Gou is practicing medicine in the clinic

Chapter 165 Overthrow everything, it is still beneficial to learn a few more medical skills

The patient's bone marrow showed active hyperplasia, and the erythroid hyperplasia was obviously active.

Accounted for about 0.64.

Among them, middle and late immature red blood cells are the main ones.Mature erythrocytes vary in size and cap shape, and fragmented erythrocytes account for 0.07.

We all know that bone marrow has hematopoietic function.

RBCs can be considered as 'children'.

From the combination of bone marrow and blood routine, Li Jingsheng found that this female patient had obvious symptoms of hemolysis.

As for the central nervous system disease, he thinks the possibility is relatively small.

Director Mu's initial diagnosis for the patient was a central nervous system infection?septicemia?
Does sepsis cause hemolysis?

Sepsis can cause abnormalities in the function of multiple systems in the body, and severe infections can indeed cause abnormalities in blood coagulation.

However, the patient's examination data and various aspects of performance do not seem to be consistent with sepsis.

"Doctor Li, I wonder if you have a diagnosis direction?"

Director Mu didn't dare to think too much about him.

Just a little bit of helpful diagnostic direction would be nice.

"I... dare not say!"

Li Jingsheng looked hesitant to speak.

"What dare you do? I won't blame you if you say something wrong. Say it, say it boldly."

Director Mu encouraged him.

Apparently, Director Mu thought that Li Jingsheng had a difficult diagnosis and weak knowledge, and was worried about saying the wrong thing.

"Then I'm going to talk wildly. I think the possibility of infection of the nervous system exists, but it is very small. As for the possibility of sepsis, I think it can be almost completely ruled out."

Li Jingsheng was afraid that he would not be able to accept it when he was too old, so he put it mildly.

Director Mu didn't speak for a while after hearing this.

After more than ten seconds, he said with a stiff face, "You mean, the two directions of first diagnosis can be ruled out?"

This is the result of discussions between Director Mu and many doctors in the department.

A neurologist was even called in to join the discussion.

As a result, the doctors in this small clinic rejected all the two first-diagnosis opinions as soon as they came.

"It should be ruled out."

Li Jingsheng was quite worried that this famous physician in internal medicine would directly collapse.

Fortunately, Director Mu is more resistant to 'shock' than he imagined.

Director Mu picked up the stainless steel thermos cup, raised his neck and took two big mouthfuls.

"Drink tea, and you also drink tea. Then talk about your direction of diagnosis. If you rule out the two first-diagnosis results we discussed, it's really you."

Director Mu was obviously not convinced.

But there is another glimmer of expectation.

For the time being, he doesn't know if the doctor in this small clinic is young and frivolous, talking nonsense here, or does he really have great skills?
Li Jingsheng's current diagnostic capabilities are mainly concentrated in three directions, internal medicine, gastroenterology, and general surgery.

For neurological diseases, he is actually not good at it.

But because of the opening of the clinic, some patients with skin diseases can often be seen.

Patients wishing to diagnose this often require knowledge of immunology.So he has learned a lot about immunology, especially skin immunology.

I often read such books to recharge.

He picked up the teacup and took a sip, the mouth was slightly astringent, and then his tongue became fragrant, and his mind was cleared.

“Good tea!”

Can't help but praise.

To be honest, he has never had such a good tea.

"Hehe, this tea was given by one of my students. He is now in a compound in Shanghai, and he heard that he has been promoted to be the leader of the team, and his income is very good. A few days ago, he sent me a small box of tea. How many times did I say such a tea would be enough?"

The implication is that the student is a bit stingy.

But Director Mu's face was clearly full of complacency.

Sure enough, everyone is the same, sometimes I want to show off something that I am proud of or proud of.

"Later, a vice-principal happened to come to see me for something, so I took some tea and brewed it for him. He could tell at a glance that it was a high-quality Dahongpao, and he also said that if it was placed in ancient times, it would be of the royal grade, and the production would be very rare. If you want to buy this tea, it is difficult to buy it with money, because the production is very small. Later, I asked someone to ask the price, just such a small box, more than 7 yuan. I am afraid, it is worth two months' salary."

Director Mu accidentally revealed the income level again.

He is the chief physician of the Department of Respiratory Medicine, and his salary is about [-], which is much lower than expected.

Li Jingsheng thought that at his level, at least [-] a month.

Some doctors cherish their reputation, abide by the law, and don't like to earn gray income.This will certainly lead to differences in income levels as well.

Also, it is the top doctors in surgery who really make money.

Although internal medicine is also very profitable, it is incomparable with top doctors in surgery.

The leader of the top surgical department in China, with a stable annual income of more than 500 million.Internal medicine, even including lectures, academic exchange meetings held by manufacturers, etc., 200 million a year is considered to be the sky.

"How much does this cup of tea cost? I have to drink it up, or it will go to waste."

Li Jingsheng didn't expect Director Mu to entertain him with such expensive tea.

Although what he said was a bit exaggerated, it was still quite useful in his heart.

"Haha, if you like to drink, I'll give you some later." Director Mu smiled triumphantly.

It's just that the patient's problem has not been solved, and after laughing, the sadness between his brows has not dissipated.

"Your student gave it to you. I drank a cup and I was already full. I got greedy after drinking it again and again. Does that patient have any other symptoms besides headache, fever, and aphasia?"

Li Jingsheng took the initiative to bring the topic back to the patient.

We have to find a way to help Director Mu break through this difficult case.

"Cheng Qian is currently in a coma, with urinary incontinence, convulsions, and soy-sauce-colored urine. The bleeding under the skin has become more serious, and a very obvious purpura has appeared."

Director Mu gave a general description of the patient's current situation.

Looking at the situation, if the cause cannot be found out as soon as possible, it may not last long.

"Is it okay to go to the ward to see the patient?"

"No problem, I'll take you there."

Director Mu personally led him to the ward for inspection.

Li Jingsheng went to the ward to check on the female patient. Although she was not admitted to the ICU for the time being, the bed card was marked with key points.

Key patients who belong to the monitoring of nurses and doctors on duty.

In this case, medical staff usually go to the ward to check every 15 minutes to half an hour.

Although there are family members accompanying the bedside, but the family members do not understand medicine and cannot discover some potential risks in time.

The patient is basically in a semi-comatose state.

Seeing Li Jingsheng standing beside the hospital bed, her eyes changed slightly, and her body twitched uncontrollably.

The middle-aged woman who accompanied the bed was less than 50 years old, and her eyes were red and swollen like peaches.

How can parents not be anxious when they see their daughter who is a good person and suddenly become ill like this.

The patient still has a high fever.

"I'll check her joints!"

Li Jingsheng said to his family.

The family members just stood aside stupidly and didn't speak.

Li Jingsheng lifted the quilt and touched the patient's arm ulna, radius, and elbow joints.Then examine her leg bones.

Because the patient's high fever persisted and the cause could not be found, he thought about trying bone palpation.

When she touched the bones, she didn't feel anything abnormal.

But strangely, he felt that the patient's bone temperature seemed to be much higher.

Because the patient is in a state of fever and the bones are in the body, it is normal for the temperature to rise.

But the bone temperature that Li Jingsheng felt was not this kind of surface temperature rise.

Instead, it feels that the patient's bones seem to be slightly higher than the body temperature.

What is the disease that will damage the patient's bones?

Then, he also found several tiny blisters appeared in some parts of the skin on the back of the patient's calf.

Uneven distribution.

This should not be a fever.

"Director Mu, I'm done checking."

After Li Jingsheng checked, he habitually cleaned his hands with disinfectant.

But inside the brain is thinking about the cause of the patient.

"Come on, let's go to the office to discuss."

Director Mu guided Li Jingsheng back to the office.

"Tell me first, why both sepsis and nervous system infection can be ruled out?"

Director Mu has obviously recovered from the blow.

"The cerebrospinal fluid examination was normal, and the intracranial pressure was also normal. No space-occupying lesions, internal hemorrhage, or cerebral infarction were found on the head CT. I think the possibility of nerve damage is very low. As for sepsis, I have seen some patients. Not only did the symptoms not match, but the medical history and characteristics also did not match. The neutrophils alone are too distracting, so it can be ruled out. I now suspect that she may be a disease of the immune system."

When Li Jingsheng first read the patient's information, he already had doubts in this regard.

After checking in the ward just now, this suspicion not only did not decrease, but increased further.

"Director Luo from Shennei mentioned that the patient may have tuberculous meningitis, what do you think?"

Hearing that Li Jingsheng suspected that the patient had an immune system disease, Director Mu disagreed.

"Isn't the cerebrospinal fluid test normal? This disease can be ruled out directly."

Li Jingsheng didn't understand why Director Mu asked such a question?
"I think so too. This case is really complicated. If you say that it is a lung or respiratory tract disease, I am more good at it. This patient has a headache and fever, which is similar to an upper respiratory tract infection. After investigation, it is actually not a respiratory tract disease at all!"

Director Mu complained like a child.

He is also unlucky when encountering such a thing.

Symptoms are similar to respiratory diseases, but are actually diseases in other fields.

He, a famous doctor in the respiratory field, was completely stunned.

"Why do you think it is a disease of the immune system? Tell me about your thinking."

Director Mu decided to listen to the opinions of young people first.

"My idea is actually very simple. Common diseases cannot explain all the symptoms of the patient. The patient must have a rare disease. According to the hemolysis of the patient, I thought of a terrible skin disease, which happened to be caused by the immune system."

Li Jingsheng's medical knowledge can only be said to be relatively solid, but he can't be regarded as a well-educated man.

At least he himself never considered knowledgeable.

It is true that I love to read books.

It is true that learning is more complicated.

One is that when working as a doctor in a large hospital, the frequency of rotation and changing departments is relatively high. Every time I go to a new department, I must strengthen the study of medical knowledge in that field.

Later, I opened a clinic by myself, not to mention.

Don't think that all the diseases you encounter are minor, but there are all kinds of diseases, and you may encounter any disease.

This also requires his extensive medical knowledge.

Director Mu was correct for a while.

Is it okay to make a diagnosis like this?

Originally, I thought that Li Jingsheng would give an eloquent medical theory and syndrome differentiation.

Unexpectedly, just one sentence, common diseases cannot be explained, so think about rare diseases.

Rough words are not rough.

In fact, diagnosis does not have to be formulaic, and it is rigidly analyzed in a textbook way.

The thinking of clinical diagnosis is more flexible, and sometimes the sword may hit the target when the sword goes sideways.

"I suspect that the patient may have SLE disease. Although the patient did not have obvious joint and muscle symptoms, nor did he suffer serious damage to the liver or kidney, but the patient had thrombocytopenia, systemic hemolysis, and some initial damage to the skin. So I suspect that lupus erythematosus may be more likely. At least it is worth further examination."

Think of the patient's bone temperature rising, blisters appearing on the back of the calf, coupled with hemolysis, persistent high fever, severe headache, thrombocytopenia for which no cause can be found, etc.

The only thing that comes to mind is the notorious disease lupus erythematosus.

It is a disease of the immune system.

The symptoms shown are various, and it is often easy for doctors to misdiagnose or be confused in diagnosis.

If it is said that tuberculosis is easy to be misdiagnosed and missed, then this disease is easy to confuse the doctor Zhanger Monk.

"Hearing what you said, it seems to make a little sense. I will immediately order a skin biopsy for the patient."

Director Mu is also a veteran of the clinical battlefield.

It's one thing to save face, but in front of the truth, he is definitely not that kind of elm lump that cannot be carved.

"The skin biopsy may take a little longer. It's safer for me to check her for anti-nuclear antibodies first."

Director Mu did not need to discuss with patients at all when prescribing these examinations.

This is the benefit of doctors in large hospitals.

Efficiency can be greatly improved without exhausting the explanation work.

"Well, you have discussed it in the case study, and I have also drunk your good tea, so I will go back first."

Li Jingsheng was also very happy to help Director Mu find this important diagnosis direction.

It seems that it is good to have time to learn a few more medical skills in the future.

If you have not studied the medical knowledge of skin diseases and skin immunology, you must be blind today.

"Don't worry, don't worry, Director Hua of the Orthopedic Surgery Department wants to ask you, how are you thinking about the things I talked to you that day?"

This matter is relatively secretive.

Only Li Jingsheng and Director Hua talked about it.

Now that Director Mu knows, it means that Director Mu and Director Hua should have a good friendship.

Also, Director Hua must discuss with the hospital leaders when recruiting people.

He can decide this matter by himself, but it is not suitable.

After all, Li Jingsheng's employment conditions have many special features.Like working only three days a week.

"Director Hua wants me to answer him now?"

Li Jingsheng asked back.

This matter was supposed to be discussed with Director Hua yesterday.

As a result, Li Jingsheng was too busy.

In addition, Dr. Xu gave him advice, saying that he would cooperate well with Li Jingsheng and let him raise his status.

Nothing out of the ordinary.

Everyone is for profit.

Now Director Hua couldn't hold back, and he took the initiative to ask Li Jingsheng about the result of his consideration, which is a good thing.

It means the time is ripe.

"I didn't say that I must give an answer now, but I said that if you come to the Second Hospital, I will let you go to his office."

"Then I'll go there now!"

Li Jingsheng just decided on this matter.

"Originally, I really wanted to snatch your talent from the orthopedic surgery department. But I can't give the orthopedic surgery department such a generous treatment. You can go. If you have time in the future, you can often come to our department of respiratory medicine. I am very optimistic about you."

Director Mu is a kind person.

Make the interests clear.

Li Jingsheng has bone-setting skills, and he is a special talent in orthopedic surgery, so his value naturally doubles.

But in the Department of Respiratory Medicine, no matter how good he is, he is very replaceable. If he wants to raise some excessive conditions, it is a fart.

He came to the orthopedic surgery with ease all the way.

Director Mu should have informed Director Hua.

As soon as Li Jingsheng arrived, Director Hua was already waiting there, waving at him.

"Li Jingsheng, here!"

After seeing Director Hua, Li Jingsheng quickened his pace and walked over.

"Because my clinic has been very busy these two days, I'm really sorry that I couldn't come to see you in time."

Li Jingsheng took the initiative to apologize to Director Hua.

"It's okay, it's all understandable. Your clinic has been on the TV news. It must be overcrowded with patients in the past two days?"

Director Hua asked with a smile.

"It's not overcrowded. It's true that the number of outpatients has increased several times compared to the usual one. But no matter what I do, it's just a clinic, and what I see are basically minor ailments with headaches and fever."

Li Jingsheng was very humble.

Director Zhao, Dr. Xu and others have all sent a signal to Li Jingsheng.

The Second Hospital is the real overlord in the south of the city.

It does not appear to allow any medical institutions that might threaten its status.

Therefore, it is necessary to sell miserably and self-depreciate appropriately.

"The clinic will indeed be subject to some restrictions, so coming to our hospital is a very good choice for you. How did you think about the matter we talked about two days ago?"

Director Hua took him into the department director's office.

"Working here three days a week, and only in the outpatient clinic, although it will have some impact on my clinic, the advantages outweigh the disadvantages. So I am very happy to be able to join the Second Hospital. Coupled with your wise and kind department director, I am even more happy."

Li Jingsheng is not hypocritical, since he has made a decision, he should be more straightforward.

"Haha, you kid, don't give me a high hat."

Director Hua couldn't help laughing when he praised him.

"Since it's agreed, let's talk about the details directly, and then we can call the personnel to sign the contract."

Director Hua was very anxious about Li Jingsheng's entry into the job.

Can you be in a hurry?

Dr. Xu is sick and cannot work.

The manipulative reset outpatient clinic lost a large number of patients. As the director of the department, he saw it and was anxious.

If Li Jingsheng could come over to replace Dr. Xu, even if he only worked three days a week, the situation would be greatly improved.

"I basically have no requirements for other aspects, and I can obey all your work arrangements for me. But in terms of freedom, some conditions may be a bit too much. Please understand and tolerate more."

Li Jingsheng now basically holds the initiative.

Negotiations are like this, and the party who is impatient will suffer a little.

But in general, everyone must be a win-win cooperation.

At most, it is a little bit of a win in some small interests.

"Tell me first, as long as it is within my scope of authority, I will try my best to take care of you."

Director Hua's expression became much more serious.

"I work three days a week, and they can't be connected together. Try to work one day and take one day off."

"no problem."

"The working hours are from [-]:[-] a.m. to [-]:[-] p.m., and I cannot be forced to work overtime. Even less, I cannot be called during non-working hours to force me to go back to the hospital to work overtime." Li Jingsheng proposed a more critical additional condition.

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(End of this chapter)