【My medical skills can add experience points】【】
Although it is a legal society now, there are too many people who are willing to take risks for the sake of huge interests.
There have been incidents where actresses were kidnapped by gangsters and then injured in various ways.
Su Qianqian is like a mirror, Zhou Can will never allow her to be broken.
"I know! I'm not a three-year-old kid, so I'll be extra cautious. But you still care about me so much, I'm very touched and very happy!"
After chatting with her, Zhou Can waited for Wei Fang's arrival.
Some people may not believe it when they say it out, but if you have money these days, if you give favors, you can really buy the loyalty of your subordinates.
Wei Fang was so down and down that she didn't even have money to see a doctor.
If Zhou Can hadn't paid a huge sum of money to help her treat her illness, her fate would have been completely different from what it is now.
She is a woman who came out of the mountains, and she is more grateful than the women who grew up in the city.
Now Zhou Can has given her a high-paying and stable job, so that she can honor her grandmother who raised her. Let her and her grandma experience the wonderful life of the big city.
Her gratitude and loyalty to Zhou Can are directly reflected in her actions.
She has devoted herself to protecting Su Qianqian for Zhou Can, and so far, there have been no mistakes.
To deal with Hu Wei this time, Zhou Can needs Wei Fang to implement the dark link.
…
After dinner, Zhou Can should spend the afternoon in the interventional operating room and inpatient department if there is no accident.
Busy until after four o'clock in the afternoon, Director Shang left in a hurry.
Zhou Can came out of the operating room and went back to the ward to deal with the twelve-bed patients in charge.
I thought it was the limit to manage eleven patients.
Unexpectedly, Director Shang saw that he was still able to manage so many patients with ease, so he added another bed for him.
Moreover, the patients entrusted to him are almost all intractable disease patients or high-risk patients admitted to the group.
What else can Zhou Can say when there is a teacher who thinks so highly of him.
You have to resist even with tears in your eyes!
However, for him, even if he is managing twelve inpatients at the same time, and often needs to go to the clinic and undergo surgery, he still does not find it very strenuous.
Instead, the most time is spent on writing medical records and courses, and discharging patients from the hospital.
As for running errands such as getting test results for patients, or sending materials to the medical department for signature, he never arranged for him.
He had just finished examining the twelve patients under his supervision, and made appropriate adjustments to the doctor's orders of some of them.
Sitting in the office and preparing to take a breath, someone came to the door.
"Doctor Zhou, are you busy now?"
Huang Liang, who used to look down on Zhou Can, now saw him with a smile on his face.
Strength is really a good thing, it can convince these arrogant opponents to lick him with the most flattering smiles.
"Doctor Huang, what's the matter?"
Zhou Can knew that this guy would go to the Three Treasures Hall for everything, and now he came to the door with a shy face, he must be asking for something.
"Hmm... That's how it is. My teacher, Director Zheng, is in the outpatient clinic. When he encounters a difficult case, he is a bit uncertain. Director Shang is not in the hospital, so I want you to go over and help with the staff."
Director Zheng is also a well-known expert in Gastroenterology.
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【My medical skills can add experience points】【】
But in terms of fame, he is not as good as Director Shang.
As for the level of diagnosis and treatment, the beholder sees benevolence, and the wise see wisdom.
Being able to make Director Zheng lose his face and personally send someone over to ask Zhou Can to be a "counselor" is enough to show that Zhou Can's status in the Department of Gastroenterology has really improved.
Director Zheng will only take action if he feels that it is possible to help him solve the problem by inviting Zhou Can over.
I believe Director Zheng must have considered it many times before he sent Huang Liang to invite Zhou Can.
"I'll go with you right away."
Zhou Can took two sips of water, stood up and left.
Director Zheng personally sent someone to invite him, this face must be given.
Following Huang Liang, he went straight to the No. 2 special needs specialist outpatient room of the outpatient clinic, and the two walked in directly.
"Hello, Director Zheng!"
Zhou Can lowered his posture and took the initiative to say hello.
It is said that giving a rose to others leaves a lingering fragrance in your hand.
Even though Director Zheng invited him to help, Zhou Can still took good care of Director Zheng's face.
Take the initiative to say hello, this is the best respect.
"Doctor Zhou is here, please come and sit down!"
Director Zheng smiled and beckoned Zhou Can to sit down.
In front of the family members and patients, Zhou Can was not polite, and sat down next to Director Zheng.
The other two young doctors stood there watching and smiled friendlyly at Zhou Can.
His eyes were clearly full of envy and friendship towards Zhou Can.
"This patient had frequent abdominal pain a year ago, and the symptoms were relieved after defecation. Until a month ago, the patient suddenly had diarrhea and loose stools, and the defecation was watery. At most, he could have diarrhea more than ten times a day, and the average The number of times of diarrhea per day will not be less than five times\\/day. For more than a week, the patient has taken antidiarrheal medicine, and the symptoms have not been relieved, but have aggravated. In addition to diarrhea, thirst, excessive drinking, Polyuria, symptoms of large urine output."
Diarrhea is the most common cause of dehydration in the body.
Especially prolonged diarrhea, no one can resist it.
The body is thirsty and needs to drink a lot of water, which is a very normal reaction.
"The patient's weight lost more than ten catties in a very short period of time, and occasionally there will be flushing on the chest, which will disappear after about ten minutes."
According to Zhou Can's diagnosis and treatment experience, the patient's weight dropped by more than ten catties in a short period of time, which is a serious problem.
It is often a sign of serious illness.
"Is that him?"
Zhou Can looked up at the patient sitting there. The family member should be the patient's mother. She was a woman in her fifties, her skin was tanned, her hands had thick bones, and the skin on the back of her hands looked very rough.
This is a miserable woman.
"That's right, my son is sick, please take care of the doctor." The patient's mother was an honest woman, and she didn't look down on Zhou Can because she was young, but she also showed respect and courtesy.
On the contrary, the young patient himself did not seem to have placed much hope in Zhou Can.
can understand.
After all, Zhou Can is very young. Even younger than this patient.
"Have you had your physical checked?"
Zhou Can asked Director Zheng.
The admission physical examination actually covers a lot of information. Including the patient's treatment status, whether it was carried or walked over, as well as body shape, measurement of basic vital signs, etc.
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【My medical skills can add experience points】【】
Visually, the patient's body was thin, but not so thin that it was scary.
Zhou Can has seen some patients in the intensive care medicine department who are so thin that they are only skin and bones, which is really scary.
"It has been checked. The patient's physical examination data, as well as the chief complaint, medical history and other information are all recorded here."
Director Zheng showed Zhou Can the medical records.
The patient was admitted to the hospital for physical examination. He was mildly emaciated, conscious, and his blood pressure, respiration, and pulse were all normal. Cardiopulmonary abnormalities were normal, abdominal compression was soft, and no obvious mass was palpable. Abdominal shifting dullness, no edema in lower extremities.
Some patients with severe diarrhea may have tight abdominal muscles, or abdominal distension, fluid accumulation and so on.
When pressing, the abdomen of this type of patients is mostly hard.
The patient's abdominal compression was soft, and many causes could be ruled out immediately.
Zhou Can continued to check the examinations done by the patient.
There are quite a lot of investigations, but the overall data of the patient did not find any obvious abnormalities.
Including urine sugar, protein and microscopic examination results were normal. Only the specific gravity is low, only about 1.0004.
The patient's stool routine, bacterial culture, and Sudan's three staining were all negative in other hospitals.
In the end, this large hospital gave a diagnosis of 'functional diarrhea'.
At the same time, because of the patient's clinical manifestations of polydipsia, polyuria, and low specific gravity urine, it was suspected that the patient had diabetes insipidus.
When it comes to diabetes insipidus, it is divided into three types, central diabetes insipidus, nephrogenic diabetes insipidus, and psychogenic polydipsia.
The patient's clinical manifestations were hypokalemia, and the blood potassium test was between 2.2 and 2.8. So the diagnosis given by this big hospital is nephrogenic diabetes insipidus?
The question mark is that it is suspected that the patient is likely to have nephrogenic diabetes insipidus caused by hypokalemia, but the receiving doctor is afraid of being slapped in the face, so he is not 100% sure.
So putting a question mark means waiting for further verification.
This large hospital made a statistics on the patient's 24-hour urine output, which was as high as ml.
This is a rather appalling amount of urine. A bottle of mineral water is 550ml, and the urine excreted by the patient in a day can fill 20 mineral water bottles.
In order to find out the cause of the patient's hypokalemia, this large hospital conducted a potassium balance test on the patient, and asked the patient to fast for three days, and intravenously drip potassium chloride 3g per day.
On the third day, blood potassium, urine potassium, and **** potassium were rechecked, and blood k was 3.3mmol\\/l. Urine k14mmol\\/day, feces k32mmol\\/day.
A day is 24 hours.
Normal people consume 100mmol of potassium per day, and the gastrointestinal tract can almost completely absorb the ingested potassium.
The kidney is the main organ that regulates the potassium balance in the body, and about 90% of the potassium is excreted from the kidney.
The **** potassium of normal people is less than 10% of the intake.
This patient obviously exceeded the standard by more than three times, which can indirectly prove that the patient has renal insufficiency.
There are only a few reasons for hypokalemia, such as insufficient potassium intake, or excessive loss such as vomiting, or the transfer of potassium ions from the outside of the cell to the inside of the cell.
Apart from diarrhea, this patient has no symptoms of vomiting, so this can be ruled out first.
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【My medical skills can add experience points】【】
Then the patient's diet is basically normal, and insufficient potassium intake can also be ruled out.
In the end, there is only the third possibility, the transfer of potassium ions from the outside to the inside of the cell.
There are four most common causes of intracellular and extracellular potassium balance.
One, acid-base balance. Two, insulin. Three, blood aldosterone. Fourth, sympathetic nerve activity.
This disease is simply a big test of human body science, no wonder Director Zheng needs to invite Zhou Can to help.
He didn't know that Zhou Can was good at diagnosing diseases, but his medical skills were far from profound.
That is to say, in the past two years, I have supplemented a lot of basic medical knowledge, so that I can barely bear it in this case analysis.
In order to find out the cause of the patient's intracellular and extracellular potassium balance, Zhou Can re-checked the patient's multiple examination data.
After layers of investigation, he finally diagnosed that the patient should be the first case, hypokalemia caused by acid-base balance factors.
More precisely, it should be alkalosis.
[Pathological diagnosis +1.]
[For the first time you diagnose a complex pathological mechanism with strong reasoning, reward pathological diagnosis +100. 】
This is the first time he has received pathological diagnosis experience points and high experience point rewards without diagnosing the final complete cause.
Diagnosing this case is of great benefit to Zhou Can.
Activate all the basic medical knowledge he has learned, and use it in practice.
"Did Doctor Zhou find out anything?"
Director Zheng was not urging him, but worried that the family members and patients were left alone for too long, and felt dissatisfied.
More or less let the family members see the doctors working hard to diagnose and treat.
Instead of sleepwalking.
"At present, it is only diagnosed that the patient is hypokalemia caused by alkalosis, and the etiology of the patient's diabetes insipidus and diarrhea must continue to be further differentiated and discussed."
Zhou Can handed over some very hard dry goods.
"As expected of the youngest and most promising doctor in our Department of Gastroenterology, his strong diagnostic ability is really rare. It is amazing to find out that the patient is hypokalemia caused by alkalosis so quickly. I also spent a lot of effort and time. It took a long time to prove it to this point. It is because of your young minds that you are so powerful!"
Zheng Hongtao couldn't help sighing.
"Congratulations! Since both of us identified the hypokalemia caused by alkalosis, it means that the conclusion of the previous syndrome differentiation is basically correct. As long as the cause of alkalosis is found out, I believe we can make a breakthrough."
Zhou Can is full of enthusiasm for the diagnosis and treatment of this super difficult disease.
It's like attacking a city and plundering land, breaking down a strong city little by little.
Now that an acropolis of the enemy city has basically been destroyed, further finding out the cause of the alkalosis is equivalent to tearing a hole in the defense of the main city.
This disease has also found a breakthrough in treatment.
Although Huang Liang is already a senior resident doctor who is about to be promoted to attending, he can't use any strength in this level of diagnosis and treatment.
There is only the copy of listening silently by the side.
"During alkalosis, hydrogen ions are transferred to the outside of the cell, causing a potential difference between the inside and outside of the cell, and potassium ions are passively transferred to the cell, which leads to hypokalemia. Is there any way to correct alkalosis?"
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【My medical skills can add experience points】【】
The first thing Zhou Can thinks about is to treat first.
It is impossible to get to the bottom of some causes, and it is a common clinical treatment method for doctors to treat first and then investigate.
It can also be called symptomatic treatment.
That is, after I discover a problem, I can try to help the patient correct the problem first, and then see how the body reacts.
Many times, the body may be just a tiny part of the whole system that goes wrong. It is also a way to correct it with drugs or other means to restore the body to normal functioning.
Many chronic diseases are almost treated in this way.
Patients need to take medicine for life.
The general meaning is that the doctor knows that a subtle link in the three major systems of the patient is wrong, but he has not found the specific cause of the error. At this time, drugs are used to intervene forcibly to help them correct their mistakes, regardless of the cause of the mistakes.
The human body is so amazing.
With the help of medicine, even if the cause of the error can never be found and cannot be cured, it will not affect the therapeutic effect.
People with diabetes, for example, need regular insulin injections.
The doctor knew that there was a problem with insulin secretion, but the specific reasons were all kinds of strange, limited by the level of medicine and technology, there was no way to break the casserole and ask the bottom line.
In the end, chronic diseases such as diabetes and hypertension require life-long medication~www.mtlnovel.com~Patients have used routine intravenous potassium supplementation in other hospitals, but the patient’s hypokalemia still cannot be corrected disease. "
If you want to correct alkalosis, you have to start with the disease of diarrhea.
Zhou Can began to jump back to the patient's diarrhea problem.
At the beginning, the patient had abdominal distension, and it took more than a month to develop severe diarrhea.
"Director Zheng, can you do a small intestine perfusion test for the patient? It will help to find out the type and depth of the diarrhea."
After Zhou Can thought for a moment, he gave a suggestion.
"Your diagnosis is still based on diarrhea?"
Zheng Hongtao's eyes brightened slightly.
When the answer to alkalosis cannot be found, it is also a good way to change the way of thinking and directly point to the disease itself.
"Don't you need someone who tied the bell to untie the bell? By looking back at the type of diarrhea and the underlying causes, it may be possible to solve this difficult case like a puzzle." Zhou Can nodded with a smile.
"It makes sense!"
Zheng Hongtao communicated well with the patient and his family members on the spot. This disease is difficult to diagnose. It is recommended that the patient be hospitalized for further observation so that doctors can find out the cause.
The small intestine perfusion test needs to be arranged, and it takes a long time to observe the whole intestinal operation process.
The patient was unable to be treated in another hospital, so he naturally understood that the disease was difficult to treat.
Now that the two doctors have discussed it, it seems that some progress has been made. Seeing hope, the family members readily agreed to hospital treatment.
The beds in the Department of Gastroenterology are as tight as ever.
The patient was placed under observation first, and the small intestine perfusion test was done first, while waiting for a new bed to be vacated, and then hospitalization was arranged.