I Can See Health

Magic City No. 1.

icu shows 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 causes of infection and fever, as well as the next steps for diagnosis and treatment.

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

"In addition to upgrading antibiotics, we must also prevent and treat complications in other organs."

"In addition, the patient has been bedridden for a long time. Although his platelets are low, he is at risk of deep vein thrombosis. Does he need anticoagulation treatment?"

The discussion among the people was very intense.

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

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

In fact, the departments most closely related to this case are the Department of Infectious Diseases and the Department of Rheumatology.

It has little to do with cardiology, respiratory and other departments.

ICU just goes through the normal procedure and invites other departments to come and see the patient.

After speaking in several key departments, the director of ICU looked solemn and somewhat dissatisfied.

Su Zhengwen also shook his head slightly in his heart.

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

This patient has been to many hospitals and has been treated with very high-end antibiotics, leaving only restrictive antibiotics.

They have been treating the infection for quite some time, but the patient's condition has not improved!

If anti-infective 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 just a cliché.

"Hey, it seems that this discussion of difficult cases is of no use..." Su Wenzheng sighed slightly in his heart.

What follows are the speeches from other departments.

However, the director of ICU has no hope for the opinions of other departments.

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

Sure enough, it was as expected by the ICU director.

The opinions of the nephrologists and gastroenterologists briefly discussed the patient's condition and the conditions related to their department.

As for the analysis of the underlying condition, there is very little!

"Hey, forget it."

The ICU director has no other hope for discussing this difficult case.

…

"Finally, the consultant cardiologist, please share your opinion." Su Wenzheng said like an animal.

Cardiovascular medicine is the last department to speak.

After he finished speaking, this discussion of difficult cases came to an end.

Lu Chen finally looked forward to his chance to speak.

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

Director ICU 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 some different views on this patient."

As soon as he finished speaking, Lu Chen attracted everyone's attention.

"This boy really dares to speak!"

Seeing Lu Chen's young appearance, everyone was filled with disdain.

Many people are still complaining about this. The cardiology department actually sends such a young doctor to participate in the discussion of difficult cases? !

Director ICU and Su Wenzheng were also slightly startled, and then their expressions returned to normal.

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

At this point, Lu Chen visibly paused, and everyone's attention was aroused.

He continued: "But when I went over to check on the patient, the patient's look changed my judgment."

"What? The look in the patient's eyes?"

Everyone present was stunned and looked at Lu Chen with doubts on their faces.

They had never heard of this argument, that the diagnosis was changed just because of the look in the patient's eyes!

At this time, everyone's interest was piqued.

Looking at the young chief resident of the cardiology department in front of them, everyone was whispering to each other and asking about Lu Chen's background.

"Dr. Lu, please give us some analysis quickly, don't be too pretentious." Su Zhengwen said quickly.

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

"Ah? Is that all you need?"

Everyone frowned, wouldn't this be a bit hasty?

None of the senior attending doctors and deputy chief physicians present seemed to understand what Lu Chen meant.

When do you rely on your eyes to see a doctor? Don't you want to read the test report?

Su Wenzheng frowned deeply and asked in confusion: "Dr. Lu, can you tell me what the eyes of patients with infectious fever look like?"

After hearing this question, everyone looked at Lu Chen, wanting to hear Lu Chen's next answer.

Lu Chen smiled slightly and explained: "A patient with long-term infectious fever, especially a patient with septic shock, will be sleepy and his eyes are indifferent due to the effect of bacterial toxins. And immune fever There are not many "toxins" in the body. Even if the fever lasts for several months, the eyes are still very alert. As soon as the fever subsides, the appetite is good. "

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

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

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

Everyone began to re-examine the issue.

At this time, a deputy chief physician in the rheumatology department suddenly said, "I think this seems to make some sense!"

"What do you mean?" The ICU director looked at the rheumatologist.

The rheumatologist thought for a while and said, "This phenomenon can be best explained by the differential diagnosis of sepsis (infection) and "sub-sepsis" (adult still). "

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

"So, it is really possible to be immune fever?"

Su Wenzheng was slightly startled, and the look he gave Lu Chen had changed at this time.

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

"You mean, use hormones?" The rheumatologist looked at Lu Chen tentatively.

Lu Chen smiled and nodded: "Yes, this patient has mainly immune fever, so increase the dose of hormone dexamethasone first. Use it for three consecutive days. If the fever subsides, it can be preliminarily determined that the patient has immune fever!"

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

This made Su Wenzheng eager to try, and he wanted to give the patient a shot of hormone right now! 16377/10445945