I can see the status bar

Chapter 20 Induction
Sun Lien made his own diagnosis for the first time, and he is very confident in this diagnosis.

But this kind of diagnosis... There is absolutely no way to convince Zhou Jun, who has always been rigorous.

In fact, only based on the existing medical history data and the patient's symptoms, the simultaneous outbreak of syphilitic encephalopathy and syphilitic liver disease is not even in the list of "possible diseases" at all.If it weren't for the status bar as a basis, Sun Lien himself would not have believed that a patient with tertiary syphilis would show symptoms of encephalopathy and liver disease at the same time.This doesn't fit the "common principles" of diagnosing the condition.At least all other possibilities should be ruled out before extending to syphilis.

"First do blood routine, five items of liver function and bacterial culture." Zhou Jun made a decisive decision and began to instruct the diagnosis work. "After confirming the state of liver failure, polyene phospholipids should be given immediately. First, give him two injections slowly to see the effect." Polyenphos refers to polyene phosphatidylcholine injection, a commonly used liver-protecting drug.Most of the names of western medicines are long and awkward, and most of the doctors will use the conventional abbreviations to call them.This appellation is different for each hospital and even each department.

"By the way, let's check his liver function and do a brain CT to make sure there is no bleeding in his brain." Zhou Jun continued to add, and he suddenly said to Sun Li'en who was recording the sum, "What other inspection items do you think are needed?"

"I think..." Sun Lien thought for a while, "Let's add a lumbar puncture to rule out other neurological diseases."

"Hmm..." Zhou Jun nodded thoughtfully, "There are enough medical reasons, and it's uncomfortable to do." He smiled at Sun Li'en, "I like this idea."

This is not part of the revenge... Sun Lien nodded with a wry smile.

Deputy Director Liu still didn't come back, probably because he continued to supervise Lin Lan's operation in the operating room.Jiang Lun, who was called by Sun Li'en on the phone, moved very quickly.Zheng Xiaoyu just finished drawing blood here when he appeared in the emergency room.

"There are not many opportunities for our department to be called for consultation." Jiang Lun smiled and shook hands with Zhou Jun, walked to the bedside and looked at Zheng Xiaoyu, "That's right, it's this son of a bitch."

"Why did he come to see you?" Sun Lien's eyes lit up, "What are the symptoms?"

"This turtle son said that he had ulcers on his body." Jiang Lun recalled the scene at that time, "But he said that he was busy with work, so he had time to visit today. The ulcers on his body had healed, and there were only some scars. I couldn't see any what is the problem."

Ulcers with special forms are one of the manifestations of tertiary syphilis.After the syphilis rash gradually expands, the center will begin to soften and break, and discharge pus-like secretions.But this kind of ulcer will not get better quickly. If it is not treated, it will take at least half a year to heal on its own.

"The patient himself denied the sexual history." The medical history is the medical term for "high-risk sexual behavior experience".Jiang Lun seemed to have guessed what Sun Lien was thinking, but his views on syphilis were as conservative as other doctors. "If the turtle son fainted suddenly, it was because of syphilis. The course of his disease must have been at least 10 years, and he has not been cured during this period." Dr. Jiang shrugged his shoulders, "It's the 21st century, and penicillin has long been out of use." It's called penicillin. Ten years to cure a syphilis? Impossible."

After suffering from syphilis, this person can delay seeing a doctor for more than half a year, so he must be a late-stage procrastinator.Sun Lien sighed, "Does he have other symptoms?"

"I guess his ears are not very good." Jiang Lun suddenly slapped his thigh, "I asked him if he had a history of drug allergies, and it took him five or six times to understand."

That's not a hearing problem... Another symptom of tertiary syphilis matched, this one is a manifestation of paralytic dementia.Sun Lien silently ticked off the checklist in his heart.

"In general, I think this may be a lunatic." Jiang Lun gave his opinion, "If you are worried, then do the five items of infectious diseases together."

Jiang Lun left with his hands behind his back, and Sun Li'en also got what he wanted.

"Doctor Jiang suggested that we do the five items of infectious diseases." Sun Lien took a chicken feather as an arrow, and began to fool his own teacher. "He said that the patient had strenuously denied any medical history."

For dermatologists, strenuous denial is basically tantamount to ghosts.Treponema pallidum antibody detection is included in the five items of infectious diseases.As long as Zheng Xiaoyu is confirmed to have syphilis after this test, Zhou Jun will definitely realize that he is facing a very difficult case of compound tertiary syphilis.

Zheng Xiaoyu here was clearly arranged by Sun Lien.The high school student who was previously protected by Sun Lien was also pushed out of the CT room.The result of enhanced angiography is very clear, this is another cerebrovascular accident.

He did not suffer from a cerebral aneurysm hemorrhage due to a fall, but the aneurysm hemorrhage caused him to lose control of his body and fell unconscious.As luck would have it, the high school student had some sense of self-safety and wore a helmet over his head.Otherwise the pavement stone that broke his helmet could have killed him.

"Put a bottle of mannitol first, and ask neurologists for consultation." A ruptured cerebral aneurysm is a very dangerous disease, and Zhou Jun, who took the initiative to take over the case, devoted himself to intense work.Cerebral hematoma caused by ruptured aneurysm can compress brain tissue, and depending on the location of compression, different symptoms of neurological diseases may appear.If the brain stem is compressed, it may even suppress the patient's heartbeat and breathing.Moreover, excessive intracranial pressure may even squeeze the already fragile brain tissue to other positions, resulting in brain herniation.

Mannitol is one of the regular medicines in the emergency room.As a good diuretic, it can effectively act on various organs of the human body, increase plasma osmotic pressure, and rapidly dehydrate the organs.In short, it shrinks the brain.

The shrunken brain frees up more space to reduce intracranial pressure, which can reduce the possibility of brain herniation in the case of cerebral hemorrhage-the fatality rate of cerebral hemorrhage is 30%, while the fatality rate of brain herniation The rate is as high as 80%.Although the shrunken brain after dehydration may cause the originally compressed blood vessels to lose pressure and rebleed, the principle of meeting two evils and its lesser is exactly the same in medical decision-making.

As the weather gradually cooled, more and more patients with cardiovascular and cerebrovascular accidents began to be encountered in the emergency room of the Fourth Central Hospital.The Fourth Central Hospital, which shoulders the two responsibilities of the stroke center and the chest pain center at the same time, has become busy.

(End of this chapter)