I Can See Health: Chapter 77 Lu Chen\'s doubts
Chapter 77 Lu Chen's Doubts
The signature of the disease course record has three big characters…
Sun Guoguo!
"The attending doctor of the eight districts in the heart, Sun Guoguo?"
Cao Zhiying frowned.
"I remember she just started working independently not long ago."
Ren Feng nodded: "Well, she is Director Li Yao's student. After graduating a few years ago, she stayed in school."
"Well, this Sun Guoguo is very good, she can actually judge the patient's condition so quickly." Cao Zhiying nodded slightly, "The course record she wrote is orderly and well-reasoned. It seems that she is very interested in this family. Hypercholesterolemia is well understood."
"I had little impression of her in the past. It seems that in the ordinary ward in my heart, there are still many young people with potential that cannot be ignored."
"Director, could it be Director Li Yao who gave guidance in the ward?" Ren Feng asked tentatively.
This Sun Guoguo is very familiar to Ren Feng.
She is indeed a young doctor who strives to make progress.
However, it seems that there is no special excellence, right?
He had only seen this rare case once.
And, because I haven't encountered such a case for a long time.
I came across it suddenly today, and I didn't react for a while.
"Probably not." Cao Zhiying shook her head, "Li Yao is having a meeting at the school today and won't be able to go back to the ward for a while."
Cao Zhiying and Ren Feng analyzed for most of the day.
But they overlooked one point.
Graduate students, regular trainees, and interns do not have their own job numbers, and they all use the job numbers of their superiors to write the course of illness and make medical orders.
…
At this time, the No. 2 Jinghua Hospital, the eighth district of the Department of Cardiology.
Sun Guoguo is sitting in front of the computer, checking the medical records of the 10-year-old girl in the morning.
These disease course records were written by graduate students or regular trainees.
Therefore, as the attending doctor, she needs to review and proofread the course record again.
However, when she clicked on the 10-year-old patient, the latest disease course record, and saw the contents clearly.
She was slightly stunned.
Such a critically ill patient not only needs to write the first course record when he is admitted to the hospital, but also needs to complete the ward round by the superior physician as soon as possible.
Generally speaking, in the content of this kind of ward rounds by a superior doctor, the “condition analysis” is indispensable.
Mainly, the doctor of the tube bed makes an analysis and judgment on the diagnosis and treatment plan of the patient based on the condition.
"Condition Analysis" is extremely difficult to write, usually written by Sun Guoguo or Li Yao.
This "disease analysis" is an important indicator that reflects the level of a doctor!
"Friends, who wrote the course record of this 10-bed patient?"
"Senior sister, it's me." Jiang Qingyan said softly, "I received this patient in the morning."
Sun Guoguo gave Jiang Qingyan a suspicious look.
"Why do you consider the diagnosis of familial hypercholesterolemia?"
Jiang Qingyan paused and said, "The patient's diagnosis of acute myocardial infarction is definitely correct. However, she is young, and has symptoms of hyperlipidemia such as tendon xanthoma, corneal ring, and intermittent claudication. , most likely vascular occlusion caused by blood lipid deposition!"
"Because of the disease at such a young age, there is a high probability of homozygous familial hypercholesterolemia!"
Sun Guoguo nodded when he heard the words.
"Junior sister, your analysis is good. Have you encountered such a patient before?"
"No, Lu Chen taught me to write this condition analysis." Jiang Qingyan shook her head gently.
"Ah? Was it taught by Junior Brother Lu?"
Why is it Lu Chen again?
A hint of surprise flashed in Sun Guoguo's eyes.
Looking around the doctor's office, Lu Chen was not there, he probably went to the ward to see the patient.
Jiang Qingyan nodded, "When he first went to work in the afternoon, he told me that he had new ideas about the patient's condition."
"Then he has seen this kind of patient before?"
"No, but he found a similar document and printed it out."
Jiang Qingyan took out three pieces of A4 paper from the medical record folder, on which were densely packed small English characters.
"This…"
Sun Guoguo's head grew big when he saw this foreign language document!
She suddenly admired Lu Chen and Jiang Qingyan.
When she was a graduate student herself, she helped out in the department with doctor's orders and writing the course of the disease every day, and spent most of the rest of the time chatting with other doctors.
When encountering a difficult case, she might think about it, but she never thought to search for the literature to get to the bottom of it.
However, Lu Chen's series of performances made her a little bit ugly.
This was the case with the last "Fitness Dry Powder" event.
The "10-year-old myocardial infarction" incident this time is also the same!
Lu Chen seems to have always maintained a desire for knowledge.
Like everyone else, he will face many clinical problems.
But he always thinks of various ways to further solve the difficulties.
…
At this moment.
Lu Chen just returned to the doctor's office.
Before he sat down, he noticed that Senior Sister Sun's eyes had changed.
This look is very complicated, with surprise, appreciation, and a hint of loss.
"Senior sister?" Lu Chen called softly.
Sun Guoguo immediately recovered and smiled quickly: "Junior Brother Lu is back."
"Yes." Lu Chen smiled.
When he saw the English documents in Sun Guoguo's hands, he understood a little.
"Senior sister, the 10-year-old girl's illness in the morning..."
"The surgery has been done." Sun Guoguo said, "Diffuse coronary stenosis, PTCA was done."
"No stand?" Lu Chen wondered.
"Not yet. In addition, I think your idea is very good." Sun Guoguo nodded, "I really did not expect familial hypercholesterolemia. But after reading the analysis of your condition, I feel that your idea is very reasonable. ."
"But if you want to diagnose familial hypercholesterolemia, you need to do a genetic test. Our hospital doesn't have this test yet. We can only send the patient to Kyoto or the magic capital to do a related genetic test to confirm the diagnosis."
"Yeah." Lu Chen nodded.
Many diseases are difficult to diagnose.
Once diagnosed, the rest of the treatment is easy!
For example, this familial hereditary hypercholesterolemia requires intensive lipid-lowering therapy in addition to conventional treatment.
Lu Chen flipped through the record of the little girl's interventional surgery.
Coronary angiography showed 75% stenosis in the proximal left main trunk and 80% stenosis in the left internal mammary artery (LIMA) at its opening. Left circumflex branch, proximal 90% to 95% stenosis, posterior.
In addition, a renal arteriogram was also performed for her, which showed that the left renal artery also showed 80% stenosis.
"The blood vessel is narrowed to such an extent, why not put a stent?" Lu Chen was puzzled.
Generally speaking, when the blood vessel narrows more than 75%, a stent needs to be implanted.
Of course, this also depends on specific circumstances and specific analysis.
If it is an unimportant blood vessel, even if it is completely occluded, the stent may not be placed.
If it is an important vessel, even if it is only 60-70% stenosis, a stent is needed.
According to the vascular condition of this patient, the stent placement has been achieved.
If the stent is not placed, there is a high possibility of restenosis!
In other words, the patient may have another myocardial infarction!
(end of this chapter)