After explaining the surgical images, Zheng Ren dropped a stone.
Cardiac Syndrome X is not uncommon, but it is easily overlooked. After all, it is difficult to find out the truth with non-invasive examinations. It is normal for patients to go to countless hospitals and not get a definite diagnosis in the end.
"Ah!" Su Yun was suddenly startled, and then said: "I forgot one thing!"
"Ah? What's wrong?" Zheng Ren asked in surprise.
"Mr. Wang came to see you just now." Su Yun said, "He asked me if you had time. When he came out, he saw a patient with cardiac syndrome X..."
"Oh, why is Mr. Wang looking for me?" Zheng Ren asked.
"There is a patient who has difficulty breathing and faints when walking. There is no easy diagnosis. I want you to take a look at it." Su Yun said, "Over in Haicheng, they are preparing for a hospital-wide consultation. It's already off work, so there's no way to diagnose it." Do you know if the consultation is over?"
"Oh?" Zheng Ren asked, "Do they think it's emphysema or vertigo?"
"Boss, do you need to charge for consultations in the future? We are all experts in the imperial capital. Just asking us for consultation is like calling a girl to have sex with you." Su Yun did not answer Zheng Ren's words, but babbled on about other things.
"Don't say it so harshly." Zheng Ren smiled, "Has the information been passed over?"
"No, he just asked to see if you were interested." Su Yun said.
"Take a look. If you don't understand, just ask the patient to come over." Zheng Ren said casually.
"What are you doing here?"
"..." Zheng Ren was startled for a moment, and then said: "Sight, touch, percussion, sight, hearing, and questioning, all of which involve looking at the patient. Do you think remote consultation can solve all difficult and complicated diseases?"
"Boss, why do you feel like your tail has been stepped on all of a sudden?" Su Yun asked with a smile. He just asked casually, but he didn't expect his boss to be so serious.
But Su Yun didn't care. He just said something to his boss out of habit and then gave up.
"Don't talk nonsense, ask Mr. Wang for information." Zheng Ren said.
Su Yun took out his mobile phone, his hands flashing back and forth on the screen of the mobile phone almost like afterimages.
The hospital-wide consultation has not ended yet, and it looks like it is indeed very troublesome, Zheng Ren judged. Regardless of the condition or the patient's family, there will be trouble.
Soon, Mr. Wang sent the patient’s information.
The patient was admitted to the hospital complaining of general weakness, fatigue and dyspnea for three months.
He does not smoke, drink, has no pets at home, and eats normally, with no special changes recently. There is no history of previous illness, no family history, etc. As a bank clerk, there is no chance of exposure to dust and other metal substances.
This situation occurs suddenly and does not heal for a long time, and neither the patient nor the doctor can do anything.
A chest X-ray was performed during the first medical visit a few months ago, and a lower respiratory tract infection was diagnosed and targeted treatment was given.
His symptoms initially improved after anti-inflammatory and symptomatic treatment, but relapsed again a month later. What's even more strange is that after the second time, his X-rays did not appear to have any problems.
All examinations were done, but still no problem was found in the patient.
Just looking at the test results, he is a very healthy person. But according to Mr. Wang's description, the patient's condition is extremely serious. Now he can't go up the stairs. He can't even walk on flat ground and has to rest after taking a few steps.
Looking at the brief introduction of the patient's condition, Zheng Ren sat on the chair in Zhou Litao's duty room and started to think about it.
"Looking at the brief description of the condition, it looks like severe pulmonary heart disease, but the chest X-ray and lung CT showed no problem," Su Yundao said.
Zheng Ren clicked the mouse to enlarge the chest X-ray image.
"Do you want the original data?" Su Yun asked.
"No, I can see clearly." Zheng Ren said: "Wheezing is not mentioned in the medical record. Su Yun, do you think asthma can be ruled out?"
"In the early stages of an asthma attack, it can be seen that the transparency of both lungs increases, showing a state of hyperinflation. This is not shown on the film, but there are also reasons why the film was not taken during the asthma attack." Su Yun continued: "But I don't think about it at all. There was no mention of wheezing, and I felt that this obvious symptom should not be omitted.”
After saying that, Su Yun smiled and said, "No matter how it is a tertiary hospital, if the wheezing sound can't be heard, Dean Xiao can take the blame and resign."
"Yes, and when asthma does not attack, it is not considered to cause weakness in the limbs." Zheng Ren added, ruling out the possibility of asthma.
"There was nothing wrong with the heart examination. The 24-hour dynamic ECG was also checked. The patient is very healthy."
"Epilepsy?" Su Yun asked.
"It's possible. It's possible that the patient reported symptoms, and the convulsions... That's not right. If the limbs are weak... I'll keep this diagnosis for now. Although it's unlikely, it's possible." Zheng Ren said solemnly.
Su Yun recorded the diagnosis of epilepsy on an A4 paper. If he wanted to confirm the diagnosis, he could just do an EEG examination on the patient during the attack.
After all, it is a remote consultation. It is not possible to check whether the patient has any other reactions during activities and to make a more clear diagnosis.
"What about pneumonia?" Su Yundao said, "On the X-ray film of the first examination, you can see vague images of inflammation. Although it did not appear in the later period, it cannot be simply ruled out."
"The anatomical classification is lobar pneumonia, lobular pneumonia, and interstitial pneumonia. Based on the patient's condition, I think interstitial pneumonia is more likely."
"The causes are divided into bacterial pneumonia, viral pneumonia, mycoplasma pneumonia, pneumonia caused by other pathogens, fungal pneumonia and other pneumonia caused by non-infectious factors, such as radiation pneumonitis, aspiration pneumonia, hypersensitivity pneumonitis... "
Zheng Ren and Su Yun investigated all the way and began to make various differential diagnoses.
Zhou Litao watched silently from behind. The patient was only 34 years old. His limbs were weak and he had difficulty breathing. After many examinations, the diagnosis was not clear. It looked so strange.
His first thought was that the patient's age was written incorrectly.
34 years old! This patient appears to be 134 years old.
…
…
Haicheng, City No. 1 Hospital.
Although they are off work, the doctors are still working like worker ants.
Mr. Wang is participating in the hospital-wide consultation.
As the support expert of the Imperial City, now the First City Hospital will ask him to help him during consultations with the entire hospital.
Only this time, Mr. Wang had no idea, so he had no choice but to use the ultimate skill-summoning Boss Zheng.
"The patient's family is very dissatisfied. After so many tests, the diagnosis has not yet been confirmed." Director Zhou of the Medical Department tapped his fingers on the table and said solemnly: "If there is no clear diagnosis, the patient should be transferred to a higher-level hospital. .”
The director of the respiratory medicine department nodded.
She had long wanted to transfer the patient away, but because the first time she was diagnosed with pneumonia in the Department of Respiratory Medicine and given symptomatic treatment, she was still a little worried.
No one expected that an ordinary pneumonia patient would persist for a long time and eventually turn into a huge trouble.
But there's nothing I can do about it, I really can't understand it. If he doesn't go to a higher-level hospital for treatment, he is afraid that the patient's condition will become worse and worse.
Judging from the degree of difficulty in breathing, it is not impossible to be put on a ventilator in a few days.
If that's the case, once you enter the ICU...
Director He of the Department of Respiratory Medicine has already begun to think about patient referrals. It does not matter if he cannot understand the disease. Who can guarantee that all diseases can be understood.
As long as the patient doesn't "smash" it in his own hands, that's fine.
Director He began to think about how he wanted to communicate with the patient's family. Would it be better to go to the provincial capital or the imperial capital? It seems that the patient's family members are more acceptable if it is in a provincial capital, because the road is closer after all.
But she didn't think the provincial capital could solve this case. Such a weird situation... She was a little distracted thinking about it.
The next few directors who came for consultation also expressed their opinions. They were very simple and they had nothing too special to say.
What to check, what is normal, what can be said.
It's all nonsense and meaningless.
Mr. Wang repeatedly recalled the patient’s condition, but still had no clue. Autonomic nerve dysfunction? Or hysteria? It doesn't even look like it.
It is quite difficult for a 34-year-old man to be so hysterical that he is out of breath even when walking.
Just as I was thinking about it, my phone vibrated.
Mr. Wang took a look and saw that it was Su Yun's call. He smiled sheepishly at Director Zhou, lowered his head and went out to answer the call.
Fortunately, this is not 912. Director Wei is asked to sit here, or Director Lin is the one presiding over the hospital consultation. Is he afraid of being scolded? As for Director Ye, Mr. Wang didn't even dare to think about it.
For ordinary doctors, Director Ye Qingqiuye of the Medical Department is the governor of Jinyiwei. If he really comes forward, he will probably be exfoliated even if he doesn't die.
Director Zhou shook his head and looked around at the directors of relevant departments in the First City Hospital. He could already guess a thing or two by seeing the expressions on their faces.
Everyone has no idea.
While going through the referral procedures, he was sent to the provincial capital in the 120 ambulance. As for who to contact in the provincial capital, Director Zhou thinks it is better to let the patient’s family contact them first.
If this kind of thing is done too often, the patient's family will definitely think that there is something wrong with the hospital's diagnosis and treatment. How could they be so attentive if they don't take care of the problem
Among them, propriety mainly lies in one degree. How to control Director Zhou has gradually become clear. Clinical work is really troublesome. As he thought about it, Director Zhou felt a little bored. When can I go to the logistics department
"Then it's settled, Director He, go and communicate with the patient's family." Director Zhou said, "This disease..."
"Director Zhou." Mr. Wang came back with his cell phone and interrupted Director Zhou.
"Mr. Wang, what do you think?" Director Zhou asked.
"I just consulted Boss Zheng, and he said that it is recommended to check an electroencephalogram when the patient has difficulty breathing. In addition, a contrast-enhanced lung CT should also be checked." Mr. Wang said seriously.
He did not change his expression because it was Boss Zheng's consultation opinion, he just calmly stated a fact.
Director Zhou was stunned for a moment, Zheng Ren? He suggested checking the lungs for contrast-enhanced CT scan.