Gou is practicing medicine in the clinic
Chapter 353 is all fulfilled, deducing the type of virus
Chapter 353 is all fulfilled, deducing the type of virus
Precisely because of Li Jingsheng's outstanding performance, her trust in Li Jingsheng also skyrocketed.
Although it's not exactly blind trust, it's not far off.
"You don't have to do this. Now that I'm here, I will definitely contribute all my abilities. But you also know that medicine is an extremely complex subject. My knowledge is limited, so I can only do my best. To save your son, The main thing is to rely on the experts on the scene.”
Li Jingsheng doesn't dare to be arrogant.
These two understated words put the credit and burden on the experts present.
He is just a small chief physician. Even if he has some abilities, he would never dare to act like a big-tailed wolf in front of these big bosses.
"Doctor Li, please sit down. Let's take the time to discuss the condition! The child's current condition is particularly dangerous. We have only found out that the child has acute encephalitis, interstitial myocarditis, and pulmonary edema. After we pick him up here, we will initially Symptomatic treatment was given. Only by identifying all the causes can targeted medication or other means of rescue be possible."
Rong Xuekai was obviously the real leader of this consultation.
After he asked Li Jingsheng to sit down, everyone began to continue discussing the child's condition.
Before Li Jingsheng arrived, they should have had a preliminary discussion.
"Doctor Li, tell me your opinion first. You should know the child's condition better than we do."
"Then let me draw out some ideas and start with two personal opinions. First, I think it is very likely that children's encephalitis and myocarditis are caused by viruses. It is possible that myocarditis caused encephalitis. When the child was four years old He has suffered from rheumatic heart disease. I suspect that there may be some pathological changes in his heart, which led to myocarditis this time.
However, rescue work should first control the progression of the brain disease.
If possible, drill holes may be drilled to explore the skull.
Second, the child has edema in the lungs and respiratory failure later, which may be due to blood stasis in the lungs.
Can anticoagulant therapy be considered? "
Li Jingsheng stopped being polite and spoke out his thoughts one by one.
"The first point raised by Dr. Li, after our discussion just now, is similar to your point of view. We also believe that the possibility of viral infection causing encephalitis is extremely high. However, there are many pathogens that cause viral encephalitis. Which virus is it specifically? We haven't been able to find out yet, so we can't use targeted medicine. Skull drilling and exploration, the emergency department of your second hospital has already done this.
At that time, you suspected that the subdural hematoma was compressing important nerves and causing problems, so we drilled and investigated.
Although no subdural hematoma was found, there was considerable gain.
It is also beneficial for reducing intracranial pressure. "
Director Rong was obviously wiping the second hospital's butt in front of the family members.
Director Luo of the Department of Neurology seemed to be possessed by an evil spirit. He stubbornly believed that the child's hemiplegia was caused by the concussion and subdural hematoma caused by the fall.
The child's head was even drilled and explored later before he gave up.
We cannot say that he is ignorant, let alone that his level is low. He has his own reasons for insisting on doing this examination.
When many doctors diagnose the cause of a disease, especially in the face of life-threatening diseases, they often use all the examination methods they think are necessary.
I believe that many patients have encountered similar experiences.
For example, some patients feel unwell and go to the hospital for examination, but the doctor fails to find out the cause of the disease.At this time, the patient will be recommended to be hospitalized for further examination, such as 24-hour EEG monitoring, ECG monitoring, etc.
Others are like this child’s surgical exploration or other examinations.
In the end, the patient listened to the doctor and was hospitalized for examination and treatment, but the cause of the disease was never found.The condition gets worse with treatment.
In this case, nine out of ten patients will smartly ask to be discharged.
The right thing to do is to change hospitals quickly.
Otherwise, if you go in alone, you can really cure it and carry it out.
Such doctors are often called quacks by their patients.
Some of them may have read rote books and have a lot of medical knowledge, but they cannot integrate it and apply it flexibly in practice.Instead, he dropped his book bag and applied the medical knowledge he learned just like formulas.
It is really unfortunate for patients to encounter such a doctor.
As long as they encounter a slightly difficult and complicated disease, they will most likely perform a full set of examinations on the patient.
Really qualified and experienced experts are very expensive, but they may just listen to the patient's description of symptoms, check the patient's condition, and directly prescribe medicine without doing any examination.
"The second point Dr. Li mentioned has even been mentioned by the director. The test results should be available soon."
The doctors at the People's Hospital are very powerful, and they have thought of everything Li Jingsheng can think of.
"This is the result of cranial endoscopy. After being transferred to our hospital, we underwent an enhanced examination. The brain and subarachnoid space were obviously expanded and congested. There were a small amount of lymphocytes and neutrophils infiltrating. Each lobe of the brain and the middle Nerve cell degeneration is present in the brain, pons, medulla oblongata, and optic thalamus. There is demyelination in the area near the lentiform nucleus, and dark blue spots on the blood vessel walls and surrounding brain tissue accumulate in the calcified perivascular spaces..."
After reading the intracranial exploration and examination results, Li Jingsheng was shocked.
The situation of sick children is more difficult and dangerous than imagined.
The lesions in the brain have reached a shocking level.
"The top priority is to identify the cause of encephalitis first! As for the heart, the endocardium and valves have been diagnosed by Professor Wang Weiwei and can be confirmed to be normal."
Director Rong Xuekai guided the topic to the most urgent issue.
Li Jingsheng's mind quickly flashed through the possible pathogens that could cause viral encephalitis.
Japanese encephalitis virus, enterovirus, scar virus, adenovirus, myxovirus, cerebromyocardial virus...
There are many viruses that can cause this disease.
"No, it's too difficult to confirm the diagnosis based on the type of virus. Laboratory tests are the most accurate, but the child's condition is critical and we simply can't wait that long."
The sampled specimens need to be separated for viruses and tested for antibodies. By the time it's done, the child's body will probably be hardened.
Li Jingsheng changed his mind and decided to start with the pathogenesis.
In this way, N answers can be directly reduced to 3.
In the first type, the virus directly infects the brain and then causes acute lesions, such as herpes encephalitis.The second type is lentiviral infection, where a defective virus has resided in the child's brain tissue for a long time and only recently became ill.The most common one is measles virus, which can directly cause subacute sclerosing encephalitis.
The third type is infectious encephalitis after contracting an infectious disease.
"Director Rong, can you let me see the test results of my child again?"
"Of course!"
Rong Xuekai signaled his assistant to bring the child's examination information to Li Jingsheng.
In addition to the procedures done at the Second Hospital, there are also expedited procedures done at the People’s Hospital.
After Li Jingsheng read it, the direction in his mind became clearer.
Routine and biochemical examinations of cerebrospinal fluid, as well as electroencephalogram, combined with the results of these examinations, it can be initially determined to be acute viral encephalitis.
The diagnostic significance of electroencephalogram is great, and it can show the extent of the disease.
However, there is no way to determine the nature of the disease.
Three new options popped up in his mind again, tuberculous meningitis, which was best diagnosed with head CT.However, cerebrospinal fluid biochemistry and routine examinations are barely enough.
Cryptococcal meningitis is the most troublesome and difficult to diagnose.
It was recorded in the paper that Li Jingsheng had read that the boss of the Department of Infectious Diseases had said that some patients, especially children, needed to repeatedly check the cerebrospinal fluid to find out.
Another characteristic of this disease is increased intracranial pressure.
And it has a subacute onset.
All aspects are consistent with this child's symptoms.
Although he had identified a highly consistent cause, he did not stop screening.
Incomplete treatment of purulent meningitis is also consistent with this child's symptoms.
To diagnose this disease, the best way is to have a head CT scan.
Cerebrospinal fluid biochemistry can also be detected, but the judgment criteria are not so clear.
Textbooks consider LDH to be clinically significant if it exceeds 50u/L.
In fact, experienced doctors like Li Jingsheng will also add some changes such as increased protein and lowered sugar.
After receiving the preliminary diagnosis results, he calmed down and began to work back on the type of virus.
This kind of diagnostic method that does not follow routines and common sense is only something he likes to use.
It's very demanding on brain cells, and it also requires very high medical knowledge, and it's not the kind of study that requires rote reading.Need to be able to flexibly apply the medical knowledge learned to clinical practice.
There are more than 25 types of viruses that can cause acute viral encephalitis in this child.
This is only what Li Jingsheng knows.
He thinks that his medical knowledge is not particularly profound. Maybe a stronger old professor can write about thirty types.
There are several enteroviruses alone, such as coxsackie virus and poliovirus. This virus was extremely scary and widespread for a period of time.Even today, children still need to receive this vaccine when they are of appropriate age.
Some parents are reluctant to spend hundreds of dollars, but they don’t know that this virus is extremely harmful.
As long as you are infected, the cost of treatment will be very scary, and the prognosis is generally not good. Disability and cerebral palsy are extremely common.
It can be transmitted through fecal-oral, oral-oral and other routes.
If a child gets infected, his life is basically ruined.
Many people still call this virus polio.
Li Jingsheng worked hard to check for matching viruses one by one.
For example, chickenpox encephalitis can be ruled out directly. He has seen the child's body and there are no blisters or rashes.
There is also encephalitis caused by the mumps virus, which can basically be ruled out.
……
At this time, Director Rong received a call.
After hanging up the phone, he told everyone, "It has just been found that the child has pulmonary congestion."
After hearing this, everyone couldn't help but look at Lian Tao and Li Jingsheng.
Both of them mentioned this, which shows that their level is very high.
"Director Rong, after our discussion just now, we can now basically confirm that the child has acute viral encephalitis. There is currently no specific drug for this disease. If we want to wait to find out the type of virus, I am afraid it will take at least 24 hours, or even longer. . Can we do some symptomatic treatment first to preserve the child’s vital signs, and then think of a solution?”
"What Director Nie said makes sense, I will make arrangements immediately."
Director Rong readily agreed.
After the child was transferred, he actually received a series of supportive treatments.
What I can do now is probably to maintain the balance of water and electrolytes, support respiratory intubation, and anticoagulate.
Then, in severe cases of cerebral edema, mannitol can be administered intravenously.
Furosemide may be used together to enhance the therapeutic effect against cerebral edema.
"I have a small diagnostic idea. Can I check for cryptococcal meningitis?"
Li Jingsheng once again gave advice at this critical moment.
(End of this chapter)
Precisely because of Li Jingsheng's outstanding performance, her trust in Li Jingsheng also skyrocketed.
Although it's not exactly blind trust, it's not far off.
"You don't have to do this. Now that I'm here, I will definitely contribute all my abilities. But you also know that medicine is an extremely complex subject. My knowledge is limited, so I can only do my best. To save your son, The main thing is to rely on the experts on the scene.”
Li Jingsheng doesn't dare to be arrogant.
These two understated words put the credit and burden on the experts present.
He is just a small chief physician. Even if he has some abilities, he would never dare to act like a big-tailed wolf in front of these big bosses.
"Doctor Li, please sit down. Let's take the time to discuss the condition! The child's current condition is particularly dangerous. We have only found out that the child has acute encephalitis, interstitial myocarditis, and pulmonary edema. After we pick him up here, we will initially Symptomatic treatment was given. Only by identifying all the causes can targeted medication or other means of rescue be possible."
Rong Xuekai was obviously the real leader of this consultation.
After he asked Li Jingsheng to sit down, everyone began to continue discussing the child's condition.
Before Li Jingsheng arrived, they should have had a preliminary discussion.
"Doctor Li, tell me your opinion first. You should know the child's condition better than we do."
"Then let me draw out some ideas and start with two personal opinions. First, I think it is very likely that children's encephalitis and myocarditis are caused by viruses. It is possible that myocarditis caused encephalitis. When the child was four years old He has suffered from rheumatic heart disease. I suspect that there may be some pathological changes in his heart, which led to myocarditis this time.
However, rescue work should first control the progression of the brain disease.
If possible, drill holes may be drilled to explore the skull.
Second, the child has edema in the lungs and respiratory failure later, which may be due to blood stasis in the lungs.
Can anticoagulant therapy be considered? "
Li Jingsheng stopped being polite and spoke out his thoughts one by one.
"The first point raised by Dr. Li, after our discussion just now, is similar to your point of view. We also believe that the possibility of viral infection causing encephalitis is extremely high. However, there are many pathogens that cause viral encephalitis. Which virus is it specifically? We haven't been able to find out yet, so we can't use targeted medicine. Skull drilling and exploration, the emergency department of your second hospital has already done this.
At that time, you suspected that the subdural hematoma was compressing important nerves and causing problems, so we drilled and investigated.
Although no subdural hematoma was found, there was considerable gain.
It is also beneficial for reducing intracranial pressure. "
Director Rong was obviously wiping the second hospital's butt in front of the family members.
Director Luo of the Department of Neurology seemed to be possessed by an evil spirit. He stubbornly believed that the child's hemiplegia was caused by the concussion and subdural hematoma caused by the fall.
The child's head was even drilled and explored later before he gave up.
We cannot say that he is ignorant, let alone that his level is low. He has his own reasons for insisting on doing this examination.
When many doctors diagnose the cause of a disease, especially in the face of life-threatening diseases, they often use all the examination methods they think are necessary.
I believe that many patients have encountered similar experiences.
For example, some patients feel unwell and go to the hospital for examination, but the doctor fails to find out the cause of the disease.At this time, the patient will be recommended to be hospitalized for further examination, such as 24-hour EEG monitoring, ECG monitoring, etc.
Others are like this child’s surgical exploration or other examinations.
In the end, the patient listened to the doctor and was hospitalized for examination and treatment, but the cause of the disease was never found.The condition gets worse with treatment.
In this case, nine out of ten patients will smartly ask to be discharged.
The right thing to do is to change hospitals quickly.
Otherwise, if you go in alone, you can really cure it and carry it out.
Such doctors are often called quacks by their patients.
Some of them may have read rote books and have a lot of medical knowledge, but they cannot integrate it and apply it flexibly in practice.Instead, he dropped his book bag and applied the medical knowledge he learned just like formulas.
It is really unfortunate for patients to encounter such a doctor.
As long as they encounter a slightly difficult and complicated disease, they will most likely perform a full set of examinations on the patient.
Really qualified and experienced experts are very expensive, but they may just listen to the patient's description of symptoms, check the patient's condition, and directly prescribe medicine without doing any examination.
"The second point Dr. Li mentioned has even been mentioned by the director. The test results should be available soon."
The doctors at the People's Hospital are very powerful, and they have thought of everything Li Jingsheng can think of.
"This is the result of cranial endoscopy. After being transferred to our hospital, we underwent an enhanced examination. The brain and subarachnoid space were obviously expanded and congested. There were a small amount of lymphocytes and neutrophils infiltrating. Each lobe of the brain and the middle Nerve cell degeneration is present in the brain, pons, medulla oblongata, and optic thalamus. There is demyelination in the area near the lentiform nucleus, and dark blue spots on the blood vessel walls and surrounding brain tissue accumulate in the calcified perivascular spaces..."
After reading the intracranial exploration and examination results, Li Jingsheng was shocked.
The situation of sick children is more difficult and dangerous than imagined.
The lesions in the brain have reached a shocking level.
"The top priority is to identify the cause of encephalitis first! As for the heart, the endocardium and valves have been diagnosed by Professor Wang Weiwei and can be confirmed to be normal."
Director Rong Xuekai guided the topic to the most urgent issue.
Li Jingsheng's mind quickly flashed through the possible pathogens that could cause viral encephalitis.
Japanese encephalitis virus, enterovirus, scar virus, adenovirus, myxovirus, cerebromyocardial virus...
There are many viruses that can cause this disease.
"No, it's too difficult to confirm the diagnosis based on the type of virus. Laboratory tests are the most accurate, but the child's condition is critical and we simply can't wait that long."
The sampled specimens need to be separated for viruses and tested for antibodies. By the time it's done, the child's body will probably be hardened.
Li Jingsheng changed his mind and decided to start with the pathogenesis.
In this way, N answers can be directly reduced to 3.
In the first type, the virus directly infects the brain and then causes acute lesions, such as herpes encephalitis.The second type is lentiviral infection, where a defective virus has resided in the child's brain tissue for a long time and only recently became ill.The most common one is measles virus, which can directly cause subacute sclerosing encephalitis.
The third type is infectious encephalitis after contracting an infectious disease.
"Director Rong, can you let me see the test results of my child again?"
"Of course!"
Rong Xuekai signaled his assistant to bring the child's examination information to Li Jingsheng.
In addition to the procedures done at the Second Hospital, there are also expedited procedures done at the People’s Hospital.
After Li Jingsheng read it, the direction in his mind became clearer.
Routine and biochemical examinations of cerebrospinal fluid, as well as electroencephalogram, combined with the results of these examinations, it can be initially determined to be acute viral encephalitis.
The diagnostic significance of electroencephalogram is great, and it can show the extent of the disease.
However, there is no way to determine the nature of the disease.
Three new options popped up in his mind again, tuberculous meningitis, which was best diagnosed with head CT.However, cerebrospinal fluid biochemistry and routine examinations are barely enough.
Cryptococcal meningitis is the most troublesome and difficult to diagnose.
It was recorded in the paper that Li Jingsheng had read that the boss of the Department of Infectious Diseases had said that some patients, especially children, needed to repeatedly check the cerebrospinal fluid to find out.
Another characteristic of this disease is increased intracranial pressure.
And it has a subacute onset.
All aspects are consistent with this child's symptoms.
Although he had identified a highly consistent cause, he did not stop screening.
Incomplete treatment of purulent meningitis is also consistent with this child's symptoms.
To diagnose this disease, the best way is to have a head CT scan.
Cerebrospinal fluid biochemistry can also be detected, but the judgment criteria are not so clear.
Textbooks consider LDH to be clinically significant if it exceeds 50u/L.
In fact, experienced doctors like Li Jingsheng will also add some changes such as increased protein and lowered sugar.
After receiving the preliminary diagnosis results, he calmed down and began to work back on the type of virus.
This kind of diagnostic method that does not follow routines and common sense is only something he likes to use.
It's very demanding on brain cells, and it also requires very high medical knowledge, and it's not the kind of study that requires rote reading.Need to be able to flexibly apply the medical knowledge learned to clinical practice.
There are more than 25 types of viruses that can cause acute viral encephalitis in this child.
This is only what Li Jingsheng knows.
He thinks that his medical knowledge is not particularly profound. Maybe a stronger old professor can write about thirty types.
There are several enteroviruses alone, such as coxsackie virus and poliovirus. This virus was extremely scary and widespread for a period of time.Even today, children still need to receive this vaccine when they are of appropriate age.
Some parents are reluctant to spend hundreds of dollars, but they don’t know that this virus is extremely harmful.
As long as you are infected, the cost of treatment will be very scary, and the prognosis is generally not good. Disability and cerebral palsy are extremely common.
It can be transmitted through fecal-oral, oral-oral and other routes.
If a child gets infected, his life is basically ruined.
Many people still call this virus polio.
Li Jingsheng worked hard to check for matching viruses one by one.
For example, chickenpox encephalitis can be ruled out directly. He has seen the child's body and there are no blisters or rashes.
There is also encephalitis caused by the mumps virus, which can basically be ruled out.
……
At this time, Director Rong received a call.
After hanging up the phone, he told everyone, "It has just been found that the child has pulmonary congestion."
After hearing this, everyone couldn't help but look at Lian Tao and Li Jingsheng.
Both of them mentioned this, which shows that their level is very high.
"Director Rong, after our discussion just now, we can now basically confirm that the child has acute viral encephalitis. There is currently no specific drug for this disease. If we want to wait to find out the type of virus, I am afraid it will take at least 24 hours, or even longer. . Can we do some symptomatic treatment first to preserve the child’s vital signs, and then think of a solution?”
"What Director Nie said makes sense, I will make arrangements immediately."
Director Rong readily agreed.
After the child was transferred, he actually received a series of supportive treatments.
What I can do now is probably to maintain the balance of water and electrolytes, support respiratory intubation, and anticoagulate.
Then, in severe cases of cerebral edema, mannitol can be administered intravenously.
Furosemide may be used together to enhance the therapeutic effect against cerebral edema.
"I have a small diagnostic idea. Can I check for cryptococcal meningitis?"
Li Jingsheng once again gave advice at this critical moment.
(End of this chapter)
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