I can see the status bar

Chapter 128 Sun Lien's Reasoning
What are good case writing techniques?Just look at the record of the association in Sun Lien's hand.Unlike ordinary outpatient clinics, most emergency patients are acutely ill and seriously ill.There is very little time left for doctors to write cases.In the Fourth Central Hospital, most cases in the emergency department are completed by interns and regular trainees.In the past two months, Sun Li'en's most important job every day was to start writing the case after he had beaten Zhou Jun.In the emergency room, Zhou Jun needs to take over, and there are at least four or five patients who need to be observed and treated every day-their cases are basically written by Sun Lien.

If the case was written according to the requirements of the association... Sun Lien was frightened by his own conception and broke into a cold sweat. The description of a patient's case would have to be densely packed on two pages, at least [-] words to start.Five patients is [-] words.This is just a record of the case, and in the middle of it, you have to deal with the patient, participate in the rescue, go to various departments to invite doctors to come for consultation, and take the time to study and enrich yourself-even the iron man can't resist it!

Although useful, it is difficult to implement.This is the biggest problem with the synergy model.Ordinary people always talk about two major problems when seeing a doctor-seeing a doctor is difficult, and seeing a doctor is expensive.In fact, after thinking about it, this is actually looking at the world, and the level of China's medical system is definitely among the top.For example, under the British NHS system model, seeing a doctor is not expensive, but the cost is that you have to wait in line for seven or eight hours in the emergency room, and wait a few days before being transferred to a specialist for treatment after the situation stabilizes. Seeing a doctor is not ordinary.And in the United States.It is not difficult to see a doctor.But even with commercial insurance with a payout limit of one million dollars, a visit to the hospital by the middle class will inevitably hurt their muscles and bones.If surgery is required, the hospital bill will never be less than [-] US dollars.

In China, as long as you come to the hospital to register, you can get timely treatment from emergency doctors and specialists.Moreover, the price of general surgery is covered by social security, and the part that an individual bears at one time will basically not exceed 2000 yuan.

Regarding this difference, there used to be such a joke among doctors.A man has appendicitis.In the UK, he perforated his appendix due to an NHS referral error.In the United States, he was charged and jailed for failing to pay the $[-] surgery fee.In China, this patient beat up the doctor who operated on him because he thought the minimally invasive hole in his stomach was not good enough.

Different countries have different requirements.Sun Lien's thoughts turned around, and he returned to the case record book in front of him.It's not his job to think about health care reform now.Participating in diagnosis and treating patients is what he should do now.

After deliberating for a long time, Sun Lien suddenly looked at the treatment records and asked, "Have you given her antibiotics?"

"Because the initial suspicion is bacterial meningitis." Yuan Ping'an replied, "This patient's symptoms are actually quite obvious. I don't quite understand why Boss Zhu asked you to diagnose this case."

Sun Li'en glanced at Lu Xuexin's status bar again, and suddenly asked, "Did you give her a cerebrospinal fluid smear and culture?"

When the cerebrospinal fluid protein is so high, it is basically tantamount to directly declaring that the patient's nervous tissue has a serious infection or lesion.If the deputy director of the emergency department of Tongxie thinks that Lu Xuexin has bacterial meningitis, then there is basically no need for further diagnosis of this patient.Just give enough antibiotics and treat other symptoms symptomatically.

"The patient was sent in this afternoon, and the smear test did not detect any pathogens. It will take about two days for culture." Yuan Pingan replied, "Is there any problem?"

"The results of the biochemical examination of the cerebrospinal fluid are a bit strange." Sun Lien found the biochemical examination report of the cerebrospinal fluid that the co-worker had given to Lu Xuexin a few hours ago.Although the cerebrospinal fluid protein mentioned above is still very high, it is only about 800mg/L.It is much lower than the current 1720mg/L indicated in the status bar.After pondering for a moment, he asked, "The patient has a history of SLE (systemic lupus erythematosus) and has been taking immune system suppressants for a long time. This situation must also be taken into consideration."

Yuan Ping'an frowned, "You mean... the bacteria that cause the infection may not be common?"

"If it was caused by common bacteria, her symptoms should improve slightly after receiving more than ten hours of antibiotic treatment." Sun Lien expressed cautious affirmation of Yuan Ping'an's deduction. "Her temperature is still around 39 degrees and she is unconscious. It doesn't look like she's getting better."

"Doctor Yuan, the MRI results of the 9th bed are out!" The little nurse who sent the MRI looked at Sun Lien curiously, "Is this the new doctor in our department?"

Yuan Pingan took the imaging photo and said with a smile, "This is a doctor from a foreign unit. He was caught by Director Zhu in the bathhouse and came here for consultation."

Sun Li'en smiled awkwardly, stood behind Yuan Ping'an, stretched his neck together with him, and watched the movie by the light of the energy-saving lamp.

"There is obvious T2 signal enhancement in the meninges..." Sun Lien's reading ability is not very strong, but he can still see something is wrong. "There is an abnormal signal in the right basal ganglia."

Sun Lien pointed to the part where he found the abnormality, which is near the basal ganglia of the human body, close to the thalamus.On the MRI image, it can be clearly seen that there are several white circles concentrated in this area.

As the two continued to read the films, more and more anomalies were identified.Abnormal signals appeared in Lu Xuexin's brain, including bilateral frontoparietal lobes, corona radiata, left lateral ventricle, right basal ganglia, and right parahippocampal gyrus.

These abnormal signals are not the same as the small white balls in Chen Wen's head. They are more like small circles. There are obvious white signals on the outside where the brain tissue meets, while the inside of the circle is more obvious than the outer brain tissue. The color is darker.This proves that what's inside the circle is at least denser than normal brain tissue.

"What's this?" Yuan Pingan, who was well-informed, was also a little dazed. He subconsciously wanted to invite doctors from the Department of Neurosurgery and Imaging for consultation, but suddenly saw the silent Sun Li'en. "Doctor Sun, do you have any clues?"

"Look here." Sun Lien pointed to the abnormal signal area that he and Yuan Pingan discovered at the beginning, "Have you noticed that the shape of the abnormal signal here is different? It protrudes into the third ventricle. "

Yuan Pingan frowned and asked, "What does this mean?" He didn't see the significance of this intrusive feature.

"The main components of the human brain are fat and protein." Sun Lien tried to explain with his own knowledge, "and its density should be relatively uniform in all regions. But the ventricle is different, and the cerebrospinal fluid contained in the ventricle can be approximated Think of them as water. They're denser than brain tissue."

Yuan Ping'an was a little dizzy. He shook his head and asked, "I know that the density of cerebrospinal fluid is greater than that of brain tissue. Then what?"

"And the intrusion here proves that the density of the substance in these white signals should be greater than that of the cerebrospinal fluid, otherwise it would not have intruded into the ventricle, but should be squeezed down by the ventricle." Sun Lien clicked on the MRI film, "I think , these could be abscesses."

"Abscess?" Yuan Pingan asked puzzled, "If it's a brain abscess, her condition should improve after antibiotic treatment."

Sun Lien looked at the treatment plan, shook his head and said, "This is the main reason why Director Zhu used this case to test me." He pointed out the treatment plan in the case to Yuan Pingan, "You have already used meropenem and cephalosporin Qu Song, but it didn't improve the performance."

Meropenem, a beta-lactam antibiotic, is commonly used in combination with ceftriaxone for the treatment of bacterial meningitis and brain abscesses.

"So, the one that infected Lu Xuexin's brain should be a bacterium that is insensitive or resistant to both meropenem and ceftriaxone." Sun Lien continued his diagnosis, "At the same time, the infection of this bacterium should not Uncommon. It can show symptoms of brain abscess and meningitis at the same time - at least I haven't heard of this bacteria."

"What do you mean uncommon?" Yuan Ping'an asked, "You mean...infections caused by rare bacteria?"

Sun Lien nodded, then shook his head again, "I can think of two possibilities at the moment. One is that the bacteria itself is very rare, so there are relatively few corresponding case reports. But this possibility is not too great— ——If you have never seen Tongxie, then the possibility of the existence of this kind of bacteria is not very high. The second possibility..." Sun Lien paused, "The second possibility is that this may be some relatively common and It is not an infection caused by serious bacteria."

Yuan Ping'an's eyes widened, "Because... SLE?"

"Strictly speaking, it's because of the drug treatment to control SLE." Sun Li'en nodded, this is what he was most worried about. "The patient has been taking hydroxychloroquine sulfate and methylprednisolone for a long time because of SLE. Her immune system will be much weaker than ordinary people. Some common bacteria may cause serious consequences."

Yuan Pingan looked at Lu Xuexin who was in a coma with some headaches, "That's troublesome. What kind of bacteria can be insensitive to two broad-spectrum antibiotics at the same time, and can't be detected on cerebrospinal fluid smears? Moreover, after infecting the brain, it can also cause meningeal infection at the same time. Inflammation and brain abscess..."

"My suggestion is to step up observation and ask neurosurgeons and radiologists to consult. First discuss whether puncture decompression of brain abscess is necessary." Sun Li'en sighed. Although he said so much, he didn't understand what exactly Bacteria caused Lu Xuexin's symptoms. "At the same time, you should ask the Laboratory Department whether there are any detection methods other than cerebrospinal fluid culture that can detect pathogens." Sun Lien paused, and suddenly thought of the idea and proposal put forward by Xiao Linfeng. "By the way, can the co-worker do mNGS inspection?"

　Everyone, I, Luo Sanguan, are back!

　　There are two updates today, and one more update will be released from 10:30 to [-]:[-] in the evening.

　　
　
(End of this chapter)