Diagnosis... There is a woolly diagnosis!
Zheng Ren looked at Su Yun on the stage and began to recall the medical history he had told before.
"Here are other data and copies of existing cases." Su Yun said with a smile: "Because things happened quite suddenly, this case discussion is just a rehearsal. The effect seems to be pretty good, Chang Yue, you said Am I handsome?"
Su Yun went through the medical records one by one and asked as he walked past Chang Yue.
"If you spend half of your time being cool on surgery..." Chang Yue took the medical records and said half a sentence.
"I kind of regret giving you the medical records." Su Yun didn't care about Chang Yue's remarks and said with a smile: "Because you don't understand it at all."
"Abdominal pain, how difficult is it to diagnose?" Chang Yue disdainfully touched his glasses and began to look through the medical records carefully.
After Zheng Ren got the medical records, he also started to look at them.
Su Yun focused on the key points, and the information in the medical records was more detailed.
Nausea, vomiting, abdominal pain, no bacterial or viral infection, what should I consider
His eyebrows furrowed, and in his mind there were countless cases in the literature that he had read during this period for reference.
"How about it, Chang Yue, tell me what you think." Su Yun waited for a few minutes and said with a smile when he saw that everyone had almost finished reading the medical records.
"Consider kidney stones." Chang Yue gave his answer, "Nausea, vomiting, and pain in the left lower abdomen, these all meet the diagnostic criteria for kidney stones."
"What a wonderful diagnosis. I can't bear to deny this fairy tale diagnosis." Su Yun said with a smile: "But, this is the first case discussion of the medical team, and Director Luo is here, you still have to Be serious."
Chang Yue put her hands on her glasses, and her eyes shone with sharp light.
“The pain caused by kidney stones can be severe and, in certain locations, can present symptoms similar to acute abdominal pain.
Urosepsis may occur when stones cause obstruction and hydronephrosis, and vomiting may be a prominent finding in severe kidney stones.
Several manifestations of this patient suggest this diagnosis. I guess you looked at the routine urine test sheet. The red blood cells++ inside give you a clear hint that this is caused by kidney stones. "
Chang Yue's hand paused.
Su Yun was like a roundworm in his stomach, what he said was entirely his own diagnostic logic, without any deviation.
It would be great if this guy didn't have such a sharp mouth.
"Unfortunately, these are all wrong!" Su Yun said with a smile: "You must have forgotten that I specifically mentioned the menstrual period. The red blood cells in the urine are considered to be caused by menstrual blood. It is not considered that the ureteral lining cells are ruptured due to urinary tract stones. resulting in bleeding."
"How do you know!" Chang Yue asked coldly.
"Dr. Chang, I think you must not have understood the enhanced CT image of the patient's abdomen. The stone is in the kidney and the ureter is smooth, so 99.9% of your diagnosis is wrong." Su Yun blew, his black hair floating on his forehead. Yeah, it's floating.
"The reason why I didn't say it was 100% is because I have to take care of your poor self-esteem." Su Yun said disdainfully.
Zheng Ren is really helpless. Su Yun is a sharp-tongued guy. It is a miracle that he can survive until now without being beaten to death.
"Brother Yun, there is something wrong with the electrocardiogram." Lao He was still kinder. At this time, he interrupted Su Yun's words and stifled Chang Yue's anger.
There are ECG images in the medical record, but Su Yun did not list the ECG.
Some heart diseases manifest themselves in the gastrointestinal tract, causing nausea and vomiting. Because Su Yun had denied all gastrointestinal diseases before, Lao He saw the abnormalities on the electrocardiogram at a glance.
The 12-lead electrocardiogram recorded at this visit showed supraventricular tachycardia; the electrocardiogram also showed a prolonged RP interval.
A cardiotogram recorded after administration of adenosine showed termination of supraventricular tachycardia.
The patient developed sinus tachycardia after a ventricular ectopic beat and a brief atrial ectopic beat. A subsequent 12-lead electrocardiogram confirmed sustained sinus tachycardia.
This is the most likely place, Lao He thought.
To perform, you must perform! As a senior anesthesiologist, Lao He is very sensitive to the heart and breathing.
As soon as he took a look, he felt something was wrong with the electrocardiogram.
"No." Before Su Yun could speak, Zheng Ren suddenly shook his head and said, "The patient's heart rhythm showed tachycardia and narrowing of the QRS complex. This finding is consistent with supraventricular tachycardia.
The patient's heart rhythm was regular, making atrial fibrillation and multifocal atrial tachycardia unlikely. The patient was experiencing sudden tachycardia, so sinus tachycardia is unlikely.
Sinus tachycardia will have a phase in which the heart rate gradually increases, rather than a sudden increase in heart rate to over 200 beats per minute.
So I suspect that this patient's regular supraventricular tachycardia is one of three types: atrioventricular reentrant tachycardia; atrioventricular reentrant tachycardia due to retrograde conduction through additional pathways; or Focal atrial tachycardia.
But no matter which one it is, if the electrocardiogram changes after using adenosine, but the symptoms do not change, abdominal pain caused by cardiac diseases is not considered for the time being. "
Zheng Ren lowered his head and overturned Lao He's diagnosis with a very clear and rigorous logical analysis.
Su Yun smiled. If Lao He could think of this, he was already an old doctor with rich clinical experience.
But this is not enough. The patient's condition is very strange, and Su Yun still only has a preliminary diagnosis.
But he didn't say.
Don't speak up and let your boss deny it. In that case, the entire stage effect will be lost and it will be very disappointing.
"Director Luo, do you have any considerations?" Su Yun softened his tone and asked Director Luo.
"The patient has taken oral opioids." Director Luo said leisurely: "Opioid withdrawal can explain tachycardia, agitation, nausea, vomiting and abdominal pain. However, the patient did not sweat or yawn. , symptoms of opioid withdrawal such as goosebumps or dilated pupils.”
"So, I now suspect that the patient has serotonin syndrome."
Su Yun smiled.
He was also thinking about serotonin syndrome.
Serotonin syndrome is a group of symptoms caused by taking serotonergic drugs or the combination of serotonergic drugs and monoamine oxidase inhibitors.
Clinically, typical cases are rare.
Mental status and behavioral changes such as hypomania, agitation, and changes in motor system function.
Symptoms such as fever, nausea, diarrhea, headache, tremors, blushing, sweating, tachycardia, shortness of breath, changes in blood pressure, and mydriasis caused by autonomic nerve dysfunction.
The patient's various manifestations are highly consistent with serotonin syndrome.
After receiving Director Luo's judgment, Su Yun's confidence greatly increased. That's the most the boss can think of.