This doctor has a system

Chapter 156 154. The patient who has been misdiagnosed for 60 years

"It's mainly about substituting for the class. In fact, my dream since I was a child is to be a great people's teacher like you, Principal Liu." Gao Feng looked at Vice President Liu sincerely. Say it again."

"Look, such an outstanding young man is still so enlightened." Vice President Liu patted Gao Feng vigorously, "You deserve your success!"

"Don't worry, after the summer vacation and the school starts, we will invite you to give open classes to the teachers and students first."

Vice President Liu left satisfied.

"There are many benefits to being an associate professor in the school." Vice President Guo said to Gao Feng, "However, the relationship inside is also complicated. After you go, just do your own thing well, and don't mix with others."

"Okay, I just go there once in a while, and I have to do ward rounds in the hospital every day." Gao Feng smiled, he knew that it was Vice President Guo who cared about him.

"Well, if only my son and nephew were as good as you." Vice President Guo suddenly thought of this, "My wife and I both have master's degrees, and they were considered highly educated talents in that era, but my son didn't even have a bachelor's degree. I didn't pass the exam, so I can only rely on my relationship to contact the small jobs in the hospital."

"My nephew has a Ph.D. He originally wanted to train him well, but he turned out to be a piece of mud that can't support the wall." He shook his head helplessly.

Vice President Guo's nephew, who can't be supported by the mud, is currently fighting with Du Jianjun, the deputy chief of the scientific research department.

"Chief Du, I have too many tasks to do now, and I can't do it." Guo Yuxin directly dismissed the challenge.

"Yo!" Du Jianjun squinted at him, "Xiao Zhang and Xiao Wang did it before, why, you can't do it when it's your turn?"

"Xiao Guo, you are a doctor! Don't I know your ability?"

Du Jianjun took a sip of jasmine tea. It is said that drinking it for a long time can relieve depression. In fact, Guo Yuxin can drink some of this. He was repaired by Du Jianjun during this period of time.

"Anyway, I can't do it." Guo Yuxin said aloud, "This is a job that can only be done by three people. You give me all of it, obviously it is revenge on me."

"I know I offended you last time, but it's been so long, it's almost enough for you to torment me, and killing people is nothing more than nodding."

You still know that you offended me, what did you do earlier, Du Jianjun sneered in his heart.

"Then let Xiao Zhang come over and help you." He felt that it was almost the same, and it would not be good to make the dog jump over the wall if he continued to toss about. Some things still need to be mastered.

"Brother Du." Li Youliang walked in at this time.

"Oh, I'm just waiting for you to come." Du Jianjun smiled and stood up, "I've filled out the form for you, you just need to sign your name." "As for the reward of 80 yuan, you are not active."

"Gao Feng and my teacher are relatively busy, so I have to come and handle this matter." Li Youliang swish signed.

"Xiao Guo, stamp Youliang quickly, don't delay his family affairs."

Guo Yuxin was filled with humiliation, but he stood up obediently and gave the badge, trying his best.

Li Youliang gave Du Jianjun a look of admiration: Niu, you have been trained well.

Du Jianjun smiled calmly: "You little brat, that's not easy to handle."

In life, there are always some people who lose their temper at every turn. As soon as others express their dissatisfaction, they will say: Oh, my temper has always been so bad, and I can't change it. Please bear with me.

I will take care of your M's head. If you have a temper, why don't you dare to vent it to the leader? Then your temper will be better.This kind of person is born to need repairs, and it's over if he does it.

"Gao Feng, a patient will be transferred from the Department of Cardiology." Dong Qianqian yawned, "I have also lived in our department, and the underlying disease is hypertrophic cardiomyopathy. A few days."

She was not very busy on the night shift yesterday, but she didn't have a good rest in the department. Dong Qianqian slept very lightly, and she woke up when there was a small movement.

"Okay, go back and rest quickly." Gao Feng urged, "I'll just watch here."

At around 11:[-] in the morning, a nurse from the Cardiology Department came with the patient.

Uncle Lu is a retired engineer of a scientific research institute in the province. He has been seeing a doctor in the outpatient department of the Provincial People's Hospital since he retired.Uncle Lu graduated from Tsinghua University with a high level of education. He talks like a scholar on weekdays. In the past 15 years, he has insisted on coming to the provincial doctor for reexaminations regardless of the weather. He has become a model patient in everyone's mouth.

Not only that, he is also the patient with the longest course of hypertrophic cardiomyopathy that Gao Feng has seen so far—it has been nearly 20 years since he was diagnosed in his 79s to the age of 60 today.

A few days ago, Uncle Lu was admitted to the cardiology department because of heart failure. He used some milrinone and Xinhuosu there, and now the symptoms have been significantly relieved, but the lung inflammation is still obvious, and the patient still coughs and coughs yellowish. phlegm.

The doctor in the cardiology department thought about it and simply transferred it to the respiratory department.

Gao Feng looked at Uncle Lu's chest CT. The diagnosis of lung infection is still very clear. The reason why the anti-infection effect is not so good may be that the antibiotic cefuroxime used is a little weak.

A large number of gram-negative bacilli can be seen in the patient's sputum smear, and cefuroxime sodium, as a second-generation cephalosporin, must have a weaker effect on gram-negative bacilli than the third-generation cephalosporin.

"I'll adjust the antibiotics for you." Gao Feng communicated with Uncle Lu and his family.

"Okay." Uncle Lu had a smile on his face. He was the same in the hospital as he was at home. He was more familiar with the Provincial People's Hospital than Gao Feng.

"I'm getting older, and my health is getting worse. I've suffered from heart failure several times in the past six months." Uncle Lu skillfully put on a nasal cannula to inhale oxygen, "No, I can't stay longer this time, so as not to keep letting the child Take me to the hospital."

"Looking for the source: As a model patient, Lu Zhuochang has been followed up in the Provincial People's Hospital for nearly 15 years. Is the root of his disease really hypertrophic cardiomyopathy? You can get 30 skill points for completing the task, and the skill points will be deducted if you fail the task. 100 points."

Hearing the task released by the system, Gao Fengren was completely dumbfounded, what do you mean?Is Uncle Lu's diagnosis of hypertrophic cardiomyopathy wrong?
And why are so many skill points deducted for mission failure?

"Because the patient has been in the Provincial People's Hospital for follow-up visits for the past 15 years, you have to bear the consequences for missed diagnosis and misdiagnosis." The system explained thoughtfully.

What the hell!

Gao Feng couldn't sit still anymore, he hurried back and looked up Uncle Lu's medical records.

In addition to cardiomyopathy and high blood pressure diagnosed at a young age, Uncle Lu's diagnosis also includes diseases such as coronary heart disease, arrhythmia, renal insufficiency, cataract, and prostatic hypertrophy.Fortunately, Uncle Lu and his family members are highly compliant, and these diseases have been diagnosed and treated in a timely manner and effectively controlled.

However, when Gao Feng clicked on the echocardiogram report, his level 5 image reading skills made him find something unexpected.

"Sister Huizhen, Brother Hao, come and help me take a look at this." Gao Feng chose to shake people, and he told them about Uncle Lu's situation.

"General hypertrophic cardiomyopathy is pure left ventricular hypertrophy, right? Why does the right ventricle seem to be thickened? And the mitral valve also seems to be a little thickened."

"There are also cases of myocardial hypertrophy at the apex of the heart, or cardiomyopathy in the middle of the heart chamber." Li Huizhen replied, "But you are right, like this at the same time, there is double ventricular wall hypertrophy and mitral valve thickening. It is extremely rare.”

"I'll take a look at his previous echocardiography." Qin Hao said as he opened the outpatient medical record system of another computer.He quickly found the first case left by Uncle Lu in the provincial hospital more than 10 years ago-this is almost the first batch of electronic medical records in the provincial hospital.

In 2006, Uncle Lu came to the Department of Cardiology and complained of frequent chest discomfort and dyspnea after walking, and his calves began to swell.

Taking into account Uncle Lu's history of hypertrophic cardiomyopathy, the receiving doctor thought that the symptoms might be caused by the exacerbation of the disease. On the basis of Uncle Lu's daily dose of metoprolol and amlodipine, he also prescribed enalapril daily. Take it, and ask Uncle Lu to take a piece of compound amiloride when the edema is severe.

The second more valuable case was in 2010.This time, Uncle Lu went to the doctor because of nausea, dizziness and chest discomfort. The electrocardiogram found third-degree atrioventricular block and obvious bradycardia. vibrator.

"Implant a defibrillator? At this time, Uncle Lu has no tachycardia, right?" Gao Feng was a little puzzled. He had just upgraded the basic diagnosis and treatment skills of cardiovascular diseases in the system, but there were too many cardiovascular diseases. Some of them he has never heard of, and these entries are all gray, which means they cannot be upgraded.

"Ask the director of the cardiology department." Li Huizhen suggested, "There is a specialization in surgery."

"That's fine." Gao Feng called Director Lu, who had a serious heart condition.

"It's time to get off work, how about this afternoon?" Director Lu has changed his clothes and is going to eat now.

"Where are you?" Gao Feng asked, "Let's eat something together."

"You kid is really awesome." Director Lu poured a few glasses of iced fruit beer, "Not to mention the freedom of wealth, but also posting nature, I won't be able to post it until I die."

"You don't know, the envy of everyone is almost torn apart."

Hearing Director Lu's praise, Gao Feng felt refreshed, "I can't help it, I just write it casually, and I haven't exerted myself yet."

"Under the handsome appearance, there are sparks that are generated by the impact of thinking. In terms of learning, I am diligent and studious and will always be the master of learning; in the department, I have a very good reputation and a high prestige; in the society In the movie, I am a representative of civilization shining like a drop of water melting into the sea, and I am marching forward to the next stage with the wings of hope."

"Enough!" Director Lu interrupted his bragging, "You don't want to be like this."

"I'm really smart, I am."

"I'm not smarter than you!" Director Lu pointed to his shiny forehead, "All the smart ones are extremely smart."

The two ordered a few side dishes and ate them slowly.

"After posting Nature, do you feel that you are different from before?" Director Lu asked.

"I don't think I've changed much, but the big guys around me look at me differently. A few days ago, Z University said they wanted to hire me as an associate professor, and Vice President Guo said that the hospital would give me a deputy senior salary, and even made a staffing arrangement. "Gao Feng picked up a chopstick of nepeta, he especially likes this smell.

"Hurry up and reject them!" Director Lu "kindly" persuaded, "You get these at such a young age, which is very detrimental to future struggles."

It was almost 1:[-] after the two of them finished their meal, and they went directly to the respiratory physician's office. Gao Feng told Director Lu about Uncle Lu's situation.

"It's old Lu, I know him, the one who graduated from Tsinghua University." When Director Lu saw Uncle Lu's name, he remembered, "The old man lived in my house, and he can write poetry."

"Why did he put the defibrillator at that time?" Gao Feng asked his own question.

"Because most of the current defibrillators have a pacemaker function, for patients with cardiomyopathy who are at risk of fatal arrhythmia like Lao Lu, implanting a defibrillator is much more cost-effective than implanting a pacemaker .” Director Lu gave an explanation easily.

Continue to read, 4 months after the operation, Uncle Lu developed atrial fibrillation. Although the cardioversion of atrial fibrillation was successful for the first time, the atrial fibrillation recurred 3 days later. This time the doctor prescribed amiodarone and warfarin for long-term treatment.

For a long period of time after that, although Uncle Lu came back to the doctor every now and then, his medical records were basically a running account. His heart condition remained very stable until a follow-up visit in 2012, when Uncle Lu was admitted to the hospital again due to pulmonary edema.

The discharge medical record reads: "After applying diuretics, Uncle Lu's condition improved significantly. He smiled slightly and asked if I could be discharged today?" Gao Yuqiang, the attending physician who made the ward rounds, said: "Okay, I will bring it to you later." Order medicine and go home to eat. The patient showed a happy smile, and his son said he would buy fruit for everyone.”

"Fuck, who the hell wrote the medical records." Director Lu's eyes were about to be blinded.

Even Gao Feng couldn't be happier.

Gao Feng found that after that visit, Uncle Lu's heart condition gradually began to decline: when he climbed stairs or slopes, he would have difficulty breathing and be extremely tired, and he often needed two pillows to fall asleep at night. , To make matters worse, the chief program-controlled defibrillator found that Uncle Lu had intermittent ventricular tachycardia during the review.

"Director Lu, do you think there is something wrong with Uncle Lu's diagnosis?" Gao Feng asked.

"Problem? What's the problem?" Director Lu was stunned for a moment, "He has hypertrophic cardiomyopathy. How many years has it been since he was diagnosed, what could be the problem?"

If there is no system, Gao Feng probably won't think there is a problem.

As soon as he got to work in the afternoon, Gao Feng assigned a task to Zhang Tianci and Huang Liya to conduct a comprehensive and detailed review of Uncle Lu's medical history.

"Let me talk first." At around 5 o'clock, Zhang Tianci made a report to Gao Feng.

"First of all, Uncle Lu's life is a legend."

Time goes back to 59 years ago.

Before the age of 20, Uncle Lu—or should I say "Little Lu"—was not troubled by heart disease.At that time, Xiao Lu not only had excellent academic performance, but also had a first-class athletic level. He was not only a member of the track and field team of Tsinghua University, but also broke the [-]-meter sprint record in the school sports meeting.

However, one day at the age of 21, Xiao Lu suddenly suffered from numbness and tingling in his calf during the school team training.At first, he didn't take it too seriously, but after resting for a period of time, not only did the symptoms not ease, but he also found that the amount of sweat on his feet and legs decreased significantly.However, the dermatologist did not give a definite diagnosis, and Xiao Lu's sports performance was affected by the injury and declined all the way.

After a sprint training, Xiao Lu suddenly felt dizzy and was sent to the hospital by his classmates.It was also at this time that he was first diagnosed with hypertrophic cardiomyopathy by a cardiologist.Fortunately, Xiao Lu's condition was not serious at that time. Apart from being unable to step into his beloved runway, he still got married and had children smoothly.

As the years went by, Xiao Lu gradually became "Old Lu", and the impact of the disease on the body became more and more obvious. At the age of 50, Lao Lu was found to have left ventricular hypertrophy and hypertension during the unit physical examination. The echocardiography showed that the left ventricular wall was thickened symmetrically to 18mm (normal value ≤ 11mm), and there were also mitral valve thickening and mitral valve regurgitation.Later, Lao Lu began to routinely take metoprolol for cardiomyopathy and amlodipine for hypertension.

In the next two years, Lao Lu’s condition remained stable. Until his retirement, he became Uncle Lu and began regular follow-up visits at the Provincial People’s Hospital closest to his home... The following story is what we saw in the outpatient system up.

After listening to Zhang Tianci's medical history report, Gao Feng fell into deep thought about several doubtful points:
First of all, it is the symptoms of less sweating, numbness and tingling in the legs that Uncle Lu experienced in his early 20s. Is it the peripheral neuropathy of the lower limbs?
Secondly, Uncle Lu’s left ventricular hypertrophy and high blood pressure seem to have occurred at the same time, and multiple consecutive echocardiograms have not found left ventricular outflow tract obstruction, which is common in hypertrophic cardiomyopathy. What does this mean?
In addition, while waiting for the medical history inquiry, he reviewed Uncle Lu's outpatient and inpatient examination reports in recent years, and found that his creatinine and blood urea nitrogen levels gradually increased. As of this hospitalization, Uncle Lu has developed Became mild renal insufficiency with albuminuria.

Abnormal cardiac conduction, double ventricular wall thickening cardiomyopathy, peripheral neuropathy, kidney disease. Is it a coincidence of different diseases?No, Gao Feng quickly dismissed this idea.No matter how many symptoms or abnormal signs a patient has, one disease should be used to cover the whole frame as much as possible. This is the basic principle of "medical monism".

So, what is the breakthrough point for Uncle Lu's various symptoms?
Gao Feng felt a little headache.

　Excuse me.I didn't pay attention when replacing it, and forgot to save it.

　　
　
(End of this chapter)