I can see health

Chapter 742
After this episode of ward rounds, Jin Miao, the ten thousand-year-old doctor, immediately realized that Lu Chen was not as bad at clinical treatment as the scientific researcher that everyone stereotyped.

Today's patient with elevated "myocardial enzymes" stayed in his bed for several days. Director Yan Wanfeng also saw the patient, but no one thought that it would be myocarditis caused by "immune checkpoint inhibitors".

This requires not only careful clinical thinking, but also a large amount of literature reading.

Otherwise, even if you encounter the drug "immune checkpoint inhibitor" and you don't know its use and principle, it is unlikely to diagnose the "myocarditis" induced by it.

Jin Miao was still lamenting how powerful Lu Chen was, "As expected of a specially introduced talent!"

What he didn't expect was that he was about to face a violent storm.

Go back to the doctor's office.

As soon as Lu Chen changed his silence in the ward, he opened the patient's medical record and slowly said to Jin Miao: "Before the ward round, I briefly looked through the medical record, and then during the ward round, I asked the patient some questions. Combined with the patient's According to the actual situation, I found that the diagnosis and treatment plan of some patients is still somewhat flawed."

"Director Lu, tell me, I'll listen." Jin Miao kept his posture extremely low.

He wanted to curry favor with Lu Chen now, and after the ward round just now, he found that Lu Chen really didn't come to the clinic to dawdle.

"Let's start with a simple one." Lu Chen's expression was extremely serious, "First of all, let's take a look at this 5-bed patient, a 34-year-old female patient, without any symptoms of chest pain or tightness, which was caused by the T wave of the electrocardiogram. You just let the patient do a coronary angiography?"

"Director Lu, this is with the consent of the patient." Jin Miao justified.

"Hehe, the patient agrees?" Lu Chen shook his head, "I'm not a clinical rookie. Communicating with patients, whether to do coronary CTA or coronary angiography depends on your inductiveness. Once you put The condition is too serious, or coronary angiography is necessary, will the patient refuse?"

Jin Miao's face was not very good-looking, his posture was already very low, but Lu Chen was still so aggressive.

"Director Lu, the patient is willing to do it and has signed the contract. Is it wrong for us to do it for her?"

Seeing that Jin Miao was still pretending to be confused, Lu Chen couldn't help laughing.

"Okay, let's not discuss whether the patient is willing or not. Tell yourself, is it necessary for this patient to undergo coronary angiography?" Lu Chen's tone became very serious.

Jin Miao remained silent for a while, before slowly saying: "The electrocardiogram shows the possibility of myocardial ischemia, and coronary heart disease must be ruled out."

"Don't change the concept secretly." Lu Chen's eyes were burning, "To rule out coronary heart disease, you must do angiography? Can't you do coronary CTA?"

Coronary angiography, no matter how noninvasive and small the wound is, it is still an operation!
When the catheter enters the blood vessel, it will cause certain damage to the endothelium of the human blood vessel and even the nerve.

Once the operation is wrong, there will be many side effects.

Such as blood vessel rupture, bleeding, hematoma, and even the possibility of infection.

Coronary CTA is more than 95% accurate in diagnosing coronary heart disease.

"Even, have you ever thought that the patient is cardiac neurosis? An autonomic disorder?" Lu Chen continued.

After hearing what Lu Chen said, Jin Miao lowered his head and stopped talking.

Who said that people engaged in scientific research are not proficient in clinical practice.

This Lu Chen, despite his young age, has quite a lot of clinical experience.

"Director Lu, everyone is doing angiography now. If we don't do it, others will do it." Jin Miao said helplessly, "Now the hospital encourages one-day angiography, and many patients regard coronary angiography as a routine examination. "

One-day coronary angiography, simply speaking, is to do coronary angiography in the outpatient clinic, do it in the morning, observe until the afternoon, and then you can leave the hospital.

"Hey." Lu Chen shook his head slightly, "I didn't say boycott surgery, I'm a surgeon myself. But the better the doctor, the better the doctor is not the one who has done a lot of surgeries, but the one who knows which surgeries can't be done!"

Jin Miao was startled when he heard this.

It never occurred to him that this sentence was actually uttered from the mouth of a junior.

Once upon a time, his teacher told him the same way.

A good doctor does not mean doing too many surgeries, but knowing which surgeries cannot be done!
The better the technology and the richer the experience, the more reverent the life will be.

Instead of being like a novice, you have to intervene in everything, and you have to suggest surgery for any kind of patients.

"Director Lu, what you said is true, I've written it down." Jin Miao nodded seriously.

"I hope you can really understand." Lu Chen sighed slightly, "There are many operations, which can certainly generate income, but the damage to patients is irreparable."

"En." Jin Miao responded in a low voice.

Lu Chen knew that what he said would definitely offend some people, and even involve other people's interests.

He may not be able to care about others, but in his own medical team, he must take care of it when he sees it.

When wearing this white dress, many responsibilities need to be taken on the initiative.

"Let's not talk about this now." Lu Chen felt that the topic was a bit heavy, "Let's look at this eight-bed patient. In the laboratory tests of the admission examination, the D-dimer level increased, and it was more than ten times higher. Why did the rounds Didn’t anyone mention this indicator at the time? There are abnormal indicators in the blood test, you just let it go and don’t check it again?”

"This...the patient should not have a pulmonary embolism." Jin Miao hesitated, "There is no thrombosis elsewhere, and he is taking anticoagulant drugs, so let's ignore it for the time being."

"Then you plan to keep using anticoagulants?" Lu Chen frowned, "Also after leaving the hospital?"

"Just stop it in a few days." Jin Miao replied very unconfidently.

"Hey, let's talk about the common causes of elevated D-dimer." Lu Chen sighed.

Jin Miao was taken aback for a moment, usually he was the one who asked students questions.

Today is my turn to be asked, but this question is simple, and said: "An increase in D-dimer indicates that the patient is in a hypercoagulable state, or the patient has a tumor, and the D-dimer content in the body will also increase."

"Can't you be more specific?" Lu Chen frowned.

Jin Miao quickly said: "For example, pulmonary embolism, myocardial infarction, atrial fibrillation, and even aortic dissection, D-dimer will increase."

"It's still not perfect." Lu Chen shook his head. "First of all, you have to distinguish between pathological and physiological. With age, D-dimer can increase physiologically. In addition, pregnancy can also cause it to increase."

"Secondly, as you said, the patient is in a hypercoagulable state, which is more general, or many diseases will make the human body in a hypercoagulable state."

"The most common is deep vein thrombosis, followed by tumors, infections, autoimmune diseases, DIC, burns, trauma, most cardiovascular diseases, hemolysis, transfusion reactions, and thrombolytic therapy can all lead to D dimer raise..."

Standing beside Lu Chen, Jin Miao looked at him who was talking eloquently, and admired this kind of clinical knowledge in his heart.

Don't look at the extremely simple basics, but most people don't care about these details.

Next, Lu Chen asked a few more questions and found out the loopholes in Jin Miao's diagnosis and treatment process.

This time, Jin Miao really had to obey!
It's no wonder that Lu Chen was able to be promoted to the deputy chief physician just after graduation, which makes sense.

Jin Miao felt that when facing Lu Chen, it was like facing Director Cen Shangwei of the Department of Cardiology!
And it only took Lu Chen the whole morning to completely convince the ten thousand year old attending doctor of the department.

(End of this chapter)