This doctor has a system

Chapter 224 212. Young Doctors Competition: Massacre
The annual Young Physician Competition is about to begin. It was held five years ago under the leadership of Academician Bao, a leading figure in the field of respiratory medicine, and has been held twice so far.

The purpose of the competition is to train the clinical thinking of young doctors. There are also monetary rewards for the top five. Although the money is not a lot, most of the people who come to participate do not value this.

Because this competition is organized by the Department of Medical Science under the National Natural Science Foundation of China, this department is the approval agency for funding from the National Natural Science Foundation of China Major Research Program (National Natural Science Foundation of China) in medicine.

Now everyone understands why so many people are flocking to it. If young people get a ranking here, they will be able to get a name in front of the leaders, and they will be able to avoid many detours when they are qualified to apply for the country in the future.

"Should I go to participate?" Gao Feng didn't want to go. "I'm only a resident doctor, so I'm still far from being able to apply to the country. I can't join in the fun."

The application process for natural science programs in medicine has always been very long, and the minimum requirements for applicants are: they must also have a doctorate or a professional and technical position above that of associate senior, which Gao Feng obviously did not meet.

"The title of associate professor is also acceptable," Director Shen said.

Only then did Gao Zheng remember that he was indeed an associate professor at University Z. "It seems that the school didn't give me a letter of appointment."

"Yes, I'll leave it for you." Li Youliang said from the side.

"Then it seems that my articles are not enough, right?"

"Absolutely enough, one article in Nature, one in Nature sub-journal, and INT J MOL ME." Li Youliang
"What about the research content, research conditions, and research plan?" Gao Feng still felt that it was not feasible. "I have only been working for half a year, and people look at these things very carefully."

"I've written it for you." Li Youliang said again.

? ? ?high wind.

"Go over and show your face." Director Zhao also advised from the side, "Academician Bao specifically mentioned you some time ago. He is a member of the Department of Medical Sciences."

"Teacher Xiong Huaxin said that as long as you perform well, the success rate of project approval is very high." Li Youliang winked at Gao Feng.

This is a back door!I don’t know why, but Gao Feng didn’t feel any disgust at all. Maybe the reason why everyone is disgusted with using the back door is: the person who used the back door is not me.

"Then I'll go?"

"The tickets have been booked for you." Li Youliang said.

high wind
"Li Xun, you should learn from Xue Youliang's approach to everything." Director Shen said, "Don't be dull all day long."

No, didn't you just praise me two days ago that I'm much smarter than before?

Li Xun gave Li Youliang a complicated look, why are you like this?Do you think you can do it?I really despise you!

After the arrival of autumn, the sky is crisp and the hot weather suddenly goes away. Many people plan to go out of the hospital for fun at this time, traveling from a city where they are tired of staying to a city where others are tired of staying to relax their mood.

There were a lot of people on the high-speed train, and the business class workshop was noisy, with a few children howling loudly.

Gao Feng didn't like noisy environments before, but he didn't know that he was going to have a child or something. This time, seeing the noisy children, he actually found it quite fun.

"There is an old man in front who seems uncomfortable." Li Xun came back after using the toilet and said.

"Where is it?" Li Youliang was very excited. He put the first aid kit on the table with a bang, "I have it with me."

"Master, what's the matter with you?"

An old man, about 5 or 60 years old, had his eyes closed and looked uncomfortable.

"My dad has a headache and dizziness right now." A middle-aged man on the side said worriedly, "I was fine when I got in the car, but I don't know what's going on now."

"Here, let me take your blood pressure." Li Youliang quickly opened the first aid kit and took out the blood pressure measuring device.

"200/114mmHg!"

"Fuck!"

The uncle is awesome.

"This blood pressure is too high!" Gao Feng was shocked, "Does the elderly usually have high blood pressure?"

"Yes, I have been taking medicine." The uncle's son was also shocked, "I have never seen him so high before."

"What kind of antihypertensive medicine are you taking? Do you have it with you? I can't add another dose." Gao Feng said.

"Dad, where are your antihypertensive medicines?"

"I finished eating last year," the uncle said.

Did you finish eating last year? ? ?
"No, what do you mean?" Li Youliang was shocked, "Does that mean you haven't eaten this year?"

The uncle nodded, "I'm thinking it's a combination of medicine and poison. Besides, there are usually no symptoms."

The crowd was speechless.

Li Youliang took out a nifedipine sustained-release tablet and said, "Here, put this in your mouth."

"It's best to get off at the next stop. The old man has to go to the hospital. He may need hospitalization." Gao Feng explained.

The middle-aged man nodded quickly and expressed his gratitude to them.

"Youliang, why do you have to carry this first aid kit every time you go out?" Li Xun asked, "It's so heavy."

"in case the emergency."

Two years ago, Li Youliang accompanied Director Zhao on an academic exchange abroad. Perhaps due to the climate, Director Zhao caught a cold the night he arrived and his fever reached 2°C.Li Youliang thought at the time that he could just go out and buy some fever-reducing medicine, but after asking, he learned that the nearest pharmacy was 39 kilometers away.

He spent a long time taking a taxi and found that the door was closed when he arrived.

I had no choice but to take Director Zhao to the hospital and waited in the emergency room for a full three hours. Finally, Director Zhao's body temperature was about to drop, and a nurse brought me some ibuprofen.

"How much do you think it cost?" Li Youliang asked
"A few tablets of ibuprofen cost about 2-3 yuan," Li Xun said.

"500 knives!"

"Damn, it's so dark!" Li Xun was shocked, "No wonder doctors abroad are treated so well."

The rest of the journey was uneventful, and the three of them quickly arrived at the hotel they had booked in advance, which was only 2 kilometers away from the venue of the competition.

Gao Feng feels that this young doctor competition is not very formal. The judges are all respiratory professors temporarily invited from major hospitals in the capital. They can treat patients, but they are really not qualified to be judges. Many people seem to give scores based on whim. , there is no unified standard.

He was assigned to Group 3. There were 8 people in the group, and the top 2 could advance to the next round.

"The first level is very simple!" said a gray-haired judge. "This level depends on the ability to read images. A good respiratory doctor must have high attainments in chest imaging."

"I will put 6 chest CT scans and 3 chest X-rays on the screen in a moment. You can write down all the information you see, and we will judge them together."

"The one who gets the most right will advance."

"This first level is considered stable." Li Youliang next to him breathed a sigh of relief and said to Li Xun, "Gao Feng's imaging reading ability is second to none in our hospital!"

"If you add the two of us, it will be a massacre!"

"Why are we two added? We are obviously supporting roles." Li Xun expressed confusion, are we useless?
"We are responsible for the quack down below, while he is killing randomly above."

"Together, it's—"

"Killing indiscriminately!" Li Xun replied quickly.

"1. Pulmonary embolism 2. Obstructive pneumonia, high possibility of tumor 3" Gao Feng wrote quickly on the paper, and he had a sense of déjà vu as he took the medical examination.

"Okay, hand in your papers." The gray-haired judge came down.

After 5 minutes, the results came out.

"Gao Feng and Murong Jiliang are promoted, and the others can go home for dinner." "Isn't that right?" someone below shouted, "Professor Kong, I think my writing is good!" He was obviously reluctant to go back for dinner.

"What you wrote is good." The gray-haired Professor Kong seemed to know this person, "But the two of them wrote better."

"If you are not convinced, you can come up and see what others have written."

Many people gathered around him, "This Gao Feng Niu got all 10 correct!" someone said.

"Dr. Gao Feng is indeed very capable. He writes better answers than the correct ones." Professor Kong also praised.

Murong Jiliang from the 307 Hospital in the audience also came up after hearing this. He was very confident in his reading skills. Could it be that Gao Feng wrote better and more comprehensively than he did?

I do not believe!
After seeing Gao Feng's answer, he walked down without saying a word. Where did this guy named Gao come from?

It seems to be a little better than what I wrote, Murong Ji Liang thought, but it doesn't matter, the next level will let you know my ability.

"This level is a case analysis question. I will show the specific situation on the screen in a while. Within 10 minutes after the screening, everyone must write down the diagnosis of the disease."

The patient, a 50-year-old female, developed cough and yellow sputum after catching a cold 6 days ago. Occasionally there was blood in the sputum, accompanied by shortness of breath after activity. She developed right side chest pain 1 day ago, which worsened when coughing and taking deep breaths. She reported no symptoms. Fever, chills, chills, no nausea, vomiting, hematemesis, abdominal pain, or diarrhea.

He went to a local hospital and a chest CT showed right pneumonia.

Physical examination after admission: body temperature 37.8°C, heart rate 108 beats/min, respiration 22 breaths/min, blood pressure 106/87mmHg, auscultation of both lungs with thick breath sounds, and a few wet rales in the right lung.

Cardiac color ultrasound showed: a small amount of mitral and tricuspid regurgitation, a small amount of pericardial effusion, and left ventricular diastolic dysfunction.

Blood gas analysis showed that the partial pressure of oxygen was slightly low, the partial pressure of carbon dioxide was normal, and the pH was within the normal range.

"This is the patient's chest CT. Take a good look at it," one of the judges said. "Here are some of the blood results of the patient when he was admitted."

On the day of admission, the patient's condition suddenly worsened and his oxygen saturation could not be maintained. He was transferred to the intensive care unit for emergency intubation. After being put on ECMO, his blood pressure still could not be maintained, and he died after resuscitation failed.

"How could he be dead?" A buzzing voice suddenly sounded from below.

"Yeah, how can pneumonia kill someone?"

"There doesn't seem to be any big problem with the heart. It stands to reason that the disease wouldn't progress so quickly!"

"Everyone, be quiet. This medical record is indeed relatively rare. The patient had an autopsy. I will announce the results later." The judge said.

Everyone in the audience began to carefully study the patient's test results and chest CT. Gao Feng also went up to take a look, and then he turned back directly.

Murong Jiliang, who was on the side, was paying close attention to him. When he saw him turning around and going back, he felt puzzled, what was this man doing?Have you given up?It shouldn't be.

In fact, Gao Feng already had the answer in his mind. When he saw the chest CT, he noticed the special nature of this case at the first sight. The patient's imaging characteristics were indeed not very typical, but if you look carefully, you can still detect the clues.

The premise is that the imaging reading ability is strong enough. Novices may not be able to figure out the reason even if they try hard.

"Are you Gao Feng?" Professor Kong came down, "Have you finished writing?"

"Yes."

Hey, Professor Kong glanced at him in surprise, "Here, let me see the diagnosis you wrote." He reached out and took Gao Feng's answer sheet.

"That's right!" Professor Kong looked him up and down, "How did you tell?"

He was indeed very curious, because he did not release some of the test results of the above case in order to make it more difficult.

As a result, the young man took a few glances and wrote down the correct answer.

"It doesn't feel difficult." Gao Feng said.

Help, someone is showing off. Murong Jiliang, who is sitting next to him, can't stand it anymore, "Professor Kong, I've written it too."

"Okay, there are three people who answered this level correctly. They are Gao Feng, Murong Jiliang, and Mai Peizhong."

"Mai Peizhong, how did you get the answer right?" Someone asked, "Your level is about the same as mine. I can hardly tell, but you can do it?"

Do you see that this is a human language?

"I'm much better than you!" Mai Peizhong choked back.

But in his heart, he was really embarrassed. This patient was a patient in their department, and he also participated in the death discussion.
"Okay, let's reveal the mystery below."

"The patient's diagnosis was pulmonary embolism. At that time, the family members had doubts about the cause of death, so they asked a third-party institution to perform an autopsy and found that it was a right pulmonary embolism."

"The patient's D-2mer is 32 mg/L."

The normal value of D-2mer is 0-0.256mg/L, and it is mainly used in the diagnosis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE).

"But unfortunately, before the above results came out, the patient's condition changed. Because the imaging was really not very typical, the doctor in charge did not think of the possibility of pulmonary embolism at all at the time."

"I didn't expect the patient's condition to progress so quickly."

"You can't blame the doctor in charge, right? I can't see the pulmonary embolism anyway."

"It would be better if we did a pulmonary artery CTA from the beginning."

"You are a typical hindsight. Based on the current chest CT scan, I think 99% of doctors will not do it for patients."

Pulmonary artery CTA requires the injection of contrast agent into the body. If there is no reasonable suspicion, no one will bother the patient. If something goes wrong, how should you explain it?

"Dr. Gao, tell us why you immediately considered that this patient had pulmonary embolism?" Professor Kong said, he was really curious.

"Actually, the patient's condition is not that confusing. Many examination results have already given us hints." Gao Feng said calmly.

"Look carefully at this chest CT. The level of the mediastinal window shows a wedge-shaped high-density shadow. The patient's clinical symptoms include hemoptysis, which has recently worsened and is accompanied by chest pain. In this case, the possibility of pulmonary embolism needs to be ruled out."

"There is also this cardiac color ultrasound. Judging from the measured values, the left and right hearts do not match, the right heart is enlarged, and the diameter of the inferior vena cava is 2.0cm, which is very supportive of PE (pulmonary embolism)."

"The electrocardiogram also showed signs, indicating right axis deviation, ectopic position of V5 in the chest lead, and mild ST segment depression in the inferior leads."

"and also."

After saying so many words in one breath, Gao Feng was a little tired. He breathed a long sigh of relief and then looked around expectantly. Is everyone exhausted?

"No, is it really as typical as he said?" Some people had deep self-doubt.

"Maybe for him."

"He said one thing after another, but I couldn't understand it at all!"

"That's right, you should read the electrocardiogram yourself??? Then why should you ask the doctor in the electrocardiogram room to do it?"

"Yes! I totally agree! It's still about this cardiac color ultrasound. The doctor in the color ultrasound room didn't even report that the right heart was enlarged. You said it was enlarged? Who are you?"

"The right heart is indeed enlarged." Mai Peizhong whispered, "It's in the autopsy report."

"Lao Mai, shut up!"

"I don't listen, I don't listen!"

Murong Jiliang felt a sense of frustration in his heart. He suddenly remembered who this Gao Feng was. He was a great writer and had such profound clinical skills?
Is there any mistake?How can we play with you like this?
I, Murong Jiliang, will restore my country in the future, bah!But if I want to become a medical leader, you are blocking my way!
The next level is the endoscope operation skills competition. This level does not require them to perform on stage. They only need to select a good practical operation video and send it up. The judges will watch and score one by one.

"The first one is Dr. Gao from HN Provincial People's Hospital." The judge introduced, and then he clicked on the video.

"Why does this video look so familiar?" someone in the audience shouted.

(End of this chapter)