This doctor has a system

Chapter 257 246. I Need More Money (5000 words)
"I don't see people a few times a year, and they always complain about me when I come."

"Aren't I busy?" the eldest son said.

"I'm not busy, am I? I have to go to work every day." The second son retorted.

"Okay, let's stop talking." The patient's wife stopped the two people from quarreling, "Now that we are in a big hospital, what's the point of arguing anymore."

At this time Gao Feng and Dong Qianqian came in.

"Doctor!" The patient's eldest son saw the doctor come in and hurriedly greeted him. "Please take a closer look. My mother still has a severe cough and severe chest tightness!"

"I just had breakfast and I couldn't stop breathing!"

This is a filial son, and Gao Feng can feel that his anxiety comes from the heart.

"Okay, let's check the old lady's vagina again." He took out the stethoscope.

The patient's lungs have low breath sounds, wet and dry rales can be heard, there are also major heart problems, and the heart rate is obviously slow.

"Why is the heart rate only about 40 beats/minute?" Gao Feng looked at Dong Qianqian.

"The patient has third-degree atrioventricular block." Dong Qianxihui reported, "It has been more than 20 years since the discovery."

Speaking of this, Dong Qianqian was a little depressed. When she first treated this patient, she was full of confidence.

Just make a bronchoscopy lavage solution and send it to NGS!There is a high probability that pathogenic bacteria can be found.

You have to ask, what should I do if I can’t find it at once?
The answer is simple: give it another try.

But this patient could not tolerate the risks of bronchoscopy. She was a patient with third-degree atrioventricular block, which is a disease caused by atrioventricular block caused by obstruction of the conduction pathway.

Normal heartbeat depends on the conduction of impulses (electrical signals). The conduction of impulses from the atria to the ventricles needs to go through an invisible and intangible "pathway". If there is a problem with the path, the impulse signals from the atria will be permanently or temporarily damaged. If the heartbeat cannot reach the ventricle, the beating of the atrium and ventricle will be completely separated, which is called third-degree atrioventricular block.

In patients with third-degree atrioventricular block, the ventricular rate is slower than the atrial rate and is generally less than 60 beats/min.

The old lady’s ventricular rate was only about 40 beats/min, which was already very slow. If she had a bronchoscopy under general anesthesia, the risk would be very high.The application of anesthesia itself will slow down the patient's heart rate. If the basal heart rate is still low, cardiac arrest may easily occur.

Unless the anesthesiologist had his brain kicked by Madhu, no one would come looking for excitement.

"Is it okay to do local anesthesia?" Gao Feng asked. He was very confident in his own level. This is true for all the bad guys.

"I'm afraid that won't work either." Dong Qianqian said hesitantly, "The old lady's stomach is very shallow, and she can even vomit even if she does oral care."

Farewell!

Gao Feng just wanted to turn around and leave.

It's not possible to do this, nor is it possible to do that. Wouldn't it put me in a difficult position?

It’s just very embarrassing, otherwise I would be looking forward to your return?Dong Qianqian looked at him as a matter of course.

What you said makes sense.

"Difficulty: Chen Xianghua's situation is getting worse and worse. To use a very appropriate saying, the old lady celebrates the New Year - every day is worse. Please use your professional medical knowledge to help her make a clear diagnosis in time. You can get skill points by completing the task. 10 points. If you fail, 30 skill points will be deducted." The system jumped out at this time.

Just waiting for you, Gao Feng thought.

Imaging shows that infection is likely, but the symptoms are not relieved after antibiotics. There must be a reason for this.

The first reason: I used fake medicine. Is this possible?Of course it exists.However, the probability of using fake antibiotics in a county hospital is about the same as the probability of being hit to death by a brick falling from the sky. Antibiotics are generally not faked, so I won’t mention the reasons here.

The second reason: the currently used antibacterial drugs do not cover the pathogenic bacteria that cause disease.Although the combination of cefoperazone sodium, sulbactam sodium and vancomycin is equivalent to the heavenly sword in the left hand and the dragon-slaying knife in the right hand, it should be invincible.But there are exceptions. If the enemy is a puddle of clear water, it's useless to hit it with a sword.

For example, tuberculosis and fungi. Although bacteria and fungi differ by just one word, the treatment drugs are very different.Even the best antibacterial drugs are ineffective against fungi. Antifungal drugs must be used for fungal infections.

Of course, there is a third reason: tumors. The elderly must be wary of the possibility of tumors, but Gao Feng made a mental evaluation and found that the probability was very small. The patient's imaging showed no obvious features.

"Check the PPD experiment and tsport, and then select the G experiment and GM experiment."

The PPD test and tsport are useful for ruling out tuberculosis, while the G test and GM test are for looking at fungi.

G test: Also known as the 1-β-D glucan test, it detects the fungal cell wall component 3-β-D glucan. After the human body's phagocytes engulf the fungus, it can continuously release this substance, causing Increased levels in blood and body fluids.

GM test: It detects galactomannan (GM). Galactomannan is a polysaccharide widely present in the cell walls of Aspergillus and Penicillium. When hyphae grow on the surface of the bacterial cell wall, galactomannan is removed from The weak hyphal tips are released and are the earliest antigens released.

Elevated values ​​of both have great reference significance in diagnosing fungal infection.

"Then what medicine should be used for treatment?" Dong Qianqian asked.

"Fluconazole injection can be given empirically as an intravenous infusion."

"You suspect it's fungus?"

"Cryptococcus is the most likely possibility. By the way, I also did a latex agglutination test."

Pulmonary cryptococcosis is a fungal disease of the lungs caused by infection with Cryptococcus neoformans or Cryptococcus gattii.

It is more common in people with low immune function such as AIDS, organ transplantation, leukemia, liver cirrhosis, diabetes, and people who need long-term use of hormones and immunosuppressants. In recent years, the incidence rate has also increased in people with normal immune function.

Symptoms of pulmonary cryptococcosis: Mild cases have no obvious symptoms or only mild non-specific symptoms such as cough, sputum, and chest tightness.

Elderly and frail patients like Mrs. Chen may develop high fever, shortness of breath, hypoxemia, respiratory failure and other symptoms, and the lesions are easy to spread and the mortality rate is high.

"No, why do you think so?" Dong Qianqian was puzzled. Where did you find out?

"Intuition." Gao Feng replied, "On the patient's chest CT, there are all infiltration and consolidation lesions, and the lesions mainly occur in the lower lobes of both lungs, followed by the middle lobes, the posterior segments of the upper lobes, etc. The lesions are in subsegments or segments of the lungs. It is a patchy consolidation with unclear boundaries, and bronchial atmosphere can be displayed in the consolidation."

"Infiltrative-consolidative pulmonary cryptococcosis is prone to such manifestations."

Dong Qianqian sighed inwardly. Every time she felt that she had almost learned something, Gao Feng would always jump out and teach her a lesson.

"You still have to practice again!"

The two returned to the office together, "Teacher Gao, are you back?" Li Xun quickly stood up.

"Well, I just went to see a patient." Gao Feng said with a smile, "Do you have any difficult patients?"

"No, mine are relatively stable."

When Li Xun first arrived, Dong Qianqian took good care of him and assigned him relatively mild patients.

After handing over the shift, the three of them led the trainees in a unified ward round.

Some patients feel extremely nervous when they see so many people coming all at once.

This is the fact. Patients feel uneasy when there are fewer people coming to see them, and even more uneasy when there are too many people coming to see them.

Anyway, when I came to the hospital, the main focus was on carelessness.

Ai Hongkai was making rounds when her cell phone suddenly rang.

"Hello."

"Hello, is this Professor Ai?" "I'm Ai Hongkai." He didn't dare to take the name of professor, and he blushed when he heard it.

"It's like this. The funds for the scientific research project you applied for at the school have been received. They will be credited to your reserved account tomorrow at the latest. Please pay attention to check."

"Okay, okay." Ai Hongkai was very happy, "Are the school's matching funds included?"

"Yes, I need to inform you that the amount has changed." The young lady's voice was very sweet.

"How much less?" Ai Hongkai asked. He was in a good mood now. If he could give some points, it would be fine. If he could deduct points, he would be fine. He couldn't pass the school.

"No less, 10 more."

Look, the school still has a keen eye for gold. Ai Hongkai is very happy. It seems that he had a villain's heart before.

If Li Youliang were here, he would definitely think that there is no quiet time, because someone is carrying the burden for you.

It was already 10 o'clock in the evening when Zhao Xingye returned home. The children were asleep and his wife was watching TV series there with tears in her eyes.

"What's going on?" He panicked, "Our mother is sick?"

His father-in-law's life was not very good. Just when the children had achieved some success, he suddenly suffered a cerebral hemorrhage. When he was found out, he was already dead.

The mother-in-law is not in good health and has been living with her brother-in-law in the south. They just visited her some time ago.

"My mother is fine." His wife rolled her eyes at him, "I was touched." She pointed to the TV.

Damn, it turns out to be a TV series.

Zhao Xingye was speechless. Nowadays, these TV series, whether they are fairy tales, romances, suspense or other themes, if you don't stir up emotion and make the audience cry, it seems that it is not a good TV series.

"Two people who clearly loved each other ended up parting ways because of a misunderstanding. What a pity!" The wife wiped her tears, "Why don't they explain to each other?"

"I guess it's because the director didn't let me." Zhao Xingye yawned, "If it's okay, let's go to bed quickly."

His wife stood up, and soon after he finished washing, a glass of warm water with a high content of citrus was brought to her.

The corner of Zhao Xingye's mouth twitched a few times, but he still took it obediently, took a deep breath, and drank it all in one gulp.

"Come on." He lay on the bed and arranged himself into a Tai character.

"What?" His wife was confused, and then rolled her eyes at him, "I can't come, I've been here for the past few days."

"Then what are you trying to make up for me?" Zhao Xingye was a little unhappy. I had already done some mental preparation, and that's it? !
"How can you say it's just nonsense? Isn't this for the future?" His wife got into his arms.

This is all focused on the future.

Who said women are short-sighted?I, Lao Zhao, was the first to disagree with this statement.

"Your boss hasn't been angry with you lately, has he?"

It feels weird to say this
"No." Zhao Xingye replied. This period of time really felt like a quiet time, and he was not used to it.

"There are several companies that have been pressing for catalytic substrates, but I think it's still early before the time agreed in the contract. I don't know what they are anxious about."

"I'm really anxious!" Xiong Huaxin of Xinhua Pharmaceutical frowned.

Thanks to the magical effect of the catalytic substrate, the company has become the leader in the monoclonal preparation industry. This year's revenue increased by 35% compared with the same period last year!Based on the size of their company, 35% is an incredible value, and some people once suspected that their financial reports were fraudulent.

The shareholders almost smiled crookedly, and the status of Xiong Huaxin's faction in the company rose accordingly.Most of the time, people who can bring wealth to the collective will definitely be valued.

But now he also encountered troubles, that is, there was not enough catalytic substrate. This was something that no one expected, and no one expected that it would be consumed so quickly.

"This is a good thing." The boss said, "Hurry up and contact Fengxin Company to increase supply!"

The purchasing department contacted Fengxin Company and said they would wait, but then they lost faith.
Zhao Xingye actually took this matter to heart. He came to the hospital to report to Gao Feng. The latter was showing a film to a patient at the time and waved his hand to express his understanding.

Later, he said it again on the phone, and the latter said yes.

The boss is not anxious about making money. What is he anxious about? He, Zhao, is not a eunuch.

Gao Feng has long forgotten about this matter. The reason is simple: he doesn't want to do it.Why do people start a company?The answer is to make money without working and enjoying the results.

The current situation is that only he knows how the catalytic substrate was synthesized. Due to the huge interests, people as close as Li Youliang and Hu Jiaran dare not get involved.

The boss actually wants to work and earn money by himself. What motivation can he have? So he keeps delaying it. Anyway, it is not yet the time stipulated in the contract.He, Gao, always kept his word, could he still lack something like them?
Now the pressure was on Xiong Huaxin's side. The boss called him over several times. Although the words were very gentle, he knew that the boss was a little anxious.Who can bear it when all the money slips away from your eyes?
The richer the boss, the more obsessed he is with making money.

Zhao Xingye: What are you talking about?

Mrs. Chen Xianghua's condition improved, and her eldest son passed on two baskets of fruits and placed them in the office.We haven't finished eating yet. Two days later, my youngest son brought another bag over.

"Where are you?" Li Xun said while chewing an apple, "The old lady will stay for a long time, how can she give out fruits like this now."

"You see, no one eats such expensive apples."

"Understood, I'll tell their families now and ask them to send something else next time." said a "smart" student from Guipei.

You know what your uncle is, Li Xun almost choked to death, is that what I mean?I'm afraid the patient will spend money!Besides, this patient is not in my charge. He is already very happy just to have two bites of an apple. How did you understand my intention?

The patient's latex agglutination test was positive, and the fluconazole treatment was effective, so the diagnosis of cryptococcal pneumonia was cleared. Dong Qianqian finally felt relieved.

"Difficulty: You completed the above task perfectly and obtained 10 skill points."

"You have initially integrated the medical knowledge acquired from the system. You are one step closer to becoming a famous Xinglin expert. You have gained 10 skill points."

surprise!Gao Feng couldn't help but smile on his face, "Here comes Xinglin Master!"
This is a small step for me personally, but it is a big step for the entire medical community. In addition to my personal efforts, I cannot achieve what I have achieved today without the love of my family, teachers and everyone here. As a new student Academician Jin, I will definitely do more
"Please allow my dust to fall to the ground."

Gao Feng was seizing the present and enjoying the future when his cell phone suddenly rang.

Who is so annoying!He picked up his phone and looked at it. It was Xiong Huaxin of Xinhua Pharmaceutical.

"Professor Gao, are you busy at the moment?"

Of course I was busy. I was giving a speech as an academician, but you interrupted me.But Gao Feng is not a grudge-bearing person, "You're not busy, why did you call me suddenly?"

"It's still about the catalytic substrate." Xiong Huaxin said eagerly, "Can you send us a batch in advance? The company is now working hard to prepare this monoclonal antibody, and the catalytic substrate is in short supply!"

"I've been a little busy lately." Gao Feng was a little embarrassed, "Is it okay after the New Year?"

New Year's Eve?Xiong Hua's confidence felt ice-cold. It was still a few months before the Chinese New Year, so how could he deliver errands to his boss?

"do not!"

Facing Xiong Huaxin's persistent pursuit, Gao Feng really had a headache. The other party had a good relationship with him and was currently cooperating deeply with Xinhua Pharmaceutical. It seemed inappropriate not to agree.And calculating the time, his son will probably be born at the end of the year, and he will definitely be very busy by then. What if he can't take care of the catalytic substrate?
It seems that I really have to work overtime in advance. Thinking of this, I said, "Okay, you can send someone here next week."

Xiong Huaxin was overjoyed, it was great, now he could finally give a job to the company.

"But you are approved in advance, so you have to pay extra." Gao Feng said.

"Jiajiajia!" Xiong Huaxin agreed happily, fearing that the other party would regret it.

(End of this chapter)