White armor

Chapter 600: I didn't know what was going on even after the diagnosis
"Well, I agree with what Xiao Luo said." Feng Zixuan quickly found the common ground between himself and Fang Xiao, and pulled Luo Hao, who was far away in the imperial capital, in, "He said that the world is just a makeshift team. If 10% of the people can do something serious, the world will run fast.

I didn’t agree with it at first, but after thinking about it carefully, it really makes sense.”

"Hahaha, that's true." Fang Xiao laughed out loud.

"Can you balance your thesis and clinical work?" Feng Zixuan asked, changing the subject.

"Compared with provincial hospitals, our prefecture-level tertiary hospitals lack sufficient scientific research resources and equipment, which makes it difficult for doctors to pursue both clinical and scientific research development.

Well, to put it bluntly, it's just fabricated nonsense. It's not even a paper. It's just copied from here and there. It's a miracle that it can be published in a journal with a Chinese prefix.

However, scientific research is a "necessary condition for promotion and evaluation" rather than a useful supplement to clinical work. We are at the grassroots level, and it is hard."

Feng Zixuan smiled when he heard Fang Xiao say this.

"Director Feng, you are busy, I won't bother you."

Then I know when to stop.

"Director Fang, you don't have to worry about your thesis." Feng Zixuan asked.

When he said this, Fang Xiao's face lit up.

"I don't need it, I don't need it. Thanks to Professor Toro, my papers are enough to be evaluated as a provincial famous doctor." Fang Xiao said happily, "And I have extra papers. As long as my doctors are obedient, they can also benefit from it."

"This is not just empty talk, it is a solid paper published in a world-class journal."

"Was it written by Chen Yong?" Feng Zixuan asked with a smile.

"Yes, New England, Dr. Chen publishes papers like a piece of cake. Last time I tried to contact Dr. Chen to see if it would work, but Dr. Chen asked me directly which author I wanted to be."

"For a world-class journal, the first three authors should be fine," said Feng Zixuan.

"It's not guaranteed, but I can bring it up now." Fang Xiao said, "I was thinking of trying to negotiate for a while, but I didn't expect Dr. Chen to ask me for my email address or something. In less than a month, the paper was published. I wanted to ask how much it would cost, but Dr. Chen didn't even reply to me."

Feng Zixuan had a smile on his face, but he felt creepy and terrified in his heart.

He heard from Shen Zizai that Chen Yong seemed to have some connection with the editor-in-chief of The New England Journal, but he didn't expect that he could publish papers at will.

What does this have to do with anything!
The most important thing is that Chen Yong did not use the resources of Boss Chai's "The Lancet".

Tsk tsk.

Although I cannot use it myself, this resource is indeed a scarce resource for frontline clinical doctors.

Fang Xiao chattered for a few words, stopped at the right time, said goodbye to Feng Zixuan and went to the department to find Luo Hao.

When he arrived at the department, he was a little disappointed. Luo Hao and Chen Yong were not there. They were both not there!
"Meng, what are you busy with?"

Facing Meng Liangren, Fang Xiao felt much more relaxed. He had worked with Meng Liangren for a few days and the two were relatively familiar with each other.

"Professor Luo is not at home, I am here to look after the house. Director Fang, why are you here?"

"It's almost Chinese New Year, so let's say New Year's greetings. I didn't expect Professor Luo to go to the capital. What was he doing there? Was he also visiting the bosses before the New Year?"

"Flying knives."

"What?" Fang Xiao didn't hear clearly what Meng Liangren said and was stunned for a moment.

"A patient came back from the Mayo Clinic and said he was incurable, so Professor Luo went to perform a flying knife surgery."

Fang Xiao understood every word Meng Liangren said, but had no idea what they meant when they were put together.

Mayo Clinic, can't cure,

912, it cannot be cured either.

913, Professor Luo goes to 912 Flying Knife.

Mom!
Is this something I can listen to? Fang Xiao felt that it was illegal for him to listen to such a statement.

"Old Meng, don't joke around." Fang Xiao said in a hoarse voice.

"Why is your voice hoarse?"

"Oh, my voice is hoarse, so stop asking questions." Fang Xiao said casually.

"Huh? Why?" Zhuang Yan looked confused.

Meng Liangren was a little embarrassed and glared at Fang Xiao fiercely.

"Ahem~~I was scared." Fang Xiao said quickly.

There was a female doctor in the office, so he couldn't just drive. Fang Xiao quickly asked seriously, "What patient?"

Meng Liangren briefly described the patient's condition, and Fang Xiao listened with great interest.

It is indeed possible that the Mayo Clinic would not be able to perform such a difficult operation, and the patient would be discharged from the hospital and go home to wait for death.

But Professor Luo is so awesome!
Who would have thought that the doctor I met could actually perform surgeries that the Mayo Clinic couldn’t do!

"This is normal." Zhuang Yan said, "Boss Zhang from the Department of Neurosurgery receives more than a dozen patients from the world's top hospitals every year."

Zhang Junting, Fang Xiao had heard of this name before, he was known as the best swordsman in Asia.

Is it so awesome? Fang Xiao vaguely remembered Luo Hao saying: China's knife, America's medicine.

He thought it was a joke at the time, but he never expected that he would witness this scene with his own eyes one day.

It can't be said that he saw it with his own eyes, but just feeling the vastness made Fang Xiao fascinated.

"Director Fang, it's such an unfortunate coincidence. Professor Luo and the others can come back tomorrow at the earliest, and the day after tomorrow at the latest." Meng Liangren explained.

"It's okay, I'll leave the stuff with you." Fang Xiao said with a smile, "It's nothing special, just some chives, sesame paste and sesame oil from Changnan City. Oh, and some black fungus that I picked myself."

"It's grown on basswood, purely natural." Fang Xiao added.

"Haha, okay, but Director Fang, don't you want to take a look at Professor Luo?" Meng Liangren asked.

"I'm busy over there too. I drove here by myself. I'll drive back in a while. I have two more surgeries tomorrow."

"Okay then." Meng Liangren said, "Let's eat later. Xiaozhuang, order some food."

"Okay!"

Zhuang Yan picked up the phone and dialed the number familiarly.

Call to order food? Fang Xiao seemed to have returned to the era more than a decade ago when there were restaurants everywhere in front of hospitals.

"Eat something before you leave. On my side..."

"Boss, the patient in bed 16 has chest pain, please take a look!" the doctor on duty said, "I think there's something wrong."

The resident manager was still listening with great interest, and when he heard about the chest pain, he hurried to see the patient.

Meng Liangren and Zhuang Yan didn't care either. The patient was not their own and the resident manager was there, so they couldn't get involved in everything.

After a while, the hospitalized boss came back and refreshed the computer.

Soon he saw the report - ST segment changes, suspected myocardial ischemia.

The resident's expression suddenly relaxed, and he called the Department of Cardiology for a consultation, then turned around and asked, "Director Fang, it snowed a few days ago, and the highway..."

"Boss, you're not going to treat this patient?" Zhuang Yan glanced at the electrocardiogram and asked in confusion.

"Ah? It's nothing. The report said it's a suspected case and it's not serious." The resident manager laughed.

"No, this is de Winter's syndrome, it's serious."

Zhuang Yan immediately took a photo, sent it to the group, and @ed Luo Hao.

She was still worried, so she called Luo Hao to remind him.

Soon, Luo Hao confirmed Zhuang Yan's idea that the diagnosis of de Winter syndrome was correct.

"Call Xuanhuan for an urgent consultation!" Zhuang Yan said immediately.

"Ah? Xiaozhuang, are you being too cautious? It's nothing serious." The resident manager glanced at the electrocardiogram, but he didn't see any major problems.

"Hurry up! Prepare for emergency surgery over there."

With that, Zhuang Yan hurried out the door, and Meng Liangren picked up his phone and called the Department of Cardiovascular Medicine.

Fang Xiao was stunned.

Lao Meng and Xiao Zhuang's behavior was a bit excessive and they crossed the line.

The patient in the other group was just suspected of having myocardial ischemia. Why were Zhuang Yan and Lao Meng so anxious?

Xiaozhuang is not stable, and so is Lao Meng.

Meng Liangren finished the call under the surprised gaze of the hospitalized boss. He spoke extremely seriously and clearly, leaving no room for ambiguity.

Fang Xiao was dumbfounded. How could he be chatting one second and the medical team entered emergency first aid mode the next?

"Doctor~~~"

Meng Liangren had just hung up the phone when a hoarse shout was heard from the corridor.

The face of the hospital manager suddenly turned extremely ugly. Anyone who works in the hospital every day knows what the voice of the patient's family member implies.

With hurried steps, Fang Xiao remained silent, stood up, and made way, hiding in the corner even though he was not blocking the way.

"120 joules of bidirectional asynchronous defibrillation!"

Zhuang Yan's voice could be heard faintly from outside.

Really professional, Fang Xiao exclaimed.

He also knows how to use a defibrillator, and uses it frequently, but Fang Xiao doesn't dare to use the 120j energy.

And to be fair, Fang Xiao felt that there was nothing wrong with the hospital manager's handling of the situation, but it was Lao Meng and Xiao Zhuang who were making a fuss out of nothing.

But it turns out there was a problem.

As the resident manager, the doctor on duty, and Meng Liangren all rushed out, Fang Xiao followed quietly behind.

He didn't want to help, nor did he need Fang Xiao's help. He just wanted to watch the rescue at the higher-level hospital in peace and quiet.

The patient's eyes rolled up, his whole body was twitching, there was foam at the corners of his mouth, and the ECG monitor showed ventricular fibrillation.

The nurse had already torn off the patient's shirt. Zhuang Yan held the defibrillator in both hands, applied the coupling agent evenly, and applied the shock immediately.

bang~~~
The patient vaguely "jumped" on the bed.

After three 120-joule bidirectional asynchronous defibrillations, the heart rate returned to sinus rhythm. At the same time, a third-line professor from the Department of Cardiology also rushed over.

He pushed the person and the bed out of the door and ran all the way.

Fang Xiao stared in amazement. The third-line professor of the Department of Cardiology did not push the patient away at all, nor did he emphasize the difficulty of the operation. Several people rushed out with the patient.

While running, Meng Liangren took out his cell phone and called the elevator operator of the special elevator for surgery.

He called for the special elevator directly.

Soon, the corridor of the ward became deserted. Fang Xiao stood in the corridor alone, surrounded by patients from other wards and their families who poked their heads out to watch the excitement. Why did it feel like a dream? Fang Xiao recalled the scene at that time and returned to the office.

The computer still shows the patient's electrocardiogram waveform.

Fang Xiao was very happy and took a photo and sent it to the director of the Department of Cardiology at her company.

"Lao Zhang, please take a look." Fang Xiao didn't say anything.

"The ST segment has changed a bit, indicating myocardial ischemia. Give the patient oxygen. Take 0.5 mg of nitroglycerin orally twice every 5 minutes. Chew 0.3 g of aspirin. Establish an intravenous line. Add 5 mg of nitroglycerin to 500 ml of sugar water and infuse."

Director Zhang gave a bunch of medical instructions.

"If the pain doesn't subside, give me half a bottle of morphine and observe. It shouldn't be a big problem."

The director of our own cardiovascular department gave this answer.

Fang Xiao was silent.

He was really desperate about the level of municipal hospitals. A member of Professor Luo's medical team knew what the syndrome was at a glance.

My own director didn’t even know!
It would have been fine if the diagnosis was not clear, but Fang Xiao was speechless because he had no idea what the disease was.

But Fang Xiao did not ridicule the director of his own cardiovascular department. He just laughed it off, expressed his gratitude and hung up the phone.

Fang Xiao stared blankly at the electrocardiogram on the computer screen.

Soon, footsteps were heard in the corridor. The sound was brisk, not as hurried and anxious as when I first arrived.

"I'm back." Fang Xiao immediately stood up and said respectfully.

"Yeah." Meng Liangren walked in first, followed by Zhuang Yan with her high ponytail swinging lightly.

"Director Fang, what would you like to eat? We'll order some home-cooked dishes. Tell me what you want." Meng Liangren asked after sitting down.

"There's no rush to eat or not, Doctor Zhuang, what syndrome did you just say the patient has?"

“de Winter syndrome.”

Fang Xiao saw Zhuang Yan using the resident manager's work number to help write the rescue record, and did not interrupt her. Instead, he started looking for an explanation for de Winter syndrome based on the transliteration.

But the disease that appeared on the Internet was Dravet syndrome - severe myoclonic epilepsy of infancy, a developmental and epileptic encephalopathy with symptoms appearing in infancy.

When seeing this disease, Fang Xiao felt the powerlessness in his body rising higher and higher, as if he was about to be shattered into pieces.

Let yourself answer the questions with an open book, and you can call your relatives and friends without knowing it! And you can easily check the answer on the Internet.

If Fang Xiao had not witnessed the patient's coma, shock, and atrial fibrillation, he would not have believed in this disease. But seeing everything with his own eyes, Fang Xiao felt that his level was too low.

Fang Xiao was silent, sitting quietly beside Zhuang Yan and watching her write the rescue record.

"Director Fang, please take a look at what to eat first. I'll be there after I finish cooking." Zhuang Yan said with a smile.

Her high ponytail fluttered as she spoke, full of energy.

"Doctor Xiaozhuang, what syndrome did you just talk about? I couldn't find it on the Internet." Fang Xiao said honestly.

"De Winter syndrome, isn't there any information about it on the Internet?" Zhuang Yan glanced at Fang Xiao's phone, also a little confused.

"Wait a moment, Director Fang. They are in urgent need of surgery and have a lot of procedures. I'll help the boss." Zhuang Yan said.

The electronic medical records must be transferred as soon as possible so that we can continue to work on a lot of content. Now is the busiest time, Fang Xiao knows.

He didn't say anything else, but waited quietly for them to finish.

20 minutes later, the medical record was turned over. Zhuang Yan finally breathed a sigh of relief, slumped down in the chair and stretched.

The young man's cheerfulness and efficiency jumped out at him, which made Fang Xiao envious.

"Oh, yes, Director Fang also wants to treat Winter's syndrome." When Zhuang Yan saw Fang Xiao, she remembered that there was such a person.

Fang Xiao broke out in a sweat, feeling that Zhuang Yan had completely forgotten about him.

Soon Zhuang Yan squatted down, opened a cabinet, and took out a thick book.

???

Fang Xiao frowned and looked at the book.

Zhuang Yan opened the book and found that every page was an electrocardiogram. Fang Xiao estimated that there were at least 2000 to 3000 electrocardiograms.

"Here it is." Zhuang Yan found an electrocardiogram with ease and handed the book to Fang Xiao.

The book fell into Fang Xiao's hand and sank suddenly.

Holy shit, it's so heavy! Like a brick.

"When the teacher compiled this book, it was not really editing, but just collecting electrocardiograms." Zhuang Yan said, "There was no name for Winter syndrome yet, so this page was specially marked to let us be careful."

"Doctor Zhuang, can you explain it in detail?" Fang Xiao felt a splitting headache and gave up immediately.

The director of the Department of Cardiology at my own hospital didn't know what de Winter syndrome was, and it couldn't be found on the Internet. I guess it's not common.

If you want to explore it yourself, you will only be asking for trouble.

"In 2008, de Winter et al., a cardiologist in Rotterdam, the Netherlands, first reported in the New England Journal of Medicine a hyperacute electrocardiographic pattern of myocardial infarction without ST segment elevation but associated with proximal occlusion of the left anterior descending artery."

"It's so serious that the syndrome was named after Dr. de Winter."

Zhuang Yan said this and picked up her phone to start searching for literature.

Compared with Zhuang Yan, Fang Xiao felt that his mobile phone was so simple and useless.

"Here, these are the documents." Zhuang Yan handed the phone to Fang Xiao.

"These scholars reviewed the electrocardiograms of 1532 patients with acute coronary syndrome with proximal left anterior descending artery occlusion in their heart center and found that 30 of them did not show the typical hyperacute electrocardiogram changes of myocardial infarction with ST-segment elevation.

There are several main characteristics of the electrocardiogram: first, the J point of the V1-6 leads on the chest is depressed by 1-3mm, the ST segment is inclined downward, and then the T wave is symmetrical and high-pointed; second, the QRS wave is usually not wide or slightly widened; third, some patients have poor R wave rise in the chest leads; and finally, most patients have a slightly elevated ST segment in the aVR lead. "

"The electrocardiogram just now is a typical case of de Winter syndrome, but it has been so many years, why can't it be found on the Internet?" Zhuang Yan was a little confused.

Fang Xiao was speechless, recalling in a daze what Xiaozhuang had just said.

He understood what Zhuang Yan said, but if he saw similar patients in clinical practice, he would probably misdiagnose and mistreat the patients.

Well, he is worthy of being a master's degree student from Peking University Health Science Center. His basic qualities are very high.

Even so, he was still beaten by Professor Luo every day, saying that his foundation was not solid enough. If that were the case, how strong would Concord Medical College be!

As he thought about it, Fang Xiao felt a surge of palpitations and longing in his heart.

"Director Fang, if you don't want to eat anything else, I'll just order some home-cooked dishes." Meng Liangren said.

"Okay, you're welcome, Old Meng." Fang Xiao looked at the ECG set in front of him that looked like a mysterious book and felt a splitting headache.

I really don’t know how Zhuang Yan can remember so many electrocardiograms.

"Oh, I saw that the flag was not raised, so I thought everything was fine." Fang Xiao explained.

"The symmetrical, high-peaked T waves in the precordial leads are a manifestation of hyperacute anterior wall myocardial infarction and will soon evolve into ST segment elevation. Director Fang, although this type of patient..."

"Xiao Zhuang, look at what to eat." Meng Liangren interrupted Zhuang Yan's explanation.

Why does he look so daddy-like at such a young age? Fang Xiao laughed in his heart.

It was still Old Meng who was capable. He could see that I didn't want to listen and didn't understand at all, so he came to smooth things over.

Things like the anterior descending branch, aren’t there specialized departments for that, Fang Xiao thought to himself.

What he was impressed with was Zhuang Yan's high quality, which was beyond words.

That’s all. In Professor Luo’s medical team, I can only be responsible for reception… Fang Xiao’s hands felt a little numb when he thought of this.

What a waste!

Zhuang Yan’s level in her own hospital is higher than that of the director. If she were to move to another place, with her background, she would definitely be a senior director.

"Doctor Zhuang, you are sure of the results, so why did you call Professor Luo?" Fang Xiao asked.

"Oh, and there is also differential diagnosis. I am not sure, so I can only make a rough estimate. This disease needs to pay attention to the similarities and differences with Wellens syndrome. Both are relatively rare characteristic electrocardiogram phenomena in acute coronary syndrome, but they are also easy to be overlooked."

"I feel at ease only when my senior brother is checking on me."

There is actually a differential diagnosis. Fang Xiao is really speechless.

"Director Fang, I don't understand this either." Meng Liangren said with a smile, "Only Xiaozhuang is willing to think about it. They come from prestigious schools, and their thinking is different from mine. Just get used to it, just get used to it."

"..."

"How many tourists are there in Changnan during the Ice and Snow Festival?" Meng Liangren changed the subject directly and didn't let Zhuang Yan give a fatherly explanation.

"A lot more!" Fang Xiao became excited when talking about these things.

Meng Liangren should not understand too well the thoughts of doctors in lower-level hospitals. Director Fang Xiaofang is relatively concerned, but if he is asked to start learning electrocardiogram now, I am afraid that even Professor Luo cannot do it here.

"How much more?"

"Let me put it this way, around 8pm, traffic jams started to form in the city!"

"So powerful!" Meng Liangren was surprised.

Changnan City is one of those cities where traffic jams only occur for less than an hour a day. Now that some traffic has been diverted, traffic jams have already started at 8 pm!
That’s really good. It seems that the spillover effect of the Ice and Snow Festival on Changnan is too obvious.

"There are crowds of people on the Zhalong side every day, and the documentary shot by Professor Luo is played on loop."

"Haha, that documentary is really well made." Meng Liangren praised.

"Yes, especially the tourists from the south who bought Longjiang Wagyu beef and shipped it back with cold chain. Our Changnan was almost emptied out. It is said that the breeding base in Baishan is almost out of meat for the Chinese New Year, and production will have to be increased next year."

"Isn't there beef from Argentina this year?" Zhuang Yan asked.

"Argentina's frozen beef is cheap and tastes okay, but it's much worse than Longjiang Wagyu. When spring comes, if you have time, I'll take you to Baishan to have a look." Fang Xiao unconsciously started promoting products.

Who doesn’t want their hometown to be better?

"Where is Baishan? It's in Baishan Town, Longjiang County, Changnan City. The Longjiang Wagyu beef breeding base is there. Many breeders can't believe that beef that usually goes unsold can be so popular this year!"

There was light and shadow flickering in Fang Xiao's eyes.

It was obvious that he was a little proud.

"So it's Longjiang County. I thought if you remove the black words, it would be called Longjiang Beef." Zhuang Yan said.

"I heard that the fat beef was researched by Ben Zi, but was later stolen by the Australians. We went to Australia to buy it." Meng Liangren said, "Is that right, Director Fang?"

"Yes, yes, it was a coincidence. After we came back, someone from the Agricultural Science Institute improved it a little bit." Fang Xiao continued to show off, describing the past and present of Longjiang Beef in detail.

Meng Liangren was well aware of Fang Xiao's rural sentiments, so he just listened to his gossip seriously without interrupting him.

Including Professor Luo’s participation in the Ice and Snow Festival, it’s actually the same. Who doesn’t want their hometown to be better?

(End of this chapter)