Gou is practicing medicine in the clinic

Chapter 261 Diagnosis of difficult blood cases

"Doctors who have signed up for blood diseases, please note that the rules of the competition will be announced first. We will give the basic information of the patients, and then the contestants will apply for inspections based on their initial diagnosis. The scoring rules are as follows. Every additional application for routine inspections One point will be deducted for each item. For CT, MRI, and advanced biochemical examination applications, two points will be deducted for each additional item. If the diagnosis direction is correct, 1 to 5 points will be added.

For example, if the initial diagnosis direction is correct, 1 point will be added, and if the second step diagnosis direction is still correct, 2 points will be added.If the diagnosis direction is always correct, a total of 5 points can be added.

If the diagnosis is completely correct, it will be worth 30 points.

For each missed diagnosis, 10 points will be deducted.A misdiagnosis is worth zero points.

Correct treatment plan is worth 20 points.

If there is an error in the treatment plan, points will be deducted based on the possible treatment consequences.For example, if the surgical plan is wrong and the patient becomes disabled, 10 points will be deducted.20 points will be deducted if the patient dies.

If the medication causes the patient's condition to worsen, 5 points will be deducted, if the patient becomes seriously ill, 10 points will be deducted, and if the patient dies, 20 points will be deducted. "

The rules of the entire competition are formulated based on clinical practice.

There is only one purpose, to find out the cause of the patient's disease and cure it at the lowest cost.

What is tested is a doctor's comprehensive diagnosis and treatment ability in all aspects.

This is only the first competition event, so strict.

It also made Li Jingsheng look forward to this skill contest a little more.

What doctors fear most is working behind closed doors.

He can take this opportunity to learn how doctors from more than 170 hospitals inside and outside the province diagnose and treat various diseases.

This will be of great benefit to his future clinic visits.

"If the contestant answers the question incorrectly, non-competitors present can also answer the question. You can open the tablet on the table and enter the name of the hospital, personal name, ID number, and mobile phone number for verification, and then you can participate in answering the question. If you get If you reach a high score, you will be considered as a participant and will be eligible to receive trophies and certificates of honor.”

The prize money in this kind of event is not attractive.

All the doctors present are at the elite level. Even if they get No. 1, the bonus is only [-] yuan.

I believe that not many doctors can take it seriously.

What is really valuable are trophies and certificates of honor.

This will become the reference basis for future evaluations, promotions, and professional titles.

It has a high gold content.

It is recognized by the competent authorities and the Western Medical Association.

"In fact, even if non-participants do not participate in the competition, they can also enter their personal information and bind it to the tablet computer on the table, so that they can answer the questions in the next competition. Or watch the correct answer when the time comes."

The examiner's words rang out again.

Everyone began to operate the tablet computers on the table.

Qiao Bang Hospital is really rich.

Even if one tablet only counts as one thousand and five, so many of them are an astronomical sum.

Li Jingsheng had a try mentality and followed the prompts to bind it.

As soon as the binding is completed, a flashing red frame will automatically appear.

Current answer.

Click on it, and the basic information of the patient will be displayed immediately.

It's really convenient.

High technology changes people's lives and brings great convenience.

Patient information: Xu Moumou, 54 years old, male, was sitting at home watching TV at nine o'clock in the evening and found purple patches on his skin.Later, when I saw that the purple spots had not dissipated, I felt frightened and rushed to the hospital for treatment.

The patient is usually in good health. He had sore throat, fever, and headache two days ago and had taken painkillers and spiramycin.

After taking the medicine, the condition improved, the headache was relieved, the body temperature returned to normal, but the pain in the throat did not improve.

On the second night after taking the medicine, small subcutaneous blood spots appeared on the face, limbs, waist, back, chest and other parts of the body.

After that, it gradually becomes larger and becomes a purple spot.

Before admission, the patient felt soreness in both knee joints and lower limb muscles.

When admitted, the body temperature was 36.7 degrees, the blood pressure was 105/75mmhg, the heart and lungs were normal, the mind was clear, and bleeding spots could be seen on the skin.

Blood spots vary in size, ranging from one millimeter to two centimeters in diameter.

Scattered throughout the body, most on the limbs and less on the trunk.

Bleeding spots and ecchymoses can be seen on the oral mucosa.

Abdominal examination revealed tenderness around the umbilicus but no muscle tension.

There is no redness or swelling in both knee joints.

That's all the basic information given.

After Li Jingsheng read it, he couldn't help but think of the case of ITP he received a few days ago.The little boy had difficulty stopping bleeding and had thrombocytopenia.

This patient's initial symptoms were a bit like a cold. After taking the medicine, his body temperature dropped and his headache disappeared.

As for the sore throat, that's normal.

Sore throat generally does not recover that quickly.

The mouth, pharynx, and nasal cavity are all special, with a humid environment and mucous membranes.If there is inflammation or abscess, it will take a little longer to recover.

Anyway, there is no money to participate.

He tried to click on the routine blood application.

1 point will be deducted immediately.

I didn't expect it to be so smart and set up the scoring rules.

The purpose of deducting points for examinations is to prevent doctors from prescribing examination applications indiscriminately.

Some hospitals have very loose management of examination applications and even encourage doctors to prescribe more examinations.In this case, the doctor's diagnostic habits will become bad.

Because there is no supervision, doctors just prescribe a lot of tests regardless of the patient's condition.

I wish every patient could undergo a full set of examinations.

In fact, this is not only a loss of medical ethics, but also a serious waste of medical resources.

One more examination for a patient will greatly increase the queuing time.

It’s common to wait in line for half an hour to have your blood drawn.

For a color ultrasound, it is normal to queue for half an hour or even longer.It is conceivable that patients dragged their sick bodies, queuing here and there, constantly struggling, and could not get timely and effective treatment at all.

After a long day, the doctor may have gone off work before the examination is completed.

This kind of doctor who prescribes random checks is very shameful.

No consideration for the patient at all.

To put it bluntly, patients become cash machines in their eyes.After the examination is issued, the patient only has to pay. As for the patient's life or death, the doctor has nothing to do with it.

In medical procedures, if an accident occurs while a patient is queuing up for an examination, or if the patient's condition worsens and threatens his life, the doctor has only the obligation to rescue the patient.There is no need to take responsibility.

In the past, there was a hospital that made big news because of a similar decline in medical ethics.

The patients are already in critical condition, but the doctors just leave the patients there without anyone taking care of them in order to take a group photo.

In the end, the patient died due to delayed rescue.

Angry family members took the hospital to court.

In the end, those doctors and nurses who neglected their duties were punished as they should be, but the lives lost by the patients could never be recovered.

What is left to loved ones is eternal sadness.

In this skills competition, points will be deducted for every examination requested by the doctor, and 2 points will be deducted for unconventional examinations and tests.

Li Jingsheng thought it was great.

That's how it should be.

A truly smart doctor must make his own judgment first, and then issue a corresponding examination application to verify whether his judgment is correct.

After Li Jingsheng clicked on the blood test application, the results came out immediately.

Hemoglobin was the first data he wanted to see, 176g/L.

White blood cells 21.9 times ten to the ninth power per liter.

Neutral lobulated nuclei account for more than 80%.

Platelets are 82 times ten to the ninth power per liter.

There is also a test result attached at the end. The patient's bleeding and coagulation time are normal.

This shows that the patient's coagulation should be fine.

But the patient's onset is very urgent, so what is the cause?

Li Jingsheng subconsciously raised his head and scanned the entire venue. Many people were lowering their heads to control tablet computers.

It is estimated that most doctors have the same idea as him. They are here anyway, and there is no fee to participate.You can definitely participate in this non-practical skill competition.

Maybe you can meet someone you are good at, and you will win.

To be selected by the organizer as test questions, they must have been carefully selected and very difficult.

It can be seen from everyone's scratching their heads and scratching their heads, frowning and thinking hard.

No one spoke up to discuss it.

This quality is still there.

Besides, there is surveillance on site, and all kinds of cheating will be clearly photographed.

The doctors who can come here are all the best among the best, and they must have face.

No one would do something stupid like cheating.

The organizers probably won't allow it either.

It can be seen from the scoring rules that the organizers hold this event really to improve doctors’ diagnostic capabilities and expand everyone’s knowledge.

"The bleeding must be caused by ruptured blood vessels. So many bleeding points indicate systemic bleeding."

Li Jingsheng thought to himself.

He is not good at blood diseases, but he has a certain level of expertise in cardiovascular diseases and immunity.

There are many factors for this kind of bleeding, which are divided into congenital bleeding and acquired bleeding.

For example, hemophilia is a genetic disease.

This patient's bleeding was more like telangiectasia than a ruptured blood vessel.

Li Jingsheng believes that the patient can live to such an old age and has never had this disease before, indicating that the possibility of congenital disease is very low.

That's nature.

The most common acquired diseases are allergic purpura, drug-induced purpura, and infectious purpura.

Before this patient developed purpura, he had taken two drugs for headache, sore throat, and fever.

The first suspect must be drug-induced purpura.

Also, Henoch-Schonlein purpura is generally not accompanied by thrombocytopenia.

Drug-induced purpura is prone to thrombocytopenia.

But there are also those that don't appear.

Li Jingsheng found that it is quite good to develop a good habit of thinking about patients and prescribing less examinations.

Now in diagnosing this case, he could feel his advantage.

Of course, this is also related to the poor conditions of his clinic and the inability to perform some examinations.

When he diagnoses a patient, he usually does a physical examination, and then checks whether a B-ultrasound or X-ray is needed as needed.

Even routine blood tests are not available.

This patient had a marked decrease in platelets.

Before the onset of the disease, it should be normal, otherwise purpura or subcutaneous bleeding would have appeared long ago.

Thrombocytopenia should be the main cause of bleeding in patients.

A normal person's platelet count can reach over 100, and a high platelet count can be close to 300.

This patient's platelet count is only over 80, so there must be something wrong.

What would be the cause of thrombocytopenia?
Li Jingsheng began to analyze the evidence one by one like peeling off the cocoon.

　I really can’t write about difficult cases for fear of making mistakes and posting them late... Please forgive me.

　　
　
(End of this chapter)