and said to Director Huo, "Director, look at this patient."
It turned out that the medical record Xu Ze handed over was that of the patient he had seen who was unable to find out the cause. Director Zhai couldn't help being stunned. After taking a deep look at Xu Ze, he finally took the medical record and started reading it.
Director Zhai looked at it very carefully, turning over page after page, and thought for a long time. He had also seen this patient today, but there were too many patients at that time. He did some examinations, and after listening to Qian Xuebin's report, he Agreed with his diagnosis. At that time, this disease was not taken into consideration.
However, based on the information I saw last time, in retrospect, some of the symptoms are very similar, which seems to be a more appropriate diagnosis than neurogenic myasthenia gravis.
After Director Cheng thought for a long time, he looked up at Xu Ze and said slowly: "Have you also seen the latest information?"
Xu Ze nodded, then looked at Director Zhai and said: "Director, I have just conducted a detailed consultation and physical examination on the patient, which is slightly more detailed than the medical history recorded by Dr. Qian. The patient had symptoms two weeks before the onset of the disease. There is a history of infection, and there is a history of limb and neck and back pain before the onset of the disease!”
After hearing Xu Ze's explanation, Director Zhai's eyes gradually brightened, and he motioned for Xu Ze to continue speaking.
"On physical examination, in addition to the decline and disappearance of limb muscle strength and the disappearance of tendon reflexes, I also found that the patient had superficial sensory impairment in the lower limbs. Although it was only mild, it did exist..."
Xu Ze paused for a moment, and seeing Director Zhai looking at him and listening carefully, he continued: "Through some of the current drug treatments conducted by Dr. Qian, the patient's effect is not certain, and it only temporarily prevents the disease." Further exacerbation and no tangible results have been achieved, indicating that the diagnosis of neurogenic myasthenia is still questionable.”
"So based on the current medical history and physical examination analysis, Guillain-Barré syndrome is very likely," he said. Xu Ze looked at Director Zhai steadily, waiting for his reaction.
After listening to Xu Ze's analysis, Director Cheng nodded slowly, looked at Xu Ze approvingly and said, "Yes, you are only at this age, but you can have such a broad knowledge and be so careful, which is very good,"
"Yes, but we must be careful when diagnosing this disease. After all, it is a newly discovered disease. There are not many reports on this in the country." Director Zhai stood up, picked up the stethoscope and percussion hammer, looked at Xu Ze and said cautiously : "Let's go check it out together!" "
Seeing that Director Que did not object to his opinion, nor did he agree easily, but insisted on checking and confirming together again, Xu Ze couldn't help but nodded secretly. This is the caution a medical expert with high-level professional qualities should have. The two of them immediately headed towards the ward without hesitation.
After watching Director Que talking with his new disciple for a while, they went out together. Zhang Yan, who was next to him, looked up in surprise, and then continued writing his own illness record.
The two pushed open the door to the ward and walked to the bed of the patient with fatigue. The family members and patients next to him had all seen Director Zhai this morning and knew that he was the professor of the attached one and the director here. When he came for the ward round today, , Doctor Qian accompanied the examination with a respectful look.
At this time, Director Zhai came in. The family member was feeding the patient porridge. Now he stood up happily and said, "Hello, Director Zhai!"
Director Cheng smiled and nodded, and then said to the patient: "There were too many patients this morning and things were too busy, so I didn't do a detailed examination on you. Now Dr. Xu and I will examine you carefully together!"
"Ah, OK, OK, I'm sorry to trouble you and Dr. Xu!" The patient looked at Director Zhai and Xu Ze beside him, and immediately thanked him excitedly and politely.
Director Zhai smiled and asked about the medical history again. Listening to Director Que's questioning, the patient became curious. Why did Director Que, like the first Dr. Xiao Xu, like to ask inexplicable and irrelevant things.
Hearing that what he asked was indeed what Xu Ze said, Director Zhai nodded, and then conducted a careful physical examination. The final result was indeed as Xu Ze said. In addition to the patient's lower limb muscle strength and tendon reflexes disappearing, , as well as mild superficial sensory impairment of the lower limbs.
After the examination, Director Zhai nodded to Xu Ze, and then the two of them left the ward.
Director Zhai looked at Qian Xuebin's medical records, frowned and shook his head, secretly wondering why Qian Xuebin didn't ask more carefully about his condition. If he had asked more carefully, he wouldn't have almost missed this disease today.
At that moment, he couldn't help but look at Xu Ze happily and said: "According to this situation, it is indeed very similar to Guillain-Barre syndrome, but there is no official information in China yet, so our diagnosis is still not certain,"
Xu Ze chuckled lightly and said: "Director, there is a characteristic thing about Guillain-Barré syndrome, which is the separation of protein cells in cerebrospinal fluid. We only need to do a lumbar puncture.
"Protein cell separation?" Director Zhai frowned and recalled the information he saw. It seemed to have this statement. He didn't remember it particularly clearly, but it seemed that what was said was not very certain. At the moment He couldn't help but look at Xu Ze and said: "Xu Ze, are you sure?"
"I remember that the treatments for Guillain-Barre syndrome and neurogenic myasthenia are almost completely different. You must be careful about this!" Director Zhai looked at Xu Ze and said seriously.
Xu Ze smiled and nodded. He was absolutely sure that what he just said was correct, because future medical technology has proven this.
"Okay, let's do a lumbar puncture now, don't waste time!" Director Guan stood up resolutely and said.
Seeing that Director Que was so anxious, Xu Ze couldn't help but said blankly: "Don't we have to wait for Doctor Qian?"
"We can't wait now. He should be getting ready for lunch now. He won't come to take over until noon. Let's do it first and make a diagnosis as soon as possible," Director Zhai said flatly.
Seeing Director Zhai's confirmation, Xu Ze no longer hesitated, nodded, and then said: "Then I'll prepare the tools!"
Although Xu Ze was not too familiar with the emergency department, with the help of nurse Hu Xia, he quickly prepared all the equipment for lumbar puncture.
Director Zhai personally called the patient's family members to come over and explained the new findings and the necessity of doing this lumbar puncture examination.
The family members heard Director Zhai's words and remembered that Dr. Xiao Xu first came to check today and then asked about the situation. Then Director Huo came and asked again before considering this issue. But she couldn't help but feel secretly grateful to Xu Ze. If Dr. Xiao Xu hadn't discovered the problem and told Director Zhai very responsibly, I'm afraid the possible cause would not have been found.
I quickly signed the lumbar puncture consent form and asked Director Huo to be more careful. While waiting, Xu Ze came in with the lumbar piercing equipment. The family members saw that Xu Ze was very enthusiastic, which made Xu Ze a little uncomfortable.
Seeing that Xu Ze was ready, Director Zhai took Xu Ze and headed straight to the ward with their things in hand.
At this time, the patient had also learned about the situation from his family members and was about to undergo such an examination. The way he looked at Xu Ze was very different from the first time, and his eyes were full of gratitude.
Director Zhai pushed up his glasses and watched Xu Ze skillfully position the patient in a side-lying position with his knees held. He felt curious again and thought to himself: "Could Xu Ze actually do lumbar puncture? Isn't that impossible? In It is impossible for the clinic to perform this lumbar puncture!"
However, out of an inexplicable confidence in the surprise Xu Ze gave him today, after Xu Ze prepared himself, he looked at Xu Ze and asked, "Xu Ze, can you do it?"
After hearing Director Que's question, Xu Ze was stunned for a moment, but he answered honestly: "Yes."
"Yes?" Director Zhai's eyes flashed with a strange light and a hint of surprise, and then he smiled and said: "Okay, then you can do it!"
"Oh, okay!" After hearing that he was told to do it himself, Xu Ze was quite excited to be able to actually perform a lumbar puncture. After all, he had only performed simulated operations in the void space before, although these simulated operations were different from real operations. Not much, but when he actually started doing it, Xu Ze was still extremely excited.
Lumbar puncture is also a small and difficult operation. Many doctors rarely succeed when doing it for the first or second time, but Xu Ze is still quite confident in himself.
At that moment, in order to achieve a successful puncture, Xu Ze adjusted the patient's position again. Make the patient's back perpendicular to the bed surface, bend the head forward and flex the chest, hold the knees with both hands close to the abdomen, make the trunk arch, and make the patient's spine protrude as far back as possible to increase the width of the intervertebral space and facilitate the insertion of the needle.
Then he began to select the location for puncture. He stretched out his hands and determined the intersection of the line connecting the posterior superior spine of the pelvis and the posterior midline of the spine as the puncture point. This is the location of the spinous process space of the third lumbar vertebra and is also the best place to puncture. a location.
Then take out the complex iodine cotton swab, perform routine disinfection of the skin at the puncture point, then put on a sterile lumbar puncture bag, and put a sterile drape on the patient...
Director Cheng looked at Xu Ze's movements with satisfaction. Xu Ze performed these procedures extremely skillfully and fully complied with the aseptic operation procedures. He did not make a mistake in any step, just like a veteran.
This made Director Cheng couldn't help but secretly marvel. Xu Ze really gave him too many surprises today. I really wonder where he learned this? How could a junior student know this
At this time, seeing that Xu Ze had laid out the sterile towel and held up the syringe, Director Huo suppressed his surprise, took out a bottle of lidocaine from the plate, opened it, and moved it in front of Xu Ze, waiting for Xu Ze to draw the medicine. , fulfill the duties of an assistant.
Zhang Suo, who had been in the office at this time, also followed him curiously. At this time, he saw that Director Zhai was actually working as an assistant for Xu Ze. He couldn't help being surprised. Director Zhai was working as an assistant for someone, and this... Man is one. Newbie, if you tell me this, who would believe it
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