White armor

Chapter 606: Fighting Monsters with Students and Leveling Up

It can't be.

No matter how poor Professor Lei's skills are, he can't be unable to diagnose a heart attack.

Luo Hao carefully read the diagnosis given by the AI-assisted diagnosis, and then he had an idea in his mind.

After Professor Lei got off the elevator with the flatbed cart, he was about to say goodbye to Luo Hao, but he saw that Luo Hao had already gotten off the elevator and was talking on the phone.

"Xiao Miao, Department of Circulation."

"???"

Professor Lei was stunned.

"There is a student who just finished his postgraduate entrance examination. He may be admitted to my Union Hospital. He wants to follow me, but I don't know if it will be possible." Luo Hao explained, "I guess this kid has never seen a patient with an acute myocardial infarction. I will take him to see one."

Professor Lei was stunned and felt a little disgusted.

So my patient is here for you to watch? Why are you so familiar with him?
Professor Lei didn't have much to complain about. He had been feeling listless lately and had no interest in anything.

Especially when facing Luo Hao, Professor Lei actually had an "illusion" that it was even more unbearable than facing Director Chen Yan.

Luo Hao is someone that Professor Lei dare not offend.

Although he was unhappy, he didn't stop it.

Luo Hao didn't say much, just followed quietly and came to the Department of Cardiovascular Medicine.

Admitted to hospital for emergency surgery.

Luo Hao took Miao Youfang to listen to the patient's family's description of the medical history, and then pulled him out of the doctor's office.

"Xiao Miao, you have examined the patient and know his medical history. What is the problem?"

Miao Youfang has some methods.

The patient's electrocardiogram showed inverted T waves in leads II, III, aVF, and V2-V4; elevated cardiac enzymes: troponin I 10.93 ng/mL.

It is a typical manifestation of myocardial infarction.

But why did Mr. Luo come to see me for this typical patient? Could it be that he had some other illness?

Looking carefully at the system panel, it did show the diagnosis of coronary heart disease, and there was nothing wrong with it.

Miao Youfang was lost in thought and did not answer Luo Hao's question for a while.

Luo Hao was not in a hurry. He held the mobile phone in his hand, pressed the buttons on the screen, and thought while smoking.

"Teacher." After a while, Miao Youfang asked cautiously, "The electrocardiogram and myocardial enzymes are very clear. It should be a heart attack. You asked me to take a look..."

"Myocardial infarction is not necessarily coronary heart disease. Drugs can also induce it. The Department of Cardiovascular Medicine needs to do coronary angiography and also requires provocative tests. By the way, is there a drug that you paid attention to?"

“???” Miao Youfang concentrated.

Myocardial infarction is not necessarily coronary heart disease!
Miao Youfang didn't know about this.

Generally speaking, the diagnosis of coronary heart disease is a preliminary diagnosis. If there is no attack, there will be no diagnosis of acute myocardial infarction. For example, the patient in front of us should have a dual diagnosis of coronary heart disease and acute myocardial infarction.

I actually overlooked it.

But what difference does this make? Miao Youfang wondered.

"Think about it first and then see it on stage later."

"Teacher, what should I pay attention to?"

"Check to see if the coronary artery is blocked."

Miao Youfang: ???

When he went on stage, the patient's condition had improved slightly and the pain in the precordial area had decreased.

Angiography, just as Luo Hao said before the operation, the coronary artery is unobstructed!

There are some traces of atherosclerosis in the coronary arteries, which are sufficient for diagnosing coronary heart disease, but they will not cause the electrocardiogram to show inverted T waves in leads II, III, aVF, V2-V4 and elevated myocardial enzymes.

This is?

Miao Youfang was stunned.

"Professor Lei, it's okay." The third-line professor of Cardiovascular Medicine greeted him inside and prepared to leave the stage.

"Professor Ma, wait a moment." Luo Hao pressed the intercom button at this time.

"Professor Luo, what's wrong?" The third-line professor of cardiovascular medicine asked puzzledly.

"Please do a provocation test."

In cardiovascular medicine, the provocative test generally refers to the acetylcholine provocation test.

It is a test that simulates natural disease conditions, uses a small amount of allergen to cause a mild allergic reaction, and is used to identify allergens.

It is mainly used for type I allergic reactions and sometimes also for type IV allergic reactions, especially when skin tests or other tests cannot obtain positive results. This method can eliminate false positive reactions and false negative reactions in skin tests.

“Professor Luo… no…” Professor Ma from the Department of Cardiology was stunned for a moment. He was about to refute but swallowed back all the words that followed.

He needed a paper, which was just posted before New Year's Day, and contacted Chen Yong.

Damn it, damn thesis, Professor Ma cursed in his heart.

If you owe someone such a big favor, you must pay it back eventually.

Not to mention the acetylcholine stimulation test, as long as the request was not particularly excessive, Professor Ma would agree with a smile.

Who makes it possible for only them to write papers for the world's top journals?

On their own?
Forget it in your lifetime, at most you can publish a few papers with Chinese characters in their titles. You can only buy SCI papers with an impact factor of 4 or above.

"Okay." Professor Ma responded, "Professor Luo, what are you considering?"

"I think the patient's precordial pain is caused by allergies." Luo Hao sat next to the technician and answered steadily.

allergy?!
Professor Ma almost burst out laughing.

Can allergies cause myocardial infarction? Although it is possible, it is not such a coincidence. Moreover, myocardial infarction caused by allergies will not be very obvious on the electrocardiogram. The electrocardiogram of the patient in front of me shows another situation.

"Professor Luo, it's so late, thank you for your hard work." Professor Lei couldn't bear to listen any longer. He came to Luo Hao and bent down with difficulty.

A year ago, it was Luo Hao who bent down to talk to him, but now he has to bend down himself. When Professor Lei thought of this, tears welled up in his eyes.

This year has been really bad, not at all, with Mercury being extremely retrograde.

Professor Lei felt aggrieved, but he tried hard to control his emotions and not offend Luo Hao.

"Professor Lei, you're welcome."

“Why not just not do the stimulation experiment?” Professor Lei “suggested.”

Luo Hao frowned slightly and looked at Professor Lei.

"Are you questioning my diagnosis?" Luo Hao asked.

The harsh tone was like a sledgehammer hitting Professor Lei's heart.

bang~
Professor Lei's mind began to waver.

He thought of the first time he met Luo Hao, the stubborn young doctor who had just been transferred from a municipal tertiary hospital.

That diagnosis was wrong, and until now Professor Lei still hasn't figured out why.

What now?
He was stunned for a few seconds. Luo Hao didn't say anything either. The air in the operating room seemed to freeze.

The technician smiled and said, "It's only right to do an acetylcholine stimulation test. Go ahead and do it. It'll be quick."

Someone handed him a ladder and Professor Lei immediately climbed down, nodding his head repeatedly without any intention of persisting.

In the past, he could have just stiffened his neck and said "no".

But this was a different time now. Not to mention how good the relationship was between Luo Hao and Director Geng of the Provincial General Administration, just talking about his own situation, he did not support a head-on confrontation with the person in front of him.

Professor Lei nodded and hid aside.

In the catheterization room, the acetylcholine stimulation test has begun.

The operation was completed quickly.

Injection of 50 μg of acetylcholine into the right coronary artery can induce chest pain. Coronary angiography showed coronary artery vasospasm and 99% stenosis at the opening of the posterior descending branch. Left ventriculography showed no ventricular wall motion in the blood supply area of ​​the posterior descending branch. During induction, the electrocardiogram showed transient ST segment depression and T wave inversion in the inferior wall leads.

Luo Hao got the result he wanted and took a photo of the information. Professor Ma had already taken off his armor and kicked open the airtight lead door and walked out.

"Professor Luo, what is your opinion?"

"Oh, the patient has no history of Kawasaki disease, rheumatic diseases, syphilis, etc. The cardiac ultrasound showed no apical spherical changes of Takotsubo cardiomyopathy and prolonged QT interval on the electrocardiogram. There is no diffuse contractile dysfunction of myocarditis related to enteritis bacteria or viruses."

"I think it's the coronary artery spasm caused by the intravenous clarithromycin used for enteritis. It's an allergic reaction." Luo Hao said calmly.

"???"

"???"

Everyone in the operating room was stunned.

The most surprised one was Miao Youfang.

Mr. Luo's statement sounds fantastic, but when he looks at the system panel, it is a different story.

The logic is self-consistent, and it is highly likely that Mr. Luo’s judgment is correct.

Miao Youfang once again felt that the system panel was not omnipotent, and there were intricate connections between the diagnosis and the actual condition.

At this moment, he really knelt down.

"Clarithromycin? I remember the adverse reactions of clarithromycin are nausea, heartburn, abdominal pain, diarrhea, and headache. Transaminase levels are temporarily elevated, but they recover after stopping the drug. In addition, allergic reactions may occur, ranging from drug rash and urticaria in mild cases to allergies in severe cases.

Transient central nervous system side effects have been reported.”

"But the contraindications below clearly state that it is contraindicated or used with caution in patients who are allergic to macrolides, pregnant women, breastfeeding women, patients with severe liver and kidney dysfunction, patients with arrhythmia, bradycardia, QT interval prolongation, iron deficiency heart disease, congestive heart failure, and water and electrolyte disorders.

This product is mainly metabolized and excreted in the liver, so people with liver dysfunction, severe renal insufficiency, and the elderly over 65 years old should pay special attention to adverse reactions when taking the drug. "

Luo Hao said lightly.

I can read the drug instructions effortlessly, as if all the instructions for using the drugs are in my mind and I can think of them as long as I think about them.

"..."

"..."

Professor Ma is very fat. He performed an operation wearing a lead suit. His chest and back were covered in sweat.

The fat on his face also began to shake.

"Let's do a clarithromycin-induced lymphocyte stimulation test, which is the DLST test. If the result is strongly positive, it will further confirm that coronary artery spasm is an allergic reaction to clarithromycin." Luo Hao said calmly.

"!!!"

"Professor Luo, what is that test?" Professor Ma asked. "It is considered to be type I Kounis syndrome. If the test is strongly positive, it proves that my diagnosis is correct. Stop clarithromycin and give a combination of nitrates and calcium channel blockers."

Luo Hao stopped talking to Professor Ma and Professor Lei. Instead, he stood up and talked to Miao Youfang beside him.

Miao Youfang followed Luo Hao, his head slightly lowered, thinking and confirming carefully.

"Kounis syndrome is not a rare disease. It is a syndrome caused by allergic reactions that activate mast cells, macrophages and T lymphocytes, synthesize and release inflammatory mediators, leading to peripheral vasodilation, decreased blood pressure, decreased coronary blood flow, arrhythmia, coronary artery spasm, coronary atherosclerotic plaque erosion, rupture or thrombosis in coronary stents. It is also called allergic myocardial ischemia syndrome."

"Clarithromycin-induced Kounis syndrome is generally mild, and patients with similar diseases will recover after a short period of treatment."

"But, I saw someone in the group asking for advice about a patient who always had a heart attack and then someone pointed out that it might be Kounis syndrome? After a series of research and analysis, it was finally determined that it was caused by clarithromycin."

"Teacher, what did you think at the beginning? If we analyze it according to normal clinical logic, you should not think of clarithromycin." Miao Youfang began to trace the source.

Professor Ma sighed as he watched them leave while talking.

He knew about Kounis syndrome, and just as Luo Hao had said, it was indeed a condition often encountered in cardiovascular medicine.

But he didn't expect that the patient in front of him would have Kounis syndrome.

"Xiao Ma, what's going on?" Professor Lei was still a little confused, and at this time Luo Hao and Miao Youfang had already left.

"Oh no, Professor Lei, I was wrong." Professor Ma was glad that he did not argue with Professor Luo at that time, otherwise he would be embarrassed now.

"What is Kounis syndrome?"

“The clinical manifestations of Kounis syndrome are divided into acute coronary syndrome manifestations, such as chest pain, dyspnea, palpitations, and acute allergic manifestations, such as rash, itchy skin, nausea, and in severe cases, acute pulmonary edema or even shock may occur.

Auxiliary examinations are also divided into coronary artery-related, such as electrocardiogram changes and elevated troponin, and allergy-related, such as elevated inflammatory mediators such as IgE and eosinophils. "

"What Professor Luo said is correct, but the chances of seeing it in clinical practice are not very high, so it is usually considered last. It may be...it may be...it may be that he has encountered it more often in the imperial capital."

Professor Lei looked confused. Not to mention making a diagnosis, he didn't even know what Professor Ma said.

Compared with Luo Hao, I am just a small doctor in a grassroots hospital?

It seems that we can think so.

"Professor Lei is gone." Professor Ma patted Professor Lei on the shoulder, "Clarithromycin, I remember using it."

"Well, it's used to treat gastroenteritis. I didn't expect it to be like this." Professor Lei said.

"Look, I told you so!" Professor Ma was very excited. "When Professor Luo suggested doing an acetylcholine stimulation test, I instinctively agreed. In fact, according to the general surgical procedure, an acetylcholine stimulation test is not performed."

"That thing still has some risks, even if it's not big. Besides, who would want to go through that in the middle of the night?"

Professor Lei felt a bitter taste in his mouth.

"Professor Xiao Luo is quite amazing...By the way, who is that person next to him? He looks very young. Is he a relative of Professor Xiao Luo?" Professor Ma asked.

"He said he had applied to be Professor Luo's graduate student. He was admitted to Union Medical College this year. In the future... he should be able to become Professor Luo's student."

"Fuck!" Professor Ma blurted out a swear word.

At that time, Miao Youfang was following the ward rounds, checking physical examinations and reading medical records. Fortunately, I didn't go up and chase him away.

The first graduate student recruited by Professor Luo at this age has extremely special significance.

And it seems that Professor Luo is very kind to this young graduate student, even giving people the illusion that Miao Youfang is Luo Hao's cousin.

At this glance, it all makes sense!
Just like Professor Luo Haoluo’s diagnosis just now, the logic is smooth and there is nothing unclear.

Professor Luo happened to meet this patient while he was teaching his first graduate student. The situation was slightly special as he was bringing his student to fight monsters and level up.

Professor Ma fell silent.

That graduate student is really lucky. There are not many people who can guide graduate students so attentively.

"Lao Lei, did anyone guide you like this when you were studying?" Professor Ma asked.

Professor Lei shook his head. How could a boss take students so seriously?

Generally speaking, the eldest brother is the leader, and most of the content involves doing experiments and working like a slave.

You are lucky if you can publish two SCI papers and graduate successfully. Many people's bosses are reluctant to let you go and keep delaying graduation until it drives you crazy.

Professor Ma sighed, that child was really lucky.

Not only did he get into PUMC, but he also had a caring teacher like Luo Hao. This person, good luck is the primary productive force.

“After I started graduate school, I quickly discovered that everyone was mentally ill,” Professor Lei said.

"Yes! I thought so too!"

The two found common topics and shared the same fate.

"Now that I think about it, I really don't know what magic there is in graduate school that can turn the entire graduate school into a huge mental hospital, where the acceptance letter is the admission letter."

"Yes, yes, yes! Before entering the school, I thought everyone was my classmates, but in fact, they were all fellow patients. The most consistent thing every day was going crazy, the kind of crazy that looked calm but was actually not normal at all."

“I pretended to be a normal person and reported to my instructor at the group meeting. Looking back now, it was really tiring.”

"When I go to give lectures at medical universities now, I can tell the difference between undergraduates and postgraduates right away," Professor Ma said with great interest. "It's not because the postgraduates are older. In school, age differences don't matter. It's mainly because the postgraduates look like they've experienced a lot, and their faces have changed."

"They have an unconcealable sense of fatigue, as if they are going crazy at any time. Before I went to school, I thought my seniors were so weak. Postgraduate study is a good thing, so why are they all so dejected? But when I started my postgraduate studies, I looked in the mirror one day and found that I was the same," Professor Lei added.

Having said this, both of them fell silent.

Why do you say so much?

Because of the graduate student who has not yet enrolled next to Professor Luo Haoluo.

If all tutors could teach students like this, would anyone go crazy?

But they knew that it was impossible for all instructors to teach students in this way, and they also knew that even Professor Luo Haoluo could only bring out senior disciples at most.

The rest was left to the senior disciple. The junior boss in the medical team was responsible for writing the thesis, and no one was worried about whether they could graduate.

As long as you don't act naughty or get into serious trouble, there will be no problem graduating.

This is simply the most awesome combination you can encounter in graduate school.

The two of them felt a little bit of envy in their hearts. No, that envy was not faint, but extremely strong, even beyond their imagination.

Think about how your supervisor treated you when you were a graduate student, and then compare it to how Professor Luo did not go home in the middle of the night, took his students to observe surgeries in other departments, and pointed out the problems directly.

The more they thought about it, the more depressed they became.

Luo Hao is lucky, and his graduate student seems to be lucky too.

Whose child is this? How could he be so lucky? The two of them were very worried.

"Old Ma, the test that Professor Luo mentioned, I think our laboratory department can do it."

"I'll ask, it should be possible. We haven't done it before. But we just need to stop taking clarithromycin. That's right! Not just clarithromycin, but all the medicines we used before."

"it is good."

Professor Lei sighed deeply.

A lot has changed in a year.

He looked at the empty corridor, as if Luo Hao was still there. It was the same night when Luo Hao knocked on his door and told him very seriously that there was a problem with the diagnosis of patients with abdominal cocoon disease.

I didn't expect that so soon, he would start supervising a graduate student, and his student is a very lucky little guy, exactly like Luo Hao.

……

"Xiao Miao, let's stop here." Luo Hao walked to the elevator entrance and smiled, "Go back and read more books and have more clinical experience."

"Okay, teacher." Miao Youfang knelt down completely this time.

Cheating?
Far from enough.

"By the way, you did a great job today. If you have any questions in the future, think about it three times and make a phone call immediately if you feel you need to." Luo Hao gave these instructions as he got into the elevator.

"Thank you, teacher." Miao Youfang bowed deeply when he saw Luo Hao enter the elevator.

"Oh no." Luo Hao waved his hand.

The elevator door slowly closed, and Luo Hao's gentle smile was countless times warmer than the lights in the elevator.

Luo Hao breathed a sigh of relief after getting in the car.

Although what happened today is not uncommon, it is definitely not common.

It is always a good thing to teach Miao Youfang to look at strange cases and increase his clinical experience.

That's why he took Miao Youfang with him to fight monsters and level up.

Luo Hao did not start the car and leave immediately, but was thinking about what to do next.

In winter, the garage is full of cars, and many medical staff simply park their cars in the unit’s garage, causing abnormal congestion.

A few minutes later, Luo Hao's cell phone rang.

Opening his phone, Luo Hao saw the message Wang Jiani left for him.

【Are you done? 】

【Busy working. 】

Luo Hao replied.

【Then I'll wait for you to come back. 】

【it is good. 】

The smile on Luo Hao's face was sincere, different from the smile he wore in the hospital.

It really feels good to have someone waiting for you when you get home.

Hoping that Xiao Miao would not send him any more messages today and that he could have a good sleep, Luo Hao started the engine and drove out of the basement.

On the way, Luo Hao called Wang Jiani and the two chatted casually.

There was no theme, and Wang Jiani, the patient Luo Hao was talking about, didn't understand, but Luo Hao just wanted to talk.

After driving all the way to the rental house, Luo Hao parked the car and got out.

Suddenly, a ray of light fell.

It was as if the gate of heaven opened at this moment, and a spotlight fell from the ceiling, covering Luo Hao on both sides.

Luo Hao squinted his eyes and looked up, and saw Wang Jiani standing on the balcony, with the window open and a spotlight in her hand.

That thing was so bright, and the focusing effect was particularly good. The beam of light covered him, as if a ray of light had fallen from the sky. In an instant, Luo Hao felt that his heart was about to melt.

Wang Jiani, who was high up, seemed to be saying something. Luo Hao looked up, squinted his eyes and looked at Wang Jiani, who was standing on the balcony with a flashlight in her hand to light the way for herself, and watched her lip movements carefully.

It was late at night and everyone was asleep. Wang Jiani didn't shout, but Luo Hao clearly heard Wang Jiani's voice - come home quickly, I miss you.

Well, I miss you too. Luo Hao’s fatigue was washed away.

(End of this chapter)