I can see health

Chapter 77 Lu Chen's Doubts

At the signature of the course record, there are three large characters...

Sun Guoguo!
"Sun Guoguo, the doctor in charge of the eighth heart area?"

Cao Zhiying frowned.

"I remember she just went to work independently not long ago."

Ren Feng nodded: "Well, she is a student of Director Li Yao. After graduating a few years ago, she stayed in school."

"Well, this Sun Guoguo is very good. She can judge the patient's condition so quickly." Cao Zhiying nodded slightly, "The record of the illness she wrote is well-organized and well-reasoned. It seems that she has a good understanding of this family history." Hypercholesterolemia is well understood."

"I didn't have much impression of her before. It seems that in the ordinary ward in my heart, there are still many young people with potential who cannot be ignored."

"Director, is it possible that Director Li Yao is instructing in the ward?" Ren Feng asked tentatively.

Ren Feng is very familiar with Sun Guoguo.

She was indeed a hard-working young doctor.

However, it doesn't seem to be particularly good, right?
He has only seen this rare case once.

Moreover, because such a case has not been encountered for a long time.

It happened suddenly today, and I didn't react for a while.

"Probably not." Cao Zhiying shook her head, "Li Yao has a meeting at the school today, so she won't be able to return to the ward for a while."

Cao Zhiying and Ren Feng analyzed for most of the day.

But they overlooked one point.

Graduate students, trainees, and interns do not have their own job numbers, and they use the job numbers of their superior doctors to write the course of illness and issue doctor's orders.

……

At this time, Jinghua No. [-] Hospital, Division [-] of Department of Cardiology.

Sun Guoguo was sitting in front of the computer, checking the medical record of the 10-year-old girl in the morning.

These course records are all written by graduate students or regular students.

Therefore, as the attending doctor, she needs to review and proofread the course records again.

However, when she clicked on the latest course record of the 10-year-old patient and saw the contents clearly.

She was slightly stunned.

For critically ill patients like this, they not only need to write the first course record when they are admitted to the hospital, but also need to complete the ward rounds of the superior physician as soon as possible.

Generally speaking, "condition analysis" is indispensable in the contents of this kind of ward rounds by superior doctors.

The main reason is that the doctor in charge of the bed makes an analysis and judgment on the diagnosis and treatment plan of the patient based on the condition of the patient.

"Illness Analysis" is extremely difficult to write, and it is usually written by Sun Guoguo or Li Yao.

This "condition analysis" is an important indicator to reflect the level of a doctor!

"Guys, who wrote the course record of this 10-bed patient?"

"Senior Sister, it's me." Jiang Qingyan said softly, "I accepted this patient in the morning."

Sun Guoguo gave Jiang Qingyan a puzzled look.

"Why did you consider the diagnosis of familial hypercholesterolemia?"

Jiang Qingyan paused, and said: "The patient's diagnosis of acute myocardial infarction is definitely correct. However, she is relatively young, and has symptoms of hyperlipidemia such as tendon xanthoma and corneal ring, as well as intermittent claudication. , it is very likely that blood vessel occlusion caused by blood lipid deposition!"

"Because of the onset at such a young age, there is a high probability that it is homozygous familial hypercholesterolemia!"

Sun Guoguo nodded upon hearing this.

"Junior Sister, your analysis is good. Have you encountered this kind of patient before?"

"No, Lu Chen taught me to write this disease analysis." Jiang Qingyan shook her head lightly.

"Ah? Did Junior Brother Lu teach it?"

Why is it Lu Chen again?

A trace of surprise flashed in Sun Guoguo's eyes.

Looking around the doctor's office, Lu Chen was not there, probably went to see the patient in the ward.

Jiang Qingyan nodded, "When he first went to work in the afternoon, he told me that he had a new idea about this patient's condition."

"Then he has seen this kind of patient before?"

"No, but he found a similar document and printed it out."

Jiang Qingyan took out three sheets of A4 paper from the medical record folder, on which were densely packed small English characters.

"This……"

When Sun Guoguo saw this foreign language document, his head grew dizzy!

She suddenly admired Lu Chen and Jiang Qingyan.

When she was a graduate student, she was in the department every day to help give medical orders and write the course of the disease, and spent most of the rest of the time chatting with other doctors.

When encountering difficult cases, she might think about it, but she never thought of searching for literature and getting to the bottom of it.

However, Lu Chen's series of performances made her a little self-conscious.

This was the case with the last "fitness dry powder" incident.

The same is true for the "10-year-old myocardial infarction" incident this time!
Lu Chen seems to always maintain a thirst for knowledge.

Like everyone else, he will face many difficulties in clinical practice.

But he will always think of various ways to further solve the difficulties.

……

At this moment.

Lu Chen just returned to the doctor's office.

Before he sat down, he noticed that Senior Sister Sun's eyes on him had changed.

This look is very complicated, with surprise, appreciation, and a hint of loss.

"Senior Sister?" Lu Chen called softly.

Sun Guoguo recovered immediately and smiled quickly: "Junior Brother Lu is back."

"Yeah." Lu Chen smiled.

When he saw the English document in Sun Guoguo's hand, he understood a little bit.

"Senior sister, the 10-year-old girl's illness in the morning..."

"The operation has been completed." Sun Guoguo said, "The coronary artery is diffusely narrowed, and PTCA was performed."

"Didn't put the bracket?" Lu Chen wondered.

"Not yet. Besides, I think your idea is very good." Sun Guoguo nodded, "I really didn't think of family hypercholesterolemia. But after reading your condition analysis, I feel that your thinking is very reasonable .”

"However, if you want to diagnose familial hypercholesterolemia, you need to do a genetic test. Our hospital doesn't have this test yet, so we can only send patients to Kyoto or Modu for relevant genetic tests to confirm the diagnosis."

"En." Lu Chen nodded.

Many diseases are difficult to diagnose.

Once diagnosed, the rest of the treatment is simple!

For example, this familial hereditary hypercholesterolemia requires intensive lipid-lowering treatment in addition to conventional treatment.

Lu Chen looked through the little girl's interventional surgery records.

Coronary angiography showed that the proximal part of the left main was 75% stenotic, and the left internal mammary artery (LIMA) was 80% stenotic at its opening.Left circumflex branch, the proximal end is 90%~95% narrow, and the posterior.

In addition, a renal angiography was performed on her by the way, which showed that the left renal artery also showed 80% stenosis.

"The blood vessel is narrowed to such an extent, why don't you put a stent?" Lu Chen was puzzled.

Generally speaking, if the blood vessel is narrowed by more than 75%, a stent needs to be implanted.

Of course, this also needs to be analyzed in detail.

If it is an unimportant blood vessel, even if it is completely occluded, no stent can be placed.

If it is an important blood vessel, even if it is only 60-70% narrowed, a stent needs to be placed.

According to the vascular condition of this patient, the degree of stent placement has been reached.

If the stent is not placed, the possibility of restenosis is very high!
In other words, the patient may have another myocardial infarction!
(End of this chapter)