I'm really an intern

Chapter 8

"Bed 40, male, 36 years old, admitted to the hospital at [-]:[-] p.m. yesterday..."

Zhang Tianyang quickly recounted yesterday's situation, and selectively skipped the part of betting with Senior Sister Liang.

Professor Liu listened silently, feeling a little surprised.

He has practiced medicine for decades, and has been leading students for nearly 20 years. Few students report as smoothly and clearly as Zhang Tianyang for the first time.

Many junior doctors with insufficient psychological quality would even stutter in front of him.

This made Professor Liu couldn't help but become interested in Zhang Tianyang, and deliberately raised his face.

"According to what you said, the patient has both high blood pressure and kidney failure and regular dialysis, so why do you think his condition yesterday was due to lack of dialysis in time?"

Hearing this, the brother who had just been scolded widened his eyes and quietly leaned back to reduce his sense of existence.

This kind of pursuit is the most terrible problem.

The most difficult thing in clinical practice is the differential diagnosis of various diseases, and the difference is a thousand miles away.

The reason why senior doctors are always authoritative is not because they are old, but because they have rich clinical experience.And these experiences endow them with the ability to distinguish diseases.

And doctors like them, who have less than three years of clinical experience, have come to learn how the bosses diagnose and treat them. Having such problems can make them break out in a cold sweat.

Fortunately, there is a junior brother to help to come to the bottom!

While lowering his sense of presence, the senior brother made a cheering gesture to Zhang Tianyang.

Junior brother, you are the one to be scolded at the front!

Brothers will support you spiritually!

Zhang Tianyang didn't know what his brother was thinking, so he blinked and sorted out his words.

"My judgment is mainly based on three points.

First, there is clinical monism.

When a patient has multi-organ and multi-system damage, it is unlikely that he has primary lesions in all organs of the body at the same time.

The more likely reason is that there is a problem with one of his organs or systems, which produces a chain reaction, causing secondary problems in other organs and systems.

As for the 40-bed patient, considering that he is only 36 years old and relatively young, he has no family history of hypertension, and I saw that his history of renal failure was two years longer than that of hypertension.

So I judged that his high blood pressure should be secondary to renal failure.

80% to 90% of patients with end-stage renal disease have hypertension.

In this patient, nephrons are lost in large numbers, resulting in water and sodium retention and increased extracellular volume, as well as renal RAAS activation and decreased sodium excretion.High blood pressure further increases the pressure of the glomerular capsule, forming a vicious circle and aggravating kidney disease.

40 beds should be the case. "

It is well-founded and logical, and even the mechanism is clearly explained to you.

After saying this, the faces of the two senior sisters except Senior Sister Liang turned from casual to surprised, and the expression of the senior brother became even duller.

The smile on Professor Liu's face seemed to become thicker, "There are two more points, you continue."

"Second, I'm thinking about hyperkalemia.

The kidneys have a strong compensatory capacity for K+ excretion, but Bed 40 is a patient with renal failure, and I calculated that his GFR is below 5.

In this case, it is necessary to rely on blood pressure dialysis to maintain a normal level of blood potassium. If dialysis is not performed for a long time, hyperkalemia will result.

Bed 40's symptoms included muscle weakness, especially in the lower extremities, and cardiac arrhythmia, which were completely consistent with the clinical symptoms of hyperkalemia.

At the same time, I have not seen the severe headache, vomiting, hemiplegia, and retinopathy caused by transient hypertension.

So I am more inclined to think that he has hyperkalemia caused by no dialysis for a long time.

In the end, the results of the urgent blood test also confirmed my judgment. "

The second point is also well-founded, and Professor Liu could not help but nodded slightly.

And the three senior sisters and one senior even temporarily forgot Zhang Tianyang's status as an intern, and started the lecture mode.

Especially senior brother, the thought of "junior brother being scolded for me" has long been thrown out of the sky, and now he is taking a small notebook to memorize the key points Zhang Tianyang said.

Maybe I will take the exam in the future!

"Yo, what about the lecture early in the morning?"

Professor He in the next group couldn't help being attracted by the situation here, and greeted Professor Liu with a smile.

Professor Liu waved his hand to signal him to hold back and let Zhang Tianyang continue.

Zhang Tianyang was not stage-frightened either, with a calm expression on his face.

"Finally, under the circumstances at that time, no matter the patient's condition changed due to various reasons, dialysis treatment was necessary and beneficial.

Moreover, I specially asked the nurse sister to prepare calcium gluconate and sodium bicarbonate for hyperkalemia immediately.

I also saw that Keli has a spare sodium nitroprusside injection for hypertensive emergencies.

Therefore, no matter how the condition changes, I can respond to all changes with the same. "

The voice fell, and the surrounding was quiet.

Three senior sisters were in shock, one senior was busy jotting down a notebook, while two professors were still appreciating and reminiscing.

After a pause for a few seconds, Professor Liu clapped his hands with a smile.

"Okay! Well said! Old He asked me if I was giving a lecture, I think, it really is!

Nice guy! "

Then, Professor Liu turned his head to the brothers and sisters again, "You guys, listen carefully, when your clinical thinking will be so clear, I will be able to let you fly by yourself with confidence!"

As he spoke, he glared at his senior brother, "Especially you, who also suffer from hyperkalemia, let's see how they deal with it!"

The senior brother nodded like pounding garlic, obediently stood at attention and was beaten.

Originally, I was thinking of "the younger brother will attract the firepower for me", but I didn't expect it to become "I have to throw it away when people compare people", which was severely treated as a negative teaching material.

But he didn't mean to resent Zhang Tianyang at all, on the contrary, he admired him immensely, "Junior brother is really amazing!"

This is the case clinically, whoever has the most ability will be the greatest.

Professor He, who came over just now, couldn't help it anymore. Everyone has a love for talent, "Old Liu, is this the new attending physician in your group?"

The levels in the hospital are roughly divided into professors > associate professors > attendings > hospitalization > advanced training > regular training > internship.

Zhang Tianyang looked too young, not like a professor or an associate professor.

But looking at his clear organization, rich knowledge base, and "reliable" atmosphere, Professor He is more inclined to guess his qualifications upwards.

"The attending doctor is definitely not. He is also called Senior Sister Xiaoliang. And he is not a resident doctor. My group does not have a resident doctor."

Professor Liu is not too sure about Zhang Tianyang's level, but seeing how seasoned he is, "Should be a trainee doctor, right? Just like Xiao Liang and the others."

Zhang Tianyang smiled and shook his head. He was about to speak when Professor Liu stopped him.

"That's the regular training doctor! You can do it, you can have such a clinical thinking during the regular training stage! Then how many years have you been in the regular training now?"

Senior Sister Liang couldn't stand it anymore, "Professor, Junior Brother is a new intern..."

"What did you say?" Before Professor Liu could react, Professor He called out first, "Is it the internship from the intern classmate?"

Zhang Tianyang explained to the embarrassing eyes of the two professors,

"That's right, I am a fifth-year senior and have just entered the clinical practice. This is my second week in the clinic."

Now, the two professors are quiet.

"Cheating, right? Intern? Second week? Patriarch's meal?" Professor He stared and murmured softly.

And Professor Liu looked at Zhang Tianyang's badge solemnly, and said the same thing for the third time.

"Zhang Tianyang, Xiao Zhang, right? You are not bad, you can do it!"

"Why didn't I meet such an intern classmate?! Is the teacher who assigned the students targeting me!"

Professor He actually started to make a fuss, and put his arm around Professor Liu's shoulder,

"Old Liu, let's discuss something. You see that there are so many people in your group. We only have two or three in our group. Why don't you give me one?"

"I don't take advantage of you, I want an intern classmate, how about it?"

"Hehe!" Professor Liu scolded with a smile, "Hurry up and go back!"

Zhang Tianyang is such a good seedling, how could he let it go again in his hands!

(End of this chapter)