I can see health

Chapter 714 The diagnosis was changed because of a look! (first update)
A hospital in the capital city.

ICU shows the classroom.

All the doctors who came to discuss difficult cases began to speak in turn.

The focus of everyone's attention is nothing more than the cause of infection and fever, as well as the next step of diagnosis and treatment.

"I agree with Director Zhang. This patient is mainly in septic shock, and the antibiotics must be upgraded!"

"In addition to upgrading antibiotics, it is also necessary to prevent complications in other organs."

"In addition, the patient has been bedridden for a long time. Although the platelets are reduced, there is a risk of deep vein thrombosis. Do you need anticoagulant therapy?"

The discussion among the people was very intense.

But the opinions are relatively unified, and most doctors consider septic shock.

In terms of treatment, antibiotics are upgraded to prevent complications in other organs.

In fact, in this case, the most relevant departments are the Department of Infectious Diseases, Department of Rheumatology and other departments.

It has nothing to do with cardiology, respiratory and other departments.

The ICU just followed the normal procedure and invited other departments to see the patient.

After speaking in several key departments, the director of the ICU had a dignified expression and was somewhat dissatisfied.

Su Zhengwen also shook his head slightly in his heart.

The opinions of these doctors cannot be wrong, but they have no practical guiding significance.

This patient has been transferred to many hospitals, and the antibiotics used are very advanced, and the rest are not used with restrictive antibiotics.

They have been treated with anti-infection for quite some time, but the patient's condition has not improved!

If anti-infection treatment is continued, it is nothing more than the use of restricted antibiotics, such as imipenem and other drugs, without any other adjustments in diagnosis and treatment.

It's all commonplace.

"Hey, it seems that this difficult case discussion is useless..." Su Wenzheng sighed slightly in his heart.

What follows are speeches from other departments.

However, the director of the ICU is even less hopeful about the opinions of other departments.

The Rheumatology Department and the Infectious Disease Department did not come up with any constructive suggestions, let alone other departments such as the Cardiology Department and the Nephrology Department.

Sure enough, the director of the ICU did not expect it.

The opinions of nephrology and gastroenterologists are all about the condition of the patient and his department.

As for the analysis of the essence of the disease, there are very few!
"Hey, forget it."

The director of the ICU discussed this difficult case and had no other hope.

……

"Finally, the consulting doctor in the Department of Cardiology, let's talk about your own opinion." Su Wenzheng said beastly.

The Department of Cardiovascular Medicine was the last department to speak.

After he finished his speech, this difficult case discussion came to an end.

Lu Chen finally looked forward to his chance to speak.

He stood up, holding the patient's case file in his hand.

The ICU director and Su Zhengwen didn't have any expectations when they saw such a young doctor.

Lu Chen cleared his throat first, and then said slowly, "Teachers, I actually have a different opinion about this patient."

As soon as the words fell, Lu Chen attracted everyone's attention.

"This kid, you really dare to speak!"

Seeing Lu Chen's youthful appearance, everyone was slandered in their hearts.

Many people are still complaining about this in their hearts. The Department of Cardiology actually sends such a young doctor to participate in the discussion of difficult cases? !
The ICU director and Su Wenzheng were also slightly taken aback, and then their expressions returned to normal.

At this time, Lu Chen opened his mouth and said: "Actually, when I first saw the patient's medical records, I also thought that the patient had an infectious fever, and after a severe infection, it caused shock. But..."

Speaking of this, Lu Chen obviously paused, and everyone's attention was mobilized.

He continued: "But when I went to check on the patient, a look from the patient changed my judgment."

"What? The patient's eyes?"

Everyone present was taken aback, and looked at Lu Chen with doubts on their faces.

They have never heard of this argument, just because of the patient's eyes, the diagnosis is changed!

At this time, everyone's interest was aroused.

Looking at the young chief resident of the Cardiology Department in front of them, everyone was whispering, asking about Lu Chen's background.

"Doctor Lu, quickly analyze it for everyone, don't be tricky." Su Zhengwen said hastily.

Lu Chen smiled and continued: "Although the patient is lying in the ICU with a high-flow oxygen mask, his eyes are still very bright and shiny. So I judge that the patient does not have an infectious fever, but an immune fever! "

"Ah? Just because of this?"

Everyone frowned, wouldn't this be a bit sloppy?
None of the senior attending doctors and deputy chief physicians here seemed to understand the meaning of Lu Chen's words.

When do you use your eyes to see a doctor?Didn't you read the test report?

Su Wenzheng frowned deeply, and said in doubt: "Doctor Lu, what do you think about the eyes of patients with infectious fever?"

Hearing this question, everyone looked at Lu Chen one after another, wanting to hear Lu Chen's next answer.

However, Lu Chen smiled slightly and explained: "A patient with prolonged infectious fever, especially a patient with septic shock, is sleepy and has indifferent eyes due to the action of the germ toxin. And immune fever Those who suffer from severe toxins do not have many "toxins" in their body, even if they have a fever for several months, their eyes are still sharp, and their appetite will be good once the fever subsides."

After Lu Chen finished speaking, the audience was completely silent.

So everyone was trying to figure out the connotation of Lu Chen's words.

At first everyone thought that Lu Chen was just exaggerating, but now he gave his own reasons.

Everyone began to re-examine this issue.

At this time, a deputy chief physician of the rheumatology department suddenly said: "I think there is some truth to this statement!"

"How do you say that?" The director of the ICU looked at the rheumatologist.

The rheumatologist thought for a while and said: "This phenomenon may be best explained by the differential diagnosis of sepsis (infection) and subsepticemia (adult Still). "

Immediately afterwards, the rheumatologist introduced the general situation of the two diseases to everyone.

"So, it's really possible that it's an immune fever?"

Su Wenzheng was slightly startled, the way he looked at Lu Chen had changed.

After the rheumatologist finished speaking, Lu Chen couldn't help but nodded, "The rheumatology teacher is right! I think this is a clinical phenomenon that cannot be described in books or papers. We can use therapeutic diagnosis to verify it." !"

"What do you mean, use hormones?" The rheumatologist looked at Lu Chen tentatively.

Lu Chen nodded with a smile: "Yes, this patient mainly has immune fever. First, increase the dose of the hormone dexamethasone. After three consecutive days, if the fever subsides, then we can preliminarily judge that the patient has immune fever!"

This time, Lu Chen not only put forward his own diagnosis opinion, but also gave the next diagnosis and treatment method.

This made Su Wenzheng eager to try, wishing to give the patient a shot of hormones now!
(End of this chapter)