This doctor has a system

Chapter 389 454. There is an expert!
"Which department are you from?" Chu Yuxun asked, "Why haven't I seen you before?"

"I'm new to the Department of Respiratory Medicine." Li Youliang quickly took out his mobile phone and scanned the QR code to add WeChat, "My name is Li Youliang."

"Chu Yuxun."

That night, Li Youliang couldn't sleep. He dreamed of getting married to a girl named Chu Yuxun, who sweetly called him husband and gave birth to two fat and white babies.

Early the next morning, he was busy asking about this girl named Chu Yuxun, and found that she was quite famous in the hospital.

"It's hard to put it into words." This is what most people say about Chu Yuxun.

Li Youliang was puzzled as to why such a beautiful and refreshing girl could not describe her in words.

"Do you want to chase me?" Chu Yuxun asked.

"Yes, it was love at first sight." Li Youliang quickly replied, "I noticed how special you are at the first sight."

"There's no such thing as love at first sight. You're totally attracted by lust." Chu Yuxun said, and then she began to educate Li Youliang on what it means to be attracted by lust.

We all went to see the patient together, and the patient happened to be coughing up blood. The family member brought the patient a disposable cup, which was full of blood, about 15ml.

The patient had a history of repeated hemoptysis for 40 years and was diagnosed with "bronchiectasis" in the local hospital. Two days ago, the patient had hemoptysis again, with a volume of about 2 ml/time and bright red blood. Accompanied by cough and sputum, the sputum is yellow and sticky, with intermittent shortness of breath, chest tightness, fatigue and discomfort.

The main complaint was "recurrent hemoptysis for 40 years, and it happened again for 2 days."

"Everyone here is rubbish: I am not discriminating against anyone, I am saying that everyone here is rubbish. Please use your professional knowledge to let these people here understand the huge difference between them and you. Complete the task to get 50 skill points Click." The system jumped out at this time.

2 weeks later
"How's it going?" Gao Feng asked, "Is there any progress?"

One thing to say, if there is no system, he himself is rubbish.

"Now I just want everyone to think about it. What should be added to her diagnosis? What should this patient do next?"

As a doctor, whenever you are bald or bald, you will become stronger.

The heart boundary was not enlarged and was regular, and a systolic ejection-like grade 4/6 murmur could be heard in the third and fourth intercostal spaces at the left sternal edge. There was no edema in both lower limbs. Physical examination of abdomen and nervous system (-).

Gao Feng thought it was funny. Where do you think this is?

"No." Li Youliang said with a smile, "How should I put it, it's like she's missing a muscle." He had already discovered Chu Yuxun's true nature.

"Directors, please show me again quickly." The patient looked a little excited when he saw so many people. "He keeps vomiting and doesn't drop anything for a day."

"Is there a muscle missing?" Gao Feng was a little curious.

Today is a day for discussing difficult medical records in the department. At around 10 o'clock, Gao Feng came to the demonstration classroom on time.

"Yes, they are very different from other girls." Li Youliang said, "But I think they are quite interesting. Such people are very pure and I like them very much."

There was no history of hypertension, diabetes, kidney disease, etc. No history of smoking or drinking. Farmer origin.

Li Youliang felt that something was not going right with the progress of the matter. He was not here to discuss impulsive mechanisms with the other party today, but seeing Chu Yuxun's seriousness, he was a little embarrassed to interrupt her.

The old lady is used to vomiting and vomiting, and she was clamoring to be discharged from the hospital the day before yesterday.

"My mental state is okay now," said the patient's son. "My mother was scared to death at first, but now she may have vomited too much, and her mental quality has improved a lot."

"I think what you said is wrong." Li Youliang said, "There are many beautiful girls, but I don't have any special feelings for them."

There are many beautiful girls in the hospital, but people like Chu Yuxun are not popular.

"Are you stupid? What kind of taste do you have?!" Fan Yulong on the side said speechlessly, "I know that Chu Yuxun, her emotional intelligence is shockingly low, how could you fall in love with her?"

"This doesn't mean you. I think your kind of mentality is in our medical field."

This is currently the only gain from being hospitalized.

The first patient to be discussed is a 68-year-old female.

Physical examination upon entering the room: body temperature 36.5°C, pulse 85 beats/min, respiration 22 breaths/min, blood pressure 129/79mmHg. Fingertip pulse oxygen 95%. Barrel-shaped chest, coarse breath sounds in both lungs, a few moist rales but no dry rales in both lower lungs.

The so-called bald head is strong, the bald head is strong!

The doctor in charge was a little embarrassed. The patient's condition had not improved and his face was really dull.

No fever, night sweats, abdominal pain, bloating, dizziness, syncope, joint pain and other discomforts.

She held up the cup for everyone to see, like a soldier showing off the results of a battle.

"You are not allowed to say that about my wife." Li Youliang.

This is the first time he has participated in the discussion of difficult cases since he came to Union Medical College Hospital. He is more curious. He was very interested in this in the provincial hospital. There must be more complex cases waiting for him to participate in Union Medical College Hospital.

The patient now coughs 2-3 times a day. The family members were frightened at the beginning but have gradually become numb now.

Concord!

Chest CT showed: bilateral emphysema, multiple bronchiectasis and infection in both lungs, especially in the lower lobe of the left lung.

"External stimulation causes you to secrete dopamine and produce impulses."

"In the end you mistake it for love at first sight."

The patient had poor results after anti-infective, antitussive, and hemostatic treatment, and is still coughing up blood every day.

"Pituitary hormone has just been stopped." The doctor in charge said, "The application time was too long."

The directors arrived late, and often the ward rounds might not be over until after 10 o'clock, so the teaching secretaries had to make phone calls one by one, and the discussion officially started half an hour later.

Looking at the many bald and bald heads, Gao Feng felt that today's system task could not be completed. He was already feeling tremendous pressure.

Gao Feng stepped forward and took a look at the old lady. Fine moist rales could be heard in the patient's lungs, and pathological murmurs could also be heard in the heart. No other abnormalities were noticed.

"Can we ask the vascular interventional department to come over and take a look?" A director expressed his opinion, "Just do the embolization and forget about it."

The embolization he mentioned refers to bronchial artery embolization, which prevents hemoptysis by embolizing damaged arteries.

The operation process is to insert a catheter through the thigh, slowly advance the catheter until the target blood vessel is found, inject contrast agent to understand the extent of the lesion, and insert embolism to block the blood supply of the artery there.

Clinically, it is mainly used in patients who have hemoptysis caused by various reasons and are ineffective after medical treatment. Because the amount of hemoptysis is too much, when it exceeds 20% of the total blood volume of the human body, the body constitution is relatively weak, and patients with many underlying diseases are at risk of shock. .

It can also be used to block the blood supply of chest tumors. The main principle is to block one blood supply of chest tumors and artificially cause ischemia, hypoxia, and necrosis of chest tumors.

"The patient has undergone vascular embolization three times at the XX Provincial People's Hospital." The doctor in charge said, "But every time, the symptoms of hemoptysis reappeared not long after."

The vascular interventional department here at Xiehe came to take a look and said that the current situation did not recommend another operation.

The reason is simple. These blood vessels are not useless things like the appendix. They are meant to supply blood and oxygen to surrounding tissues. It may not be obvious if you embolize 1-2 blood vessels, but if there are more of them, it will definitely cause blood supply problems. This is equivalent to asking you to solve the problem of hemoptysis. After just one operation, the patient will die.

Has the goal been achieved?
Achieved, the bleeding stopped.

The operation was successful, but the man died.

The family members may not be able to accept it.

"Then this is going to be difficult." The director who expressed his opinion adjusted his glasses, "What about surgery? Don't the people in the thoracic surgery department like to cut out people's lungs? What do they say?"

Thoracic surgeons are indeed very good at cutting lungs, but that also depends on the specific situation.

This old lady has bronchiectasis in her entire left lung. Is it possible that the entire left lung needs to be cut off?
"It's not the kind of limited expansion that they said they couldn't do," the doctor in charge said.

"Then there's nothing we can do?" Director Ma, who came on the way, frowned, "How is the patient's coagulation condition? If it doesn't work, the force to stop the bleeding should be strengthened."

Their Union Hospital is one of the best hospitals in the country. Patients must be full of hope when they come here. Director Ma doesn't want to see everyone helpless.

"Could it be related to the heart?" he asked.

The patient's cardiac color ultrasound showed that the sizes of each chamber and ventricle were normal, tricuspid valve insufficiency (moderate), left ventricular systolic and diastolic functions were normal, and pulmonary hypertension (severe), with an estimated pulmonary artery pressure of about 95mmHg.
When pulmonary hypertension occurs, the communicating branches of the systemic and pulmonary circulation can cause dilation and rupture of the bronchial arteries, causing hemoptysis.

Gao Feng was also thinking hard. When he heard Director Ma's words, he was suddenly stunned, and then a bright light flashed in front of his eyes.

"That's not right." He said subconsciously.

"Not quite right? What's not right?" A director sitting with Gao Feng asked curiously, "Does Professor Gao have any advice?"

When he called out Professor Gao, he felt a little uncomfortable. After working for so many years, it was the first time he met such a young professor. The key is that the other person should be really talented and learned, which made him feel a little more complicated.

Several other directors also turned their attention to Gao Feng. They had been with Xiehe for a while, and they were familiar with Gao Feng and knew that this young man had a lot of skills.

"The results of the cardiac ultrasound are not right." Gao Feng continued, "Have you noticed? The patient has severe pulmonary hypertension, but the color ultrasound said that the sizes of her chambers and ventricular cavities are normal."

This is very unreasonable. You must know that when pulmonary hypertension occurs, the right ventricle will almost always enlarge and the ventricular wall will thicken, which can also be a criterion for diagnosing pulmonary hypertension.

However, the color Doppler ultrasound report showed that the size of the ventricular cavity was normal.

"Could it be a mistake?" someone asked.

"It may be that bedside color ultrasound is not very accurate." The doctor in charge said. It turned out that the patient had been coughing up blood at the time, and he kept him absolutely bedridden.

The cardiac color ultrasound is performed at the bedside, and the bedside machine is definitely not as accurate as the patient going to the color ultrasound room in person. Moreover, the patient was coughing up blood at the time, and his cooperation was also poor.

"No, there is something wrong with the short-axis section of the aorta on the cardiac color Doppler ultrasound. It should be congenital heart disease." Gao Feng said, and he suddenly realized it.

"Congenital heart disease?" Everyone was stunned, why did this involve congenital heart disease?

"Professor Gao, everyone has only a superficial understanding of cardiac ultrasound." Director Ma said, "Can you explain it in more detail?"

He was a little embarrassed after saying this, but to be honest, he wasn't good at echocardiography either. He was specialized in the art, so there was no shame in it.

"This patient has muscular stenosis of the right ventricular outflow tract." Gao Feng said. He was about to continue talking when he suddenly heard a voice.

"Right ventricular double chamber heart?"

Ouch, there is an expert!

The speaker was a director named Zhang. He noticed Gao Feng's gaze and waved his hand quickly.

"Professor Gao, please continue, I only know the name."

"It's amazing to know a name." Gao Feng praised.

Director Zhang couldn't help but smile on his face, like a primary school student being praised. For a moment, the scene was slightly out of place.

Double-chamber right ventricle, also known as double-chamber right ventricle, is caused by one or several abnormal muscle bundles crossing the right ventricular cavity, dividing the right ventricle into a high-pressure cavity in the inflow part and a low-pressure cavity in the outflow part, causing blood flow obstruction. A congenital heart disease, also known as abnormal right ventricular muscle fascicles or abnormal right ventricular muscle fasciculation stenosis.

The incidence of right ventricular double-chamber heart disease is low. This disease accounts for 1% to 1.5% of congenital heart disease. It can be said to be a very rare congenital heart disease in clinical practice.

"If there is obstruction in the outflow tract, tricuspid regurgitation cannot be used to estimate pulmonary artery pressure, so this pulmonary artery hypertension is an illusion."

"The patient's murmur is a systolic murmur in the third and fourth intercostal spaces on the left sternal edge. This murmur is the murmur in which blood flows from the high-pressure cavity into the low-pressure cavity through the narrow muscle bundles of the two cavities."

"Of course, the murmur of ventricular septal defect is also in this location, but the murmur of pulmonary valve stenosis is in the second intercostal space on the left sternal border, and the murmur of patent ductus arteriosus is also in the second intercostal space on the left sternal border, and it is a biphasic murmur. , both in systole and diastole.”

When Gao Feng said this, everyone suddenly understood. Director Ma couldn't sit still and immediately called the director of the ultrasound department.

The latter held the ultrasound probe and looked at it in amazement for a long time.

"Oh, this is so rare," he said. "I've been working for so many years and I've only seen it five times, including this case."

"Your skills are too bad." Director Ma complained, "I didn't notice it last time I came here!"

"This itself is not good-looking," the director of the color Doppler ultrasound room argued. Besides, the people beside the bed are young people who need to grow up. They have not seen many things and still need to learn.

How to study? From the patient, of course.

This is why many patients prefer to seek treatment from older doctors. Old doctors have more experience, are more knowledgeable, and have a lower rate of misdiagnosis and missed diagnosis.

Someone said, wouldn’t it be over if we just let the old doctor see the doctor? So everyone is happy.

If you can say such things, you definitely have no brain.

Where did the experience and knowledge of the old doctor come from?
That’s not just starting from young doctors and learning from patients step by step.

These old guys will die sooner or later. If young doctors cannot grow up as soon as possible, then where will the experienced doctors come from?

You can't go underground to seek medical treatment from old doctors, right?
Some people have said that in fact, it can be done like this. Let the young doctor look at it first, and then let the old doctor look at it again. This is both OK and OK.
Nice idea, but unrealistic.

The doctors are overwhelmed with the current sample.

Still have two jobs? You are thinking too much.

The old lady's double-chamber right ventricle had a pressure gradient of more than 5.3 kPa between the high-pressure chamber and the low-pressure chamber, which meant she needed surgical treatment.

The family members were very hesitant because the risks of surgery were relatively high.

Naturally, everyone is happy, but if there are risks, it will undoubtedly be difficult to accept.

But this was something that the family should be worried about. The doctor in charge finally breathed a sigh of relief. In any case, the cause of the disease was finally figured out.

(End of this chapter)