I Can See Health

After this episode of ward rounds, Jin Miao, the long-standing attending physician, immediately realized that Lu Chen was not as good at clinical treatment as everyone's stereotype of a scientific researcher.

Today's patient with elevated "cardiac enzymes" stayed in his bed for several days. Director Yan Wanfeng also saw the patient, but no one expected that it was 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 purpose and principle, it is unlikely to diagnose the "myocarditis" induced by it.

Jin Miao was still sighing at Lu Chen's greatness, "He is indeed a specially introduced talent!"

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

Back to the doctor's office.

Lu Chen changed his silence in the ward, opened the patient's medical record, and slowly said to Jin Miao: "Before the ward rounds, I briefly looked through the medical records, and then during the ward rounds, I asked the patient some questions. Combined with the patient Based on the actual situation, I found that the diagnosis and treatment plans for some patients still have some flaws. "

"Director Lu, you tell me, I'm listening." Jin Miao's posture was very low.

He wanted to fawn over Lu Chen now, and after the ward rounds just now, he found that Lu Chen really didn't just come to bed to hang out.

"Let's start with something simple." Lu Chen's expression was extremely serious. "First of all, let's take a look at this 5-bed patient, a thirty-four-year-old female patient. She didn't have any symptoms of chest pain or chest tightness. Just based on the T wave of the electrocardiogram, As a result, you let the patient undergo coronary angiography? "

"Director Lu, this is what the patient agreed to," Jin Miao defended.

"Haha, the patient agreed?" Lu Chen shook his head, "I am not a newbie in clinical practice. It depends on your inducibility to communicate with the patient about the condition, do coronary CTA or coronary angiography. Once you If the condition is too serious, or if coronary angiography is necessary, will the patient refuse?”

Jin Miao's expression was not very good, and his posture was already very low. Unexpectedly, Lu Chen was still so aggressive.

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

Lu Chen laughed dumbly when he saw that Jin Miao was still pretending to be confused.

"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, then slowly said: "The electrocardiogram showed the possibility of myocardial ischemia, so coronary heart disease must be ruled out."

"Don't change your mind." Lu Chen's eyes were blazing. "To rule out coronary heart disease, we must do angiography? Can't we do coronary CTA?"

No matter how non-invasive and small the wound is, coronary angiography is still a surgery!

When the catheter enters the blood vessel, it will cause certain damage to the human body's vascular endothelium and even nerves.

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

For example, blood vessel rupture, bleeding, hematoma, and even infection may occur.

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

"Have you ever thought that the patient has cardiac neurosis? Autonomic nerve disorder?" Lu Chen continued.

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

Who says people who engage in scientific research are not proficient in clinical practice?

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

"Director Lu, basically 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 put, is to do coronary angiography in the outpatient clinic in the morning, observe it until the afternoon, and then you can be discharged.

"Hey." Lu Chen shook his head slightly, "I didn't say I boycott surgery. I am a surgeon myself. But the better doctor is not the one who does more surgeries, but the one who knows which surgeries not to do!"

Jin Miao was startled when he heard this.

He never thought that these words would actually come from the mouth of a junior.

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

A good doctor does not mean that he performs many operations, but that he knows which operations should not be performed!

The better the technology and the richer the experience, the more reverential one will be for life.

Instead of being like a novice, you have to have a hand in everything and recommend surgeries to all kinds of patients.

"Director Lu, you are right, I have written it down." Jin Miao nodded seriously.

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

"Yeah." Jin Miao responded softly.

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

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

When wearing this white dress, you need to take the initiative to take on many responsibilities.

"Let's not talk about it for now." Lu Chen felt that the topic was a little heavy, "Let's take a look at this patient in eight beds. In the test for admission examination, D-dimer increased, and it was more than ten times higher. Why did he do the ward rounds? No one mentioned this indicator at the time? There were abnormal indicators in the blood test, so you just let it go and didn’t check again?”

"This... the patient should not have pulmonary embolism." Jin Miao hesitated, "There is no blood clot elsewhere, and he is taking anticoagulant drugs, so we will leave it alone for the time being."

"Then you plan to keep taking anticoagulants like this?" Lu Chen frowned, "You will also take them after you are discharged from the hospital?"

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

"Hey, please tell me first what causes elevated D-dimers are common." Lu Chen sighed.

Jin Miao was stunned. He was the one who usually asked the students questions.

Today it was my turn to be asked a question, but the question was simple. He simply said: "The elevated level of d-dimer indicates that the patient is in a hypercoagulable state, or if the patient has a tumor, the level of d-dimer in the body will also increase."

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

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

"It's still not perfect." Lu Chen shook his head, "First of all, you have to distinguish whether it is pathological or physiological. As age increases, 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. This is more general. In other words, many diseases can cause the human body to be in a hypercoagulable state."

"The most common one is deep vein thrombosis, UU Reading www.uukanshu.net, followed by tumors, infections, autoimmune diseases, DIC, burns, trauma, most cardiovascular diseases, as well as hemolysis, transfusion reactions, and thrombolytic therapy All can lead to an increase in d-dimer..."

Jin Miao stood next to Lu Chen, watching him talk eloquently, and was really impressed by his ability to talk about this kind of clinical knowledge.

Don't look at the extremely simple basic knowledge, 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 accept it!

No wonder Lu Chen was promoted to deputy chief physician just after graduation. It makes sense.

Jin Miao felt that facing Lu Chen was like facing Director Cen Shangwei of the Department of Cardiology!

It only took Lu Chen one morning to completely impress the department's ten thousand year old chief.

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