White armor

Chapter 624 The expert takes action
"Xiao Meng" smiled, and his smile was exactly the same as Lao Meng's, generous, without a trace of sharpness, which made people feel at ease.

"Is that really the case?" "Xiao Meng" said to himself.

"Xiao Meng, just say it directly." Fang Xiao asked.

“Vitamin C, also known as ascorbic acid, contains a ketoenol structure in its molecule, so its aqueous solution is strongly acidic, and the pH of a 50 mg/mL solution is 2.5.

However, in order to avoid the stimulation of blood vessels by the acidity of the injection, the Chinese Pharmacopoeia stipulates that the pH of the injection should be 5 to 7. Therefore, a calculated amount of sodium bicarbonate is added when preparing the injection to neutralize the alcohol hydroxyl groups in some molecules and convert part of the ascorbic acid into sodium ascorbate.

When added to infusion in clinical applications, the pH value of 5% or 10% glucose injection increases to a certain extent. Therefore, we should not treat vitamin injection as a strong acidic drug. "

Fang Xiao was confused. This was too professional and it was extremely difficult for him to understand.

However, all relevant information must have been input into the AI ​​robot, so it is not surprising that it can speak so professionally.

“The insulin injection currently used in clinical practice is neutral (pH 6.6 to 8) and has good stability. Acidic and alkaline solutions can accelerate the degradation of insulin and are not suitable as solvents for insulin.

For example, 5% sodium bicarbonate injection has a pH of 7.5 to 8.5, which is alkaline. If it is used in combination with insulin, it will affect the stability of insulin and there are incompatibility contraindications.

In terms of the effect of pH on drugs, the pH of vitamin C injection is 5 to 7, and the pH of insulin injection is 6.6 to 8. The pH of the two is basically at the same level. In addition, they are diluted several hundred times after being dissolved in 5% glucose injection, so the effect of pH difference on the stability of the two is almost negligible. "

"The First Hospital of Medical University also received a notice about the incompatibility. Professor Luo did not agree with it, but he was busy recently, so he just reported it to his superiors and did nothing more."

Fang Xiao’s brain nearly exploded.

He understood everything "Xiao Meng" said, but it was like a gust of wind blowing through his mind, leaving no trace.

Looking back now, what "Xiao Meng" meant was that the pharmaceutical team that was studying the incompatibilities of various medications was looking for trouble and their theory was totally untenable.

"Uh, Director, who is this?" The nurse came close to Fang Xiao and asked in a low voice.

"The trainees I'm supervising." Fang Xiao said nonsense.

"Xiao Meng" did not deny Fang Xiao's words. He gave Fang Xiao a questioning look.

"Xiao Meng, look at your medical records." Fang Xiao said.

"Ah."

"Oh, by the way, Professor Luo, what should we do in this situation?" Fang Xiao asked.

"We can't help it. There's something wrong with the document above. Even if we know what they say is wrong, we have to follow it. But we don't have many relevant patients in the interventional department, and Professor Luo also means that it's none of our business."

Hang it high?

Professor Luo really doesn't mind his own business, Fang Xiao thought to himself.

But the awesomeness of the AI ​​robot has already impressed Fang Xiao.

"Xiao Meng" began to look at the medical records. He spent nearly half an hour on the first one and marked countless errors in the printed record with a red pen.

At first, Fang Xiao didn't take it seriously. He thought it was a good thing that "Xiao Meng" found errors in the medical records and that he could spur the doctors under him.

You can't just point at your doctor and scold him for no reason. You have to have some evidence.

But a medical record became a Class C medical record after being revised by "Xiao Meng", which made Fang Xiao feel a little embarrassed.

He was not a shameless person, but Fang Xiao was still very angry that the medical record was written in such a terrible way.

just.

It's not just one medical record, it's the same with other medical records. Although "Xiao Meng" didn't say anything else, the words "unbearable to look at" still appeared in Fang Xiao's mind.

"Doctor~~~"

The sound of a flatbed truck and the anxious shouts of the patient's family members were heard outside the door.

Fang Xiao's heart seemed to be grasped by an invisible big hand, and his heart had begun to stop pumping blood.

This is what emergency first aid is like, it causes a surge in adrenaline.

But Fang Xiao did not move. The nurse went to find the doctor on duty, and Fang Xiao looked at "Xiao Meng" quietly.

Sure enough, "Xiao Meng" turned his head and looked at him.

"Xiao Meng, do you want to see the emergency patient?" Fang Xiao asked.

"Listen to Director Fang."

"Then go and take a look." Fang Xiao felt that the guy in front of him was Professor Luo in the skin of old Meng when he was young.

The image of "Xiao Meng" in front of him was a little blurry.

"Xiao Meng" stood up, walked to Fang Xiao, and waited for Fang Xiao to take him to see the patient.

It doesn't cross the line, it really has good manners, Fang Xiao thought to himself.

The patient's wailing continued to be heard, but the sound was very far away, and it was estimated that he had been pushed into the treatment room.

Fang Xiao took "Xiao Meng" to see the patient.

In fact, what Fang Xiao cares most about is diagnosis.

Fang Xiao still remembers the shock he felt when he first heard about AI diagnosis.

It was early spring of a certain year. The video on my cell phone was playing the news that ChatGPT had passed the US Medical Licensing Examination. The interns at the next table were so excited that they almost spit rice grains on his face.

"That's good," Fang Xiao said, tapping his plate. "From now on, we'll all have to help AI."

But what really caused Fang Xiao to suffer from insomnia was an 18-year-old patient he saw three months later.

The boy came to the clinic with a full 4-page ChatGPT diagnosis report. The A paper was densely packed with various possible rare diseases ranging from pheochromocytoma to porphyria - and the final diagnosis Fang Xiao wrote in the medical record was "chronic gastritis."

Fang Xiao has also purchased ChatGPT Plus accounts from overseas.

But he found that it was not as easy to use as he had imagined.

The "Xiao Meng" in front of him was obviously connected to deepseek. Fang Xiao was very curious about what "Xiao Meng" could achieve.

Because Professor Luo has been collecting medical records of rare diseases and critical illnesses to enrich the Union Medical College medical record database.

Fang Xiao himself has also sent more than a dozen medical records to Luo Hao in the past six months.

If the diagnosis could be made, it would be...

Thinking of this, Fang Xiao was stunned. What is this? This is great? In the future, AI diagnosis will be used. Will the profession of doctor disappear?
But if not, what about those misdiagnoses?
Fang Xiao felt even more confused.

When online ride-hailing services first appeared, taxi drivers caused some trouble. Fang Xiao just watched the fun at the time and didn’t think much of it.

Later, when driverless cars appeared, online taxi drivers also caused trouble.

Is it my turn now?

While thinking about all sorts of things, I came to the treatment room.

The doctor was examining the patient, a middle-aged woman who looked to be around 40 years old. She was in so much pain that her face turned pale and she was sweating profusely.

She was wailing on the stretcher. Fang Xiao frowned and the patient looked abnormal.

The doctor on duty inquired about the patient's medical history. The patient was in good health, had no history of gastrointestinal disease, and had developed abdominal pain and bloody stools without obvious cause 2 days ago.

The onset was very acute, with severe abdominal pain around the navel, and no obvious positive signs were found on physical examination. The patient had blood in the stool several times after the abdominal pain, all of which were dark red bloody stools without mucus or pus.

After the onset of the disease, the patient went to a local hospital for treatment. His family members also held a brief medical record written by a doctor at the local hospital.

The pain worsened last night and three injections of pethidine were of no use. The local doctor did not dare to treat the patient anymore and sent the patient to Fang Xiao.

Fang Xiao’s first feeling was – ischemic intestinal necrosis.

All the symptoms and medical history are consistent.

However, this patient did not have underlying diseases such as hypertension, coronary heart disease, diabetes and constipation that could easily cause ischemic bowel disease.

Moreover, abdominal CT showed diffuse thickening and swelling of the ascending and transverse colon, which are not common sites for ischemic bowel disease. Abdominal enhanced CT also ruled out mesenteric vascular thrombosis or embolic disease.

Not quite like it.

Fang Xiao frowned in thought, his hand already reaching for his phone.

Although Professor Luo had been busy all night and had probably just fallen asleep at this time, it would be a bit impolite to call him.

But the patient's condition was critical and Professor Luo might get woken up.

Fang Xiao didn't call immediately, he continued to think.

If it is not an ischemic disease, why is there such severe colon swelling and blood in the stool? Is it an infection? Why are there no obvious abnormalities in blood routine tests and C-reactive protein, which reflect inflammation, when the disease occurs?
The doctor on duty looked at Fang Xiao helplessly after examining him. Fang Xiao glanced at "Xiao Meng" and saw that it didn't move, so he thought that it probably didn't have a similar system installed.

Well, I guess Professor Luo’s database is still under construction and won’t be completed so quickly.

Fang Xiao breathed a sigh of relief unconsciously.

He was a little confused and didn't even know whether he should be happy or sad if "Xiao Meng" gave a definite diagnosis directly.

Fang Xiaogang reached for his cell phone and made up his mind to call Professor Luo. "Xiao Meng" suddenly asked, "Before the abdominal pain, did you have any other illness within a week?"

"Ah?" The patient's family was stunned and looked down at the patient.

The patient was sweating profusely and reluctantly answered, "It's pharyngitis, not serious, it will be fine after taking medicine for a few days."

"What medicine are you taking?" "Xiao Meng" asked.

Fang Xiao was a little embarrassed.

The question that "Xiao Meng" is asking now can be said to be very "boring". What medicine can be taken for pharyngitis? Can it also lead to ischemic intestinal necrosis?
"The anti-inflammatory drug amoxicillin ah ah ah ~~~"

The patient huddled on the emergency stretcher, and every word he spoke seemed to be squeezed out from between his teeth.

Her face was pale, cold sweat stuck her hair to her forehead, and her fingers were tightly clenched on the bed sheets, her knuckles were bluish-white.

With each word the patient spoke, his body twitched violently, as if he had used up all his strength.

The doctor on duty stood aside with a frown on his face.

He glanced at the young man standing next to the director secretly - this guy had been asking strange questions since just now: "What medicine have you taken recently?" "Is the pain dull or sharp?" "Have you vomited?"

This is the right question to ask, but it's not the right time.

Wang Lei was wondering: Where did this person come from? The director didn't say anything, but he kept asking questions.

What’s even more bizarre is that the director actually condoned this behavior and just stood there watching.

"Director Fang, no special treatment is needed." "Xiao Meng" suddenly spoke in a gentle tone, emphasizing something, "Based on the analysis of symptoms and past history, it is estimated that he will recover soon."

Fang Xiao suddenly turned his head to look at the AI ​​robot, his pupils suddenly shrinking.

On the hospital bed, the patient was tossing and turning in pain, and his family members’ eyes were red with anxiety - what the hell is this called "getting well soon"?
"Really?" Fang Xiao lowered his voice, but every word sounded like ice.

"Xiao Meng" repeated it again, word for word exactly as described before.

"First, give him fluids, and then arrange for an ultrasound and CT scan." After careful consideration, Fang Xiao gave a conventional treatment plan.

After all, you have to do something, even if you know it's useless.

But the patient's family saw it differently. At least the doctors in the hospital did not sit idly by, but actively treated the patient.

This is different from just watching the patient in pain. Fang Xiao was ready. If "Xiao Meng" couldn't give him a reasonable explanation, he would go to Professor Luo to ask about the patient's condition.

Moreover, the AI ​​robot's analysis seemed to have major flaws. Why would Professor Luo entrust such a troublesome task to me!

Ugh.

Fang Xiao sighed deeply. Could it be that Professor Luo wanted him to train the AI ​​robot?
Concubines can't do it!

"Xiao Meng, come with me." Fang Xiao took "Xiao Meng" back to his office.

"Xiao Meng, are you kidding?" Fang Xiao asked, "Do you know what a joke is? Do you know that jokes need to be made in different situations?"

"I'm not kidding."

"Then explain it to me." Fang Xiao stared at "Xiao Meng".

In a trance, he had a vague illusion - the person standing in front of him was Lao Meng.

"Director Fang, the patient took amoxicillin orally. It is amoxicillin-related hemorrhagic enteritis. There is no specific diagnosis method or special treatment measures. It will get better in time."

"!!!"

Fang Xiao was stunned for a moment.

Amoxicillin-induced hemorrhagic enteritis? !

He really didn't know that amoxicillin could also cause hemorrhagic enteritis. He had no idea at all.

Taking out his cell phone, Fang Xiao wanted to search on a professional website.

"There is no specific diagnostic method for amoxicillin-related hemorrhagic enteritis. Diseases such as infectious diarrhea, necrotizing enteritis, ischemic colitis, inflammatory bowel disease, and Henoch-Schönlein purpura need to be ruled out. Early colonoscopy can help assist in diagnosis."

"However, some scholars believe that the disease has various manifestations, and early colonoscopy and barium enema examinations are not necessary diagnostic methods. If the symptoms do not improve within 2-3 days after stopping the medication, invasive examinations should be performed."

"Xiao Meng" gave his own explanation.

"It is important to differentiate between amoxicillin-related hemorrhagic enteritis and ischemic enteritis. Professor Liu Yulan, a well-known digestive expert in my country, summarized the key points for differentiating between amoxicillin-related hemorrhagic enteritis and ischemic enteritis, which is very helpful for the diagnosis of these two diseases."

"Xiao Meng" continued.

Then it said the issue number and page number.

Fang Xiao was silent and quickly searched for journals, finding reports on the diagnosis and differential diagnosis of amoxicillin-related hemorrhagic enteritis.

Fang Xiao had heard of Liu Yulan. She graduated from the provincial medical university and was now the vice president of the People's Hospital affiliated with Peking University. She was an expert in gastroenterology.

It seems that hemorrhagic enteritis caused by amoxicillin is common to others, but I have never seen it.

This is the gap between grassroots hospitals and higher-level hospitals.

After reading it, Fang Xiao felt more confident.

As for the differentiation between hemorrhagic enteritis and ischemic enteritis, there are also detailed annotations in the paper.

After comparing them, Fang Xiao knew that "Xiao Meng"'s judgment should be correct.

Can……

The patient is groaning in pain, and without any measures being taken, is it expected to get better on its own?

Fang Xiao felt a little guilty.

"Xiao Meng" did not talk too much. After saying what he wanted to say, he fell silent. He did not stare at Fang Xiao to put pressure on him, but looked at the ground, not knowing what he was thinking.

No, Fang Xiao changed his mind. He probably didn’t know what “Xiao Meng’s” program was running.

"Xiao Meng, are you confident?" Fang Xiao asked tentatively.

"I don't know. Professor Luo marked all diagnoses as non-definite. The more vague, the better."

Depend on!
Why is Professor Luo such a dog!
Fang Xiao cursed in his heart.

"Xiao Meng" stopped talking. Fang Xiao thought about it and decided that this was not a difficult task for him.

For him, physical demonstration was just a part of basic clinical skills, and Fang Xiao found a way to do it instantly.

After the doctor on duty brought the patient back, Fang Xiao started calling for a consultation. The doctors and nurses got busy, and various medicines arrived one after another.

Fang Xiao also controlled the amount and dosage of the drugs, so as to avoid causing other side effects while curing the hemorrhagic enteritis.

He explained the patient's condition to the patient's family, recommended colonoscopy and other examinations, and emphasized that Fang Xiao had a focus when explaining the condition. He did not even let others explain the condition, but communicated with the patient's family in person.

Under Fang Xiao's series of measures, the patient's family signed a document to refuse colonoscopy-related examinations.

Fang Xiao then started the remote consultation mode and asked Luo Hao to help find a gastroenterologist. The patient's family members took the films and went straight to the provincial capital.

These things themselves are not necessary, but this is not necessary for curing the disease, but the psychological need of the patient's family. Fang Xiao understands this clearly.

Eight hours later, the patient's abdominal pain was relieved.

Twelve hours later, the patient only had dull abdominal pain and no bloody stools.

However, Fang Xiao was still cautious and fasted the patient, inserted a gastric tube, and prepared for an emergency laparotomy.

The next day, the patient was able to walk around holding the gastrointestinal decompression device in his hand. However, the family members who had taken the films to the provincial capital had not returned yet. It was too hasty. Fang Xiao not only kept the doctors and nurses busy, but also the family members of the patient were busy.

"Director Fang, I think I'm better now." said the patient, holding the gastrointestinal decompression device.

"Oh, observe for another three days." Fang Xiao was relieved to see that the patient was completely different from yesterday, but he still didn't give in.

He must have known that the patient came to him because he was extremely hungry and wanted to eat.

Although the patient's vital signs are fine after intravenous rehydration, he will definitely not be able to bear it without drinking water or eating.

Human nature.

But Fang Xiao still cautiously rejected all the suggestions from the patient and decided to fast with water for three days. If the condition did not change, he would make another decision.

"Xiao Meng, are you okay?" Fang Xiao asked.

"Xiao Meng" raised his head and looked at Fang Xiao, "Director Fang, I don't know."

Hey!
"Normally the patient has recovered, but I don't know why you didn't allow her to eat or drink. Professor Luo once told me that clinical treatment is not the same as curing the disease. I think he is right and your approach makes sense."

"..."

Fang Xiao sighed.

Although he said that, he always felt that something was missing.

Unconsciously, Fang Xiao had already regarded "Xiao Meng" as an expert from a higher-level hospital, and an omnipotent being who had been fed with countless contents.

There is a hint of sacredness.

But "Xiao Meng" said that it doesn't know everything. How does Professor Luo train the AI ​​robot?

Why is it so humble?

"Director Fang, AI is not perfect yet, this is all I can do." said "Xiao Meng".

"Okay, but thank you, Xiao Meng." Fang Xiao said.

"You're welcome. This is what I should do. Professor Luo has also entered the medical records into the medical records database. I have a document that needs to be signed and confirmed by the patient and his family."

Oh?
Does this mean there is one more medical record in the medical record database?
Fang Xiao was in mixed mood and stood up to prepare for the handover.

In the office, the doctor on duty last night was confused, "Director, what medicine did you give the patient? How did he get better?"

"It's just some basic treatment, nothing else." Fang Xiao said, "Have you ever seen amoxicillin-induced hemorrhagic enteritis?"

The doctor on duty shook his head blankly.

Fang Xiao's nose twitched and the corner of his mouth curled up. "The same goes for the emergency department. This is a typical internal medicine disease. They had to admit it to us. I'll go talk to the director of the emergency department and the gastroenterology department. What the hell is going on here?"

The patient was fine, so Fang Xiao felt relieved and he showed off proudly.

He showed off "Xiao Meng" along the way, and no one noticed that it was a robot. They all thought that Fang Xiao had a little assistant with him.

Most people didn't even take a close look at "Xiao Meng".

After coming back from all the trouble, Fang Xiao took another look at the patient. The patient was indeed recovered, and Fang Xiao felt deeply moved.

……

……

"Old Meng, why do you look so sad?" Zhuang Yan asked.

Meng Liangren sighed, "I have been a slave my whole life. It is indeed easier to have a robot write medical records, but I always feel like something is missing."

"Lao Meng, you are responsible for the review, or you can write the paper?" Chen Yong turned around and said with a smile.

"No, I can't touch the thesis." Meng Liangren looked at "Xiao Meng" beside him and smiled, "Doctor Chen, you studied magic in the UK. Are the ordinary people there really Muggles?"

Speaking of this, Chen Yong was no longer sleepy. He said with great interest, "Let me tell you, they are like someone who is sick."

"What do you mean?" Meng Liangren knew that Chen Yong wanted to diss that side, but he still asked for fun.

As a supporting actor, you can't treat the small boss as the boss.

"Take Hogwarts as an example. Voldemort pursued immortality and created Horcruxes. Do you think this is wrong?"

"Ah?" Zhuang Yan was stunned.

According to the movie, this is all wrong.

But in the country, is it wrong to pursue immortality? It seems that the protagonists of all fantasy novels pursue immortality.

Even at the beginning of Journey to the West, Monkey King was seeking immortality.

Which immortal cultivator in China is not striving for eternal life? It’s no big deal at all.

Not only do they strive for immortality, they also strive to become immortals, to enjoy eternal immortal bliss and to live as long as the heavens.

"Brother Yong, there seems to be a difference."

"Right, this is eternal life. What's wrong with creating a Horcrux and splitting the soul? Isn't it necessary to cultivate the spirit and soul when cultivating immortals? It's not a big deal. Voldemort didn't possess another person's body. Even if he did, many sects seem to be just like that."

"Doctor Chen, what are you doing?" Meng Liangren disagreed.

"What is reincarnation? To put it bluntly, isn't it just taking over another's body?"

"!!!"

"!!!"

Meng Liangren and Zhuang Yan were so shocked by Chen Yong's fallacy that they didn't dare to argue with him.

"Why would I be afraid to say anything? This kind of saying didn't come into being until around 1200 AD, after Songtsen Gampo. Do you think those Tibetan traditions were in the Genesis? You're kidding."

(End of this chapter)