I can see health

Chapter 46 Li Yao's Invitation Letter
Lu Chen's heart skipped a beat.

To buy a night shift, it doesn't matter if you have money or not.

The key is to work the night shift and deal with various emergencies, which is one of the ways to quickly improve the system completion and gratitude value.

If you just stay in the general ward, the efficiency of gaining gratitude will be slower.

However, Lu Chen decided to stay put. He had to figure out what the system's gratitude value was for before making any further plans.

……

After lunch, there is a two-hour break at noon.

As soon as Lu Chen returned to the dormitory, he began to check the relevant electrocardiogram data.

The electrocardiogram he encountered this morning is somewhat familiar, but what it is and what its significance is requires further research.

Find out your long-preserved "Electrocardiogram Advanced Manual".

Lu Chen began to wander in the sea of ​​books, flipping through similar electrocardiograms.

Ventricular arrhythmia, supraventricular arrhythmia, atrial arrhythmia, coronary ischemic ECG...

After flipping through most of the manual, Lu Chen racked his brains, but still couldn't find any clues.

It was one o'clock in the afternoon without knowing it, and there was still an hour before going to work.

Lu Chen felt a little sleepy, so he leaned on the desk, squinted for half an hour, and then went to work.

Come to the eighth district of the heart.

Because Sun Guoguo worked the night shift yesterday and is off this afternoon.

If there is something that cannot be handled in the group, Sun Guoguo explained to the attending physician of the other group, and asked Lu Chen and others to find him to solve it.

In the morning, Lu Chen and the others had already filled up all the hospital beds, and no new patients would come in the afternoon.

Lu Chen began to sort out the medical records of the four-bed patients under his care.

Bed 10 is an old man who suffered twice in a row this morning. The diagnosis is coronary heart disease, ischemic cardiomyopathy, and heart failure. He is currently in critical condition and may die suddenly at any time.

Bed 11 is a mother-in-law in her 70s, diagnosed with grade 3 hypertension (very high risk group). Recently, because of large fluctuations in blood pressure, she came to the hospital this time to lower her blood pressure. At present, her blood pressure is still unstable.

12 beds, a woman who just admitted in the morning, was diagnosed with an arrhythmia whose cause is yet to be investigated. The electrocardiogram was abnormal, and no cause has been found for the time being.

Bed 13 is a patient with chest pain who is going to undergo elective coronary angiography to rule out coronary heart disease.

For the four patients, except for the 12th bed admitted in the morning, the condition of the other beds is relatively stable.

During this period, Lu Chen took the time to look at the old man in bed 10.

He is still sitting upright and has intermittent dyspnea, but his condition has improved significantly compared to when he became ill in the morning, and he can chat with others energetically.

And the color on his head has always been red, which means that Bed 10 is not completely out of danger.

The aunt on the 12th bed, Lu Chen asked her to have an echocardiogram and a chest CT in the afternoon, and there was no obvious abnormality in the results.

Lu Chen also re-examined the electrocardiogram for her, and there was no big change from the electrocardiogram when she was admitted to the hospital at the beginning of the morning.

All her auxiliary examinations have been completed, and no problems have been found in blood tests and imaging examinations.

"Doctor, when can I leave the hospital?"

"Doctor, have you found out what's wrong with me?"

"Doctor, what kind of injection are you giving me now?"

The 12-bed woman couldn't sit still in the ward, and went to the doctor's office in less than an hour.

The color of the patient's head is yellow, which means that his life is not in danger for the time being.

Lu Chen could only patiently explain to her, then comfort her, and wait for Sun Guoguo to deal with this difficult problem tomorrow.

……

Until the end of get off work, a nurse suddenly walked into the office.

"Is the doctor from the director's team here? The 10-bed patient has hematuria, go and see."

Lu Chen was extremely sensitive about his 10 beds, so he said quickly:
"Someone is here, I'll go and see right away."

Lu Chen kept the medical records he was writing, put on his stethoscope, and walked quickly towards bed 10.

As soon as he walked out of the ward, Lu Chen bumped into Li Yao who was returning from the outpatient building.

"Hello Mr. Li."

"You are Lu... Lu Chen? You just entered the department today, right?"

Li Yao's memory is not bad, and she recognized Lu Chen immediately.

"Well, yes." Lu Chen smiled.

"Running out in such a hurry, what are you going to do?" Li Yao asked with a smile.

Lu Chen said: "Just now bed 10 suddenly had hematuria, I'll go over and have a look."

"Bed 10... Is it still the old man with heart failure?" Li Yao pondered for a moment and asked.

"Yes."

"Then let's go and see together."

After speaking, Li Yao turned around and walked in the direction of bed 10.

Lu Chen froze for a moment, and followed closely behind.

Come to the ward.

The family member of the 10-bed patient, the old lady saw Li Yao at a glance.

"Director Li, you are here."

The old woman smiled and stood up from the chair beside the bed.

Li Yao nodded, and looked down at the urine bag next to the bed.

It was indeed blood red.

Normal urine should be clear and pale yellow.

"Hematuria started today?" Li Yao asked.

The old lady nodded and said: "It was fine a few days ago, just now he urinated once, and I saw that the urine tube was red, and I thought it was abnormal, so I told the nurse."

"En." Li Yao responded, and then began to examine the patient.

After auscultating the chest, Li Yao lifted the patient's quilt to examine his limbs and torso.

Check is complete.

"Director Li, is my old man okay?" the old woman said nervously.

Li Yao didn't reply, but turned to Lu Chen and asked, "Lu Chen, what is hematuria?"

Lu Chen was taken aback by the sudden question.

But he quickly reacted.

"Hematuria is divided into two types, one is gross hematuria and the other is microscopic hematuria."

"Urine containing a certain amount of red blood cells is called hematuria. If the blood volume in 1000ml of urine exceeds 1ml, and the appearance of the urine is red, it is called gross hematuria. The appearance of the urine is normal, and the fresh urine centrifuge sediment examination has more than 3 red blood cells per high power field. This is called microscopic hematuria."

Li Yao nodded slightly, "Then what do you think is the cause of this patient's gross hematuria?"

Lu Chen pondered for a while, then carefully observed the patient's urine bag.

"According to normal thinking, the hematuria caused by the damage of the urinary catheter to the urethral mucosa should be considered first. However, the patient has been intubated for a few days, and if no one pulls the catheter externally, it will not suddenly cause hematuria."

Li Yao nodded: "Since it's not the injury of the urethral mucosa, what's the reason?"

Lu Chen thought about the blood clot in the patient's throat this morning, and continued after thinking about it.

"The patient coughed up bloody sputum this morning, and sucked out a blood clot in his throat. In connection with all these situations, abnormal blood coagulation or bleeding caused by drugs should be considered!"

"I looked through all the patient's doctor's orders, because the patient is currently diagnosed with coronary heart disease and needs to routinely use antiplatelet drugs, and also has atrial fibrillation. According to the CHA2DS2-VASC score of anticoagulation in atrial fibrillation, anticoagulant drugs should be used in combination, Berry OK."

"Antiplatelet combined with anticoagulation, the patient is older, and the risk of bleeding increases. Currently, it is considered that the bleeding may be caused by the drug."

After listening to Lu Chen's analysis, Li Yao showed admiration on her face.

"Yes, well-organized and well-founded."

It is rare to have such an outstanding little guy, Li Yao is very pleased.

And Lu Chen breathed a sigh of relief, he finally knew why Senior Sister Sun Guoguo liked to ask questions so much!

It turns out that this is a tradition in the group, inherited in one continuous line!

At some point, Ke Yue and Jiang Qingyan also came to the ward.

Li Yao looked at them.

"Ke Yue, tell me how to deal with this kind of bleeding, bleeding caused by anticoagulant and antiplatelet drugs."

Ke Yue's face turned bitter.

I really shouldn't have followed you to the ward.

Now this is a fire!
"You should stop taking the medicine first..."

After speaking, Ke Yue glanced at Lu Chen.

Seeing her looking at him, Lu Chen immediately understood and shook his head gently.

Ke Yue shook his head immediately: "Ah, no, we can't stop the medicine first."

Li Yao frowned, "What measures are you using?"

Ke Yue grimaced and pursed her lips.

"Teacher, I, I forgot."

Li Yao shook her head lightly, sighed, and looked back at Jiang Qingyan who was beside her.

"Jiang Qingyan, what's your opinion?"

Jiang Qingyan raised her brows, and said slowly: "You should check the blood routine and coagulation immediately. If these indicators are okay, then replace the aspirin with indobufen and Xarelto with intravenous low-molecular-weight heparin." If the blood routine and coagulation indicators are abnormal, the drug can be stopped first, and the antiplatelet and anticoagulant drugs can be started after the bleeding stops."

"Lu Chen, what's your opinion?" Li Yao looked at Lu Chen.

"It's almost the same as Jiang Qingyan's." Lu Chen said, "But there is one thing to add. In fact, patients with long-term stable coronary heart disease and atrial fibrillation can use anticoagulant drugs alone and stop using antiplatelet drugs, especially for the elderly, Patients at high risk of bleeding."

Jiang Qingyan frowned. In her impression, this kind of treatment method didn't seem to be written in the internal medicine book.

Lu Chen seemed to have seen through her thoughts, and added in a low voice.

"This is mentioned in the latest atrial fibrillation guidelines, it's not written in the book."

Jiang Qingyan nodded lightly and said, "Well, thank you."

Ke Yue was already holding a pen to record Jiang Qingyan and Lu Chen's treatment opinions in his notebook.

Li Yao on the side looked at Lu Chen with satisfaction, and at the same time turned her head and said to Jiang Qingyan and Ke Yue.

"The two of you need to improve your knowledge. It's no different than when you were an undergraduate student. You not only need to be familiar with the knowledge in internal medicine books, but also frequently read the relevant guidelines of the Department of Cardiology."

"You have to remember one thing, follow the guidelines to treat diseases, and we will be invincible in the event of medical disputes! But if everyone believes in treating diseases freely, no matter how good your treatment is, if any mistakes occur, If you cause bad consequences, then you are fully responsible!"

"Understood, teacher."

Ke Yue and Jiang Qingyan nodded.

"This patient will be treated according to what Jiang Qingyan and Lu Chen said." Li Yao said, "Also, Lu Chen, please come to the office with me."

"Okay." Lu Chen nodded.

Li Yao walked out of the ward, and Lu Chen followed closely behind her.

……

Walk into the director's office.

This is the second time Lu Chen has come to this office, and the first time was when he was transferred.

The office is furnished as usual.

A desk, a welcoming pine.

"It's your first day in the department, how do you feel?" Li Yao asked with a smile.

"It's good. There are a lot of patients. In the first morning, I encountered two rescues."

Li Yao smiled, "I heard from Guoguo that the patient in bed 10 had heart failure twice in the morning, and the second time was thanks to your help suctioning the sputum."

Lu Chen smiled, and rubbed the back of his head embarrassingly.

"Do you have any plans for your postgraduate career in the next three years?" Li Yao got straight to the point.

Lu Chen pondered for a long while before saying:

"Work hard, learn clinical knowledge, and be a qualified doctor."

If you talk about your goals.

It's very simple, to be the best cardiologist in the world.

But this goal is too ambitious and too illusory.

Say it, the credibility is not high.

So such a lofty goal needs to be completed in stages.

The goal of the postgraduate period is to be familiar with the diseases in each department.

An excellent cardiologist must first be an excellent physician!
"What about future career planning?" Li Yao said, "If you want to go far in medicine, a master's degree and a doctorate degree are just the beginning, and there is still more room for you to explore in the future. If you just want to find a job work, maybe read a master’s degree or a doctor’s degree, and publish a few articles to be able to enter most hospitals in China.”

Lu Chen firmly said: "Teacher, I want to do my best!"

Li Yao smiled and understood what Lu Chen meant.

"According to the current domestic medical environment, if you want to be an excellent doctor, it is not enough to just learn clinical theoretical knowledge, you also need to have independent scientific research ability!"

"In the past three years, in addition to mastering clinical knowledge and skills, you must not lag behind in scientific research!"

"You can't go far in the hospital system just by doing clinical work. You can't even be promoted to deputy director."

At present, the promotion of senior professional titles in domestic medicine requires the support of thesis.

In some cases, scientific research capabilities far outweigh clinical capabilities.

For example, doctoral graduates in general surgery may not even be able to perform an operation on appendicitis or gallbladder stones!

Being able to write papers means that you can apply for various projects and funds.

With money, the hospital can develop, publish more articles, and apply for larger projects.

This is the result of a virtuous circle and vice versa.

Lu Chen somewhat understood what Li Yao meant. She asked herself to participate in scientific research experiments.

"But you don't need to be too impatient to do scientific research." Li Yao continued, "If you have time, you can come to the laboratory building at the back door of the hospital. I have a few experimental projects at present, and I will let your senior brother and sister take you to study."

Lu Chen nodded and said, "Thank you teacher, I will definitely study when I have time."

Li Yao said: "In addition, I want to remind you that the school has various scholarships and bursaries every year, and these scholarships are evaluated through essays."

"For example, the national scholarship is 1 yuan, and the dissertation evaluation accounts for the vast majority of the proportion. Whether you can get these scholarships depends entirely on your own efforts."

"Thank you teacher for reminding."

From the current point of view, Li Yao's tutor is very good.

For the sake of students, help Lu Chen make career plans.

Li Yao asked Lu Chen a few more questions about the department and life.

Lu Chen answered one by one, and the conversation ended.

Before leaving, Li Yao also handed Lu Chen a card, which was the access control card of the laboratory building at the back door.

Besides, Li Yao asked Lu Chen to leave her email address.

As soon as Lu Chen returned to the doctor's office, he received an email from Li Yao.

This is an electronic invitation.

(End of this chapter)