I can see health

Chapter 461 Guessing the Diagnosis?

There are three electrophysiological surgeries in one morning, and the consultation fee is 6000 yuan in total.

Lu Chen put away the envelope for the time being, and planned to communicate with Li Yao later.

"Congratulations, I received +1 from Fan Zhiping!"

"Congratulations, I received a thank you value of +5 from Yin Chao!"

"Congratulations, the thank you from Lin Xin is worth +1!"

"..."

After completing these three surgeries, Lu Chen also received dozens of thank you points.

The degree of system upgrade completion has also been improved accordingly.

"Director Li, I booked a hotel for noon." Yin Chao said with a smile, "You and Dr. Lu can have lunch first, and then rest for a while."

"Okay." Li Yao nodded in agreement.

Lu Chen was slightly taken aback.

He thought Li Yao would go straight back to the hospital, but he didn't expect to stay all afternoon.

"Lu Chen, we will go to the cardiology ward in the afternoon." Li Yao explained.

"Ah."

With the envelope in his arms, Lu Chen got into the business car and arrived at the hotel with Li Yao.

After eating a sumptuous lunch, after Yin Chao and the others left, Lu Chen said, "Teacher, about the consultation fee..."

Li Yao smiled and waved her hands, "Take it, you did the operation, and you deserve the consultation fee."

"Teacher, but this is too much." Lu Chen paused.

If you work for two and a half hours in the morning, you can get 6000 yuan.

For most people, this is a lot of money.

"Regular income, after the approval of the medical department and the health bureau, you can take it." Li Yao said seriously, "What's more, our electrophysiologist is a small head, and there are more coronary interventions than us. You young people, spend money There are many places to talk about love and so on, and the usual living expenses are definitely not enough."

Seeing what Li Yao said, Lu Chen couldn't refuse the mentor's kindness, so he nodded and agreed.

"If there is a chance in the future, I will take you out for a walk." Li Yao added.

"Thank you, teacher."

Lu Chen knew that this was another opportunity for Li Yao to create for herself.

What he lacks now is the opportunity to practice.

In addition, flying knives can make some extra money, which is what others can only wish for!

……

After lunch break, two o'clock in the afternoon.

Lu Chen and Li Yao came to the Cardiology Ward of Fengm County People's Hospital.

Lu Chen also learned that this visit to the ward was mainly for a patient.

This patient is not only a relative of the dean, but also an acquaintance of the school leader.

The patient is currently hospitalized in the Department of Cardiology, but after almost a month of treatment, he still hasn't improved.

Originally, it was transferred to Jinghua University Hospital for treatment, but the patient was old and in an unstable condition, and could not withstand the long journey, so he had to be treated conservatively in the county hospital.

……

This time, taking advantage of Li Yao's visit to Fengm County People's Hospital, the director personally invited her to come and see her.

"Professor Li, this patient's family members are not very good at communicating!" Fan Zhiping quietly said to Li Yao, "The attitude is not very good. We usually let the director communicate in person."

He happened to be the doctor in charge of the patient.

For this kind of "relationship" patients, they really have a headache.

Don't think that acquaintances are easy to communicate. A considerable number of "related" patients rely on this relationship to ignore various rules of the department and even interfere with the process of treatment and medication.

For example, this medicine is made in China and cannot be used.

The other medicine has any side effects and cannot be used.

But thinking about this kind of patients, Li Yao has seen a lot.

If she hadn't been personally invited by the dean, she definitely wouldn't have come.

Li Yao looked indifferently, and said softly: "I am here to see a doctor, not to please patients and their families."

Fan Zhiping smiled mischievously, only professors have this kind of courage, these little doctors don't dare to do so.

"Professor Li, should we first see the patient or the medical record?"

"Let's see the patient first." Li Yao said.

Afterwards, Fan Zhiping brought the two of them to the ward.

……

This is a VIP single room.

The patient was half lying on the bed, and the head of the bed was shaken.

His eyes were a little dull, his lips were blue and purple, but he was conscious and his vital signs were stable.

Next to the hospital bed, there was a middle-aged woman sitting. She had big red waves and was dressed in bright and beautiful clothes.

Walking to the bedside, Fan Zhiping began to introduce, "This is Professor Li Yao from the Cardiology Department of Jinghua Second Hospital, who came here to see patients."

The big wave woman immediately stood up with a smile on her face.

"Professor Li, please sit down."

As she said that, she really took out a chair and put it in front of Li Yao.

Li Yao frowned, "I don't need to sit when I come to see patients. Besides, we doctors never sit in the ward."

"Uh." The smile on the big wave woman's face stagnated, and then she smiled mischievously.

At this time, Fan Zhiping began to report the medical history.

"The patient is an 80-year-old male who complained of chest tightness, shortness of breath and edema of both lower extremities and was admitted to the hospital for 1 month."

"The patient developed exertional chest tightness, shortness of breath, edema of both lower extremities, loss of appetite, cough, and sputum a month ago. He was diagnosed with cor pulmonale and chronic obstructive pulmonary disease at the local health center, and the treatment effect was not good. "

"He had hypertension and chronic bronchitis in the past."

After listening to the introduction of the medical history, Li Yao nodded and began to conduct simple consultations.

Lu Chen followed behind Li Yao, conducting a physical examination on the patient.

"The mind is clear, the jugular veins are distended, the breathing sounds of both lungs are clear, and no dry or wet rales are heard. Both lower extremities are edema. Abdominal and nervous system examinations are negative."

After the consultation and physical examination were over, everyone prepared to return to the doctor's office.

However, just as he was about to leave, he was stopped by a middle-aged woman.

"Professor Li, how is my father's illness?"

In front of the patient, Li Yao couldn't say much, "Don't worry, I will communicate with your bed doctor after I finish reading the medical records, and your bed doctor will communicate with you when the time comes."

Li Yao was about to leave, but the middle-aged woman was still a little reluctant, "Professor Li, the dean is a relative of my family, and he came here today..."

Li Yao paused slightly, then left the ward without stopping.

……

Get out of the ward.

Fan Zhiping shook his head helplessly and said in a soft voice: "Professor Li, don't worry, she's not bad today, her usual attitude is much worse than this."

Li Yao shook her head slightly: "I have seen this kind of patients a lot, so go back and read the medical records."

"it is good."

Back in the doctor's office, Fan Zhiping frowned and said, "Professor Li, the main problem with this patient is that the treatment effect is not very good."

Li Yao replied unhurriedly: "The treatment effect is not good, do you have any thoughts?"

Fan Zhiping had been in the Eighth District of Heart for half a year, and Li Yao also knew him.

Fan Zhiping paused, and replied: "Professor Li, the first thing I think about is whether the drug treatment is not in place? Second, is our diagnosis wrong?"

While talking, Fan Zhiping took out the patient's medical records.

He printed two copies of all the medical records and handed them to Lu Chen and Li Yao respectively.

……

After reading all the medical records, Li Yao asked, "What is your current diagnosis?"

Fan Zhiping organized the speech and said: "The patient was diagnosed with cor pulmonale in the hospital. I think the possibility is relatively small. According to the echocardiography and other examinations, we consider hypertensive heart disease, heart failure, chronic obstructive lung disease."

After hearing Fan Zhiping's description, Lu Chen looked through the patient's echocardiography report.

The echocardiographic report shows: the end-diastolic diameter of the left ventricle is 40mm, the end-diastolic diameter of the right ventricle is 16mm, the left atrium is 46mm, and the right atrium is 59x44mm.In line with hypertensive cardiac ultrasound changes, biventricular enlargement, left ventricular systolic function is normal.

Lu Chen knew in his heart that Fan Zhiping's diagnosis should be based on the echocardiography report.

"However, we have given antihypertensive and anti-heart failure treatments, and the symptoms of heart failure are still obvious." Fan Zhiping said.

Diagnosed, but the treatment effect is not satisfactory, or not much effect.

……

On the side, Lu Chen continued to look through all the examinations of the patient.

pro-BNP: 8141.02 pg/ml.

Blood routine, liver and kidney function, QR-CRP, coagulation function, D-dimer, blood lipid, blood sugar, nail function, urine protein, and stool routine showed no obvious abnormalities.

Chest CT showed: bilateral lower lobe infection, a small amount of bilateral pleural effusion, and multiple small nodules in the upper and middle lobe of the right lung.

"Professor Li, your opinion..." Fan Zhiping said calmly.

Li Yao didn't answer directly, but instead asked, "Where's the patient's ECG?"

"Oh, here it is." Fan Zhiping took out the electrocardiogram from the medical record folder.

Li Yao glanced at it, then handed it to Lu Chen, and said with a smile, "Lu Chen, what do you think?"

When Lu Chen heard this, he paused slightly, "According to all the symptoms and examination results of the patient, heart failure is certain. Now we need to look at the cause of heart failure."

Heart failure is just the end of the disease.

Many diseases can lead to heart failure, such as coronary heart disease, hypertensive heart disease, valvular disease, cor pulmonale, fat heart disease, etc...

"I don't think this patient has cor pulmonale nor hypertensive heart disease."

Lu Chen's words stunned everyone present.

In the echocardiography report, hypertensive heart disease has been written.

Why not?
Fan Zhiping asked doubtfully, "Coronary heart disease?"

"No." Lu Chen shook his head.

"Fat heart disease?" A doctor said.

"no……"

"Valvular disease?" Another doctor asked.

Lu Chen was quite helpless, who is this, trying to guess all the diagnoses?

(End of this chapter)